Disk lesions in the cervical spine are less common than in the lumbar spine. Often disk extrusions are an indication for surgery because of potential compromise of the spinal canal and pressure on the spinal cord. Patients may present with peripheral neuropathy and forward-head posture without a diagnosis of disk pathology. Symptoms increase with activities and postures that increase flexion in the lower cervical and upper thoracic spine and decrease with extension in that region (axial extension or neck retraction). Conservative management is similar to that in the lumbar spine and follows the same principles described in the previous section. Medical management includes pharmacological pain and inflammation control measures.

Acute Phase
Passive Axial Extension (Cervical Retraction)
Patient position and procedure. Begin with the patient supine, with no pillow under the head or neck. Gently nod the patient’s head, and allow the neck to flatten against the treatment table. If the neck is deviated or rotated to one side, moving the head and neck back toward the midline must be done first. This may require gentle progressive positioning and may take 10 to 20 minutes to accomplish.

Progression. Progress the retraction to hyperextension of the cervical spine and then progress to rotation. Use caution and carefully monitor the signs and symptoms; do not progress if symptoms peripheralize down the arm.

Patient Education
Teach the patient to retract his or her head and neck passively in the sitting position. The patient may gently push against the chin (caution not to push so hard as to cause joint compression of the temporomandibular joint) to direct the motion. This technique has been shown to improve the H-reflex amplitude and may be useful for improving mobility and decreasing symptoms of radiculopathy by decompressing nerve roots in the lower cervical spine.

Traction
Cervical traction may relieve the patient’s symptoms. As described for lumbar traction, during the acute phase sustained traction should be no longer than 10 minutes and intermittent traction no longer than 15 minutes in duration. The dosage is at an intensity that causes vertebral separation (at least 15 lb).

Kinesthetic Training for Posture Correction
Instruct the patient in safe mechanics for maintaining the head position. During the acute phase, the patient may need to wear a cervical collar to immobilize the spine. It is important to help the patient identify the posture that centralizes the symptoms and to adjust the collar to maintain that position.

Progression as Symptoms Stabilize
Faulty cervical, thoracic, and scapular posture may be present. Emphasize kinesthetic training for postural awareness, stabilization exercises for postural control with emphasis on the scapular and shoulder muscles, environmental adaptations to reduce postural stresses, and functional activities with safe spinal mechanics.

Buy the Book that holds this excerpt: Therapeutic Exercise: Foundations and Techniques (Therapeutic Exercise: Foundations & Techniques)

Related Articles