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I was wondering if anyone has come across what I can only term as "side-impact whiplash" - ie: injury to the Csp occuring from impact from the side (eg: MVA), forcing the Csp into LF +/- Rotn. If so is there anything in particular to consider in this injury apart from that which would normally be considered in a "normal" whiplash injury?
Thanks & regards
Ray
Check the integrity of the cervical ligaments (CAREFULLY and THOROUGHLY) especially the alar ligament.
I have had this happen to myself and it went undiagnosed for 4 years (headaches+++). Chin retractions and upper cervical and deep neck flexor strengthening was the key strategy for me. Also avoidance of end-range lateral cervical flexion (even if you can go there comfortably because without the protection of the alar ligament you can flex too far and it causes irritibility of structures).
As already stated it is necessary to evaluate the upper cervical ligaments and of course continue to evlauate segmentally. Once the ligaments are cleared it is important to evaluate accessory motions in the upper cervical spine, in addition to active motions. I instruct the client in precautions and advise how to gently and safely return to neutral should any motions provoke adverse signs and symptoms. Motions can then be gently stacked to work on specific active or pasive motions. Example: actively side bend fully to the left, then perform gentle active oscillations at end range to enhance left side bending, or add the opposite, which will be isolated in the upper cervical, especially the O-A. To that you can add glides, rotations, flexion, extension, etc. You can treat unilaterally or bilaterally. The list is long, the potential vast. You must have a working knowledgeof the biomechanics, indications and contra-indications, perform proper screen, etc. I have used these on myself and have found them to be very effective at isolating subtle motion restrictions. I hope this has planted some seeds.
Best Regards
jerry Hesch, MHS
Adendum-the lower cervical spine
A pattern I see on occasion in the lower cervical spine is perhaps best visualized as occuring on the convex side of the injury in which the first ribe is compressed medially and 1st thoracic is stuck as well. Clasping the 1st rib posteriorly and pulling the medial portion of the clavicle laterally will reveal the restriction. The clavicle is restricted and by inference so is the 1st rib anteriorlay and posteriorly. The lateral traction is performed gently after taking the sllack out and is maintained for up to 5 minutes. Side-glide cervical mobility is tested in sidelying with the head and shoulders off the table. The eyes are perpendicular to the floor and the head and neck are allowed to gently achieve end-range of side glide towards the floor. If a restriction is perceived by the client thay can then "open up" the restriction by abducting the arm (that is on the top) and at approximately 90 degrees there will be an almost immediate and easily discernible release, though the position is maintained for up to 2 minutes.
Give consideration to the possibility that the opposite of the above is occuring on the opposite side and proceed according. When rib joint or thoracic joints are involved (just like the si/pelvis) I always treat both sides and treat as a hoop, coming full circle with respect to mobility testing and treatment. I try to think outside the body of traditional manual therapy and especially think in terms what else is possible and ultimately let the client's body reveal itself. "The 1st step towards mastery is the actual envy of the unknown." Thomas Mann The Magic Mountain. I hope I have been helpful.
Thank you.
Jerry Hesch, MHS, PT
[email protected]
Another simple test of first rib dysfunction is simply LF C/S L and R while palpating the top of the first rib. In normal motion, you will feel the rib move inferiorly e.g. Left 1st rib moves inferiorly when C/S LF L.
Abnormal motion is seen as the rib not moving down during sideflexion. The first rib is usually fixated superiorly and a simple MET will help move it.