I recently evaluated and treated a few very painful acute cervical cases. Here are various ways I was able to mitigate threat and stretch perception.
As a review, let's watch the Easiest Cervical Screen Ever and Nuances of the Easiest Cervical Screen Ever.
- remember, MET is nothing but fancy PNF, heck, let's just call it isometrics
- most acute cervical cases have a very painful block to extension, and/or SB/retraction or rotation
- if it's 1 plane that is mostly limited/threatened, lightly and gently move into the barrier and have them resist gentle hand contact to "Meet my resistance"
- very lightly start resisting, then gradually increase it, but not too much
- this prevents unnecessary irradiation and firing of global tonic muscles
- the right contraction (usually into the limited barrier) seems to be a novel enough stimulus to increase motion and give you a window to further improve motion
- repeat until you attain end range
- no, not mechanical traction, manual traction!
- in one recent case, PNF, light IASTM, functional mobilization, none were making any headway in her severe loss of unilateral SB/rot and retraction to the left (left sided acute neck pain)
- in supine, I performed very strong manual traction, then proceeded to cervical retraction and light SB into where the barrier was - previously about 10 degrees SB
- to the patient and my surprise, she had no pain and was able to go near full motion with only some mild discomfort at end range
- after about 20 reps, full motion was restored actively and in WB
- video of this coming up next week!
- more importantly, she was able to maintain and reinforce this new motion with HEP using cervical retraction and SB left with PNF to get to pain free end range
3) Functional Mobilization
- the perceived area of tightness, "joint lock," or pain is often literally and figuratively a sticking point for patients/clinicians
- have the patient identify the area that feels most limited/painful
- lightly slack the skin in the direction or wiggle it back and forth just prior to getting to the barrier and then into the barrier as they perform the motion actively
- Motion Guidance's new Contact Pads are an AMAZING new way to modulate pain and stretch perception
- these sticky pads help you lightly and firmly contact skin and move it around to modulate the perception of stretch, a little slack goes a long way!
- Formal review coming soon, but I have been experimenting with them in the clinic and I (and my patients) love them!
4) IASTM with Movement
- different strokes for different folks
- similar to above, have the patient identify the area under most threat, and have them move into the barrier
- lightly scrape the skin with an EDGE Tool, into and out of the threatened position
- the light scraping will modulate threat and the nervous system will let you move past the previously locked down area
- after 1-2 minutes, you should be able to attain threat free end range for the patient to maintain with HEP
- example video here
- last and most important is education!
- not only should you be explaining why any of the above or other techniques work, but why the patient must maintain them
- also, get across that hurt does not equal harm, and especially in the cast of acute pain and severe loss of ROM, that the motion is there, the nervous system is just doing it's job and locking down the area because it is threatened
- it just needs a little coaxing to gradually restore motion
- if you haven't read and implemented Therapeutic Neuroscience Education and A Guide to Better Movement, what are you waiting for?
- If I had to choose between any of the above inputs, OR education, I would just sit and have a nice educational chat with the patient, education/repetition of ideas and concepts goes a long way!
Hope you found this post and video links helpful! Comments/questions, leave below or on the facebook page! Have a great weekend everyone!
Want to learn more?
Sample treatments and live eval and treats of all of the above can be found on The OMPT Channel!
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Reminder! 20% off of all EDGE Mobility System products through the weekend! Use coupon code summer20 to save