Tip 6 Checking Quality of Movement Instead, it is designed to support and enhance your existing skills and is crammed with the kinds of tips you may not have come across, tips and tricks I have picked up over the years, and which I hope you too will find beneficial in your practice. Of course, there will be material with which you are familiar, but I am hoping that you will discover a selection of assessment tips which make you think, “Ah, I haven’t tried that, maybe that will work!”. To perform, make sure your neck is retracted, then sidebend to the SAME SIDE it hurts until you feel a pinch. Question: Does it matter which movement the client performs first? If you were to keep your neck flexed but look over your right shoulder, you are now combining forward flexion with right rotation. Place a mark on your client’s acromion process. How easy did I find using a goniometer to measure cervical ROM? (“Cervical spine rotation and lateral flexion combined motion in the examination of the thoracic outlet”). Locate the very top of the head and the acromion process. Therefore, if with passive elevation of the shoulders, pain/stiffness/discomfort is reduced, and ROM is increased, there is a strong likelihood that muscles such as upper trapezius, levator scapulae, or rhomboid minor are contributing to the client’s problem. Lateral flexion can also be measured using a goniometer as the therapist stands in front of the client. Question: Does it matter which movement the client performs first? Chapter I The illustrations at the top of the table are a reminder of the six movements you need to check. What we need to be asking is whether their “pulling” or “crunching” sensation has diminished. Observe the degree and quality of movement, and ask how the movements feel. The problem with measuring ROM is that people’s necks can “hinge” in different places. Instead, it is designed to support and enhance your existing skills and is crammed with the kinds of tips you may not have come across, tips and tricks I have picked up over the years, and which I hope you too will find beneficial in your practice. As with your documentation of the actual ROM, you will need to find a way to record the quality of movement in a way that you understand. • Left lateral flexion 30% Starting Position:  Stand with your feet hip-width apart, toes pointing forward or turned slightly outwards, with arms by your sides. Why not document your client’s problem using the word “pain” as a generally descriptive term? Method: ROM was measured, and muscle function was estimated in 38 infants at the ages of 2, 4, 6, and 10 months. Slowly return to starting position. Let us take the example of a client who comes to you with a stiff neck. Is there anything I need to do differently next time? 1. Clients with neck pain or a stiff neck have a tendency to twist at the waist and move their thorax in order to rotate to the right or to the left, instead of rotating their neck. Position the goniometer parallel to the tongue depressor. Sometimes a client is able to perform full ROM, yet the quality of their movement is poor. Measuring Neck Rotation with a Goniometer Daily living, poor posture, and injury often result in tight neck muscles.. Safeguard your own posture as you do this to avoid straining your back. Instruct them to move their head slowly or to stop if they feel in any way dizzy or unwell. 5 and 6) lateral flexion may be best described as trying to place the ear upon the shoulder through a sideways movement of the neck, directing the ear toward the shoulder tip on both sides (below) These six movements may be slowly performed occasionally to stretch the neck ligaments if they tend to feel tight. Are there differences in left- and right-sided readings? For this test, you will need to stand behind your client, which, as was noted in Tip 1 (p. 6), has certain disadvantages. How might I explain ROM findings to my client in a way that is reassuring? 1. Measuring Lateral Flexion of the Neck with a Goniometer Unilateral contraction produces lateral flexion of the neck on the same (ipsilateral) side and lateral rotation of the head to the opposite (contralateral) side. Tip 22 Neck Disability Index Have these measurements changed over time and if so, in what way? Repeat this on the opposite side. 1. With a correct lateral flexion and enough length in the neck, the horse should follow the green line. You may already be doing this and may know that this is called a range of movement (ROM) test. So you have tested your client’s active cervical ROM. • Or, it could be a line, either superimposed over the sketch or simply on its own. • Right rotation 20% This position is also more conducive to the development of rapport. The disadvantage is that the client may feel anxious having someone stand behind them, even though the cervical ROM test is quick to perform: as you know, people are protective of their necks, more so if they are in pain or have suffered neck problems in the past. This action, in which your neck moves from a straight position to a lateral bend, is called lateral flexion, and a group of muscles called the scalenes (or scalenus muscles) help make it happen. When a client comes to you with a neck problem, one of the simplest assessments you can make—once you have finished asking questions—is to observe which movements they can (and cannot) perform with their neck. Then, position your goniometer as shown in this tip and measure the different ranges. Among the lateral neck muscles, the muscle that acts as the prime mover to flex the head is the Anterior Flexion of the head is accomplished by the _______ neck muscles. Hesitancy may be common following whiplash injuries, for example, when the tissues are healed, but the client is fearful of reinjury. Question: What if a client reports a problem involving movement, yet when you test them, they appear to have a normal ROM? Measuring Neck Extension with a Goniometer When you see someone who can only flex their head to the side a little, you will know that they have a ROM less than the norm. If you want to be more accurate in your cervical ROM measurement, you could use a goniometer. Accurate documentation is important for several reasons. Tip 3 Using a Goniometer to Measure Cervical ROM Conversely, when a client effortlessly bends their head to the side so that their ear appears to almost touch their shoulder, you will know that they have a ROM greater than the norm. Move the goniometer as they do this, keeping it parallel with the tongue depressor. You are now combining left lateral flexion with both right and left rotation. The neck flexion stretch is felt throughout the back of the neck. Did they understand? Repeat on the other side. Tip 20 Palpating Suboccipitals Conversely, when a client effortlessly bends their head to the side so that their ear appears to almost touch their shoulder, you will know that they have a ROM greater than the norm. For example, flexion, then extension and back to neutral; right rotation, then left rotation and back to neutral; right lateral flexion, then left lateral flexion and back to neutral. Lateral flexion is made possible by cartilaginous joints between adjacent vertebrae in the spinal column, which unlike most of the bodys movable joints function not as individual units o… Active ROM tests may not be safe in certain, very specific, circumstances: following an accident or following surgery to the neck, for example. There are many factors contributing to neck discomfort (movement is one of them). Another example is if they report experiencing dizziness when they look up to the ceiling. These muscles or their surrounding fascia, or both may be shortened. 4. • Or, you could guesstimate in degrees the amount by which the range is decreased. Align the arm of the goniometer that is to move with nares. Measure the distance from the mastoid process to the acromion process Ask your client to take their head as far back as possible, trying to get the back of their head to touch the top of their back. Because you are going to ask the client to perform the movements themselves, this is an active ROM test. Neck pain, radiculopathy, and myelopathy are common presentations of cervical pathology across populations and age groups. If you see movement in the shoulders, instruct your client to start again, while keeping their shoulders stationary. Sometimes a client is able to perform full ROM, yet the quality of their movement is poor. Or someone who says they have a “sore” neck or that it is “a bit crunchy”? Measure the number of degrees of lateral flexion when they reach the end of their active ROM. So, it may be that a client’s condition is aggravated not by one movement, but by a combination of movements, and this is worth remembering as it provides further clues that will help you determine what the problem, and the appropriate treatment, might be. 4. Some therapists stand behind their clients when assessing active cervical ROM. Clients with neck pain or a stiff neck have a tendency to twist at the waist and move their thorax in order to rotate to the right or to the left, instead of rotating their neck. If, following the treatment of a client with such symptoms, we ask them, “Has your pain diminished?” the answer will be meaningless. However, a good tip is simply to assess a lot of people. 3. Therefore, if with passive elevation of the shoulders, pain/stiffness/discomfort is reduced, and ROM is increased, there is a strong likelihood that muscles such as upper trapezius, levator scapulae, or rhomboid minor are contributing to the client’s problem. In head and neck exercises we often use our traps and torso to accelerate and decelerate weight, either consciously or unconsciously, interfering with development. 4. Save now. This test relies on what your client says, so it is important to listen to the descriptive terms they use. Aug 25, 2019 | Posted by admin in MANUAL THERAPIST | Comments Off on Neck Assessment, Tip 2 How to Tell What Is a “Normal” Range of Movement, Tip 3 Using a Goniometer to Measure Cervical ROM, Tip 4 Using a Tape Measure to Measure Cervical ROM, Tip 9 Measuring Neck and Shoulder Distance, Tip 14 How to Observe Scalenes on a Client, Tip 15 How to Palpate Scalenes on a Client, Tip 17 Appreciating the Neck/Upper Limb Relationship. Similarly, if you look up into the sky and trace the path of an aircraft as it passes overhead, your neck is in extension and will involve a degree of rotation, depending on which way the aircraft is moving. Don't delay! Here are some ideas. For example, if you have not done so already, you may discover that, as we age, the range through which we can actively move our neck decreases. Question: What might you record if you observe a client to have full range of active neck movement, yet in order to perform the movements the client keeps wincing? This offers bilateral comparison cervical lateral flexion. These are inexpensive and may be obtained from many pharmacies. “Pulling” or “crunching,” for example, are descriptions of sensations which we are likely to want to lessen. By doing this you will soon get to build up a kind of visual database, a set of images in your mind as to what is normal and what is not. Are there differences in left- and right-sided readings? • Or, it could be a line, either superimposed over the sketch or simply on its own. Try rubbing your left ear on your left shoulder by moving your head. • Or, you could guesstimate in degrees the amount by which the range is decreased. That is, flexion, extension, lateral flexion (both left and right), and rotation (both left and right) all appear fine, with little or minimal discomfort. In documenting your observations, would it be appropriate to write something like: Many clients visit a therapist hoping to get relief from discomfort in their neck. Lateral flexion is performed by being in an upright position (standing or sitting), shoulders should be square and spine is in a neutral position. 3. However, it is necessary for this particular test. Another important reason for using and documenting what clients say is that by doing so people feel that they are being “heard.” This alone increases the chances of building rapport between the client and the clinician. Assuming that the goal of your treatment is to decrease their feelings of stiffness and/or increase their actual active movement, you will need to document the client’s current limitation in ROM, as well as their posttreatment increase in ROM. 1. Tip 23 Postural Assessment Reminder Document your findings Active ROM tests are safe for most people because everyone moves their head through these ranges—and combinations of these ranges—during the day. “Pulling” or “crunching,” for example, are descriptions of sensations which we are likely to want to lessen. Lateral Neck Flexion And Leverage Training the head and neck is complex and leverage must be managed. Question: Does it matter where you stand when carrying out this assessment? For example, if they had greater cervical rotation, would that help when they are looking over their shoulder to reverse their car? In what way might a ROM finding relate to my client’s daily life—does decreased (or increased) ROM make any daily tasks more difficult? “When you say it is uncomfortable, can you be more specific?” Soft tissue injuries and bony immobility can restrict your range of motion. Measuring Neck Flexion with a Goniometer Active ROM tests may not be safe in certain, very specific, circumstances: following an accident or following surgery to the neck, for example. Then, position your goniometer as shown in this tip and measure the different ranges. You assess them, asking them to do the active ROM test, and then you decide on an appropriate treatment. Be sure to maintain body alignment keeping your shoulders down and back. full movement—? Tip 18 What Are “Knots” in the Neck Region? Vertebrae do not form hinge joints, as you know, but the movement impairment that is sometimes observed when people perform ROM assessments may be thought of as a hinging movement. There are many factors contributing to neck discomfort (movement is one of them). Using these kinds of open-ended questions encourages the client to search for words that best describe their symptoms and can help you discover more about the nature of the problem. Also, movement decreases in one or more ranges following injury if the client has not been properly rehabilitated; and people who regularly perform yoga may have an increase in cervical range, or may maintain their cervical range for longer as they age. You will find only a few cautions written into the text in this chapter, and the reason is that the majority of these assessments are perfectly safe for the majority of people you are likely to be assessing. 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