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Loss of rotation or unilateral upper cervical headaches could benefit from an Upper Cervical Rotation Mobilization.

When a clinician thinks of dizziness from the neck, or Cervicogenic Dizziness or Cervicogenic Vertigo, typically the zygapophyseal joints come to mind as a proprioceptive and nocioceptive abnormal afferent input.
In fact, most authors agree that the following order, C1-2, C2-3, C0-1 and C3-4, are the most often influenced in cervical symptoms following mTBI due to high influence of proprioceptive activity from these levels.
Moreover, the muscles of the posterior cervical spine, the suboccipital musculature, have an abundance of muscle spindles and are high in mechanoreceptor concentrations.  These deep, short intervertebral neck muscles are also typically involved in proprioceptive and nocioceptive abnormal afferent input.
Interesting enough, a recent case report in 2018 and literature review appeared in Medicine Journal with title, “Vertigo caused by longus colli tendonitis“.
For us with anatomical training, we know the longus colli is anterior to the cervical spine and doesn’t typically come to mind with proprioceptive activity.  However, we do know it has proprioceptive distribution (albeit less) and commonly injurious after whiplash injuries.
This case report of a 38 year old male with vertigo arising from longus colli tendonitis is interesting as there was no description of trauma (other than running).  The authors hypothesize that the swollen longus colli muscle stimulated the cervical sympathetic ganglia, resulting in symptoms, which were then alleviated by corticosteriod injection and acupotomy.
The hypothesis of Cervicogenic Dizziness as a cause of vertigo / dizziness has a strong trend towards the proprioceptive pathogenesis and less of a trend towards sympathetic dysfunction.  In fact, stimulation of the cervical sympathetic ganglia is now becoming discarded in the literature.
This case report, albeit n=1, brings back to life this hypothesis and although rare, could be a cause of vertigo in your patients when all other medical causes are ruled out.  Even though in this report by Shen et al 2018 found 0% of previous cases (n=278) exhibited symptoms of vertigo or dizziness, there could be some anatomical variations in the longus colli muscle and if the perfect storm was created (i.e. trauma, stress, weakness, etc), the individual could be symptomatic.
I would liked to have seen conservative treatments (i.e. physical therapy) introduced prior to invasive procedures but nevertheless, was successful for the patient and worth a read.

You can learn more about the screening and treatment process of Cervicogenic Dizzinesss through Integrative Clinical Concepts, where the authors (husband–a manual therapist a wife—a vestibular specialist), teach a very unique course combining both the theory and practice of vestibular and manual principles in their 2-day course.  Pertinent to this blog post, the 1st day includes the “Optimal Sequence Algorithm”, a multi-faceted physiotherapist approach to the assessment of Cervicogenic Dizziness, which includes the appropriate ruling-out process and cervical examination of the articular and non-articular systems. Also pertinent to this blog post, the 1st day includes the “Optimal Sequence Algorithm”, a multi-faceted physiotherapist approach to diagnosis of Cervicogenic Dizziness while ruling out other causes.
If you would like to host a course for your staff (either a vestibular, neuro, sports or ortho clinic), please do not hesitate to contact me at harrisonvaughanpt@gmail.com for more information.

AUTHORS

Harrison N. Vaughan, PT, DPT, OCS, Dip. Osteopracic, FAAOMPT    
Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts
Danielle N. Vaughan, PT, DPT, Vestibular Specialist  
Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts

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Part 1 of this Post Op Progression Series is here - 5 Considerations for Post-Op Patients

Over my years of practicing, I’ve realized that many clinicians have no criteria for progressing/regressing their post-surgical patient's rehab programs.  They seem to do it randomly or solely based on time or “just because.” And if you’re anything like me, those reasons (especially the “just because”) doesn’t fly.



On this episode, Modern Rehab Mastery mentee Dr. Dana Palmer goes over how some education changed many lives and helped save countless limbs in a small island country she decided to work at just because it looked nice.

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Untold Physio Stories is sponsored by the EDGE Mobility System, featuring the EDGE Mobility Tool for IASTM, EDGE Mobility Bands, webinars, ebooks, Pain Science Education products and more! Check it out at edgemobilitysystem.com .  Be sure to also connect with Dr. Erson Religioso at Modern Manual Therapy and Andrew Rothschild at Modern Patient Education.

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Today, I want to give you my two proven strategies for raising your rates in your cash-based practice. Check it out below!


What qualities do you prefer in your patients? Motivation, having a growth mindset are two I prefer. Having high self efficacy is also important and has been associated with more positive rehab outcomes. Here's another awesome infographic via Brad Beer on Self Efficacy.

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[BELIEF IN OUR ABILITY: SELF EFFICACY] 🧠 _ πŸ‘‰πŸ»What Is Self-Efficacy? It has been defined as ‘the belief in one’s abilities to organise and execute the courses of action required to manage prospective situations’ 🧐 _ πŸ‘‰πŸ»More simply self-efficacy is a person’s belief in his or her ability to succeed in a particular situation. This belief in turn determines how we in turn can think, behave, and feel πŸ‘€ _ πŸ‘‰πŸ»An individual’s self-efficacy plays a major role in how goals, tasks, and challenges including injuries are approached 🎯 _ πŸ‘‰πŸ» People with a strong sense or high levels of self-efficacy: . ▶️View challenging problems as tasks to be mastered . ▶️ Develop deeper interest in the activities in which they participate . ▶️ Form a stronger sense of commitment to their interests and activities . ▶️ Recover quickly from setbacks and disappointments _ πŸ‘‰πŸ»People with high efficacy approach difficult tasks as challenges to be ‘mastered’ rather than as threats to be ‘avoided’ which in turn lowers vulnerability to depression ⬇️⬇️ _ πŸ‘‰πŸ»Not surprisingly higher levels of self efficacy have been associated with better rehabilitation outcomes ⬆️πŸ’ͺ🏻 _ πŸ‘‰πŸ»Evidence suggests that self-efficacy can play an essential role as a protective factor + a ‘mediator’ in the relationship between pain & disability πŸ” _ πŸ‘‰πŸ» A 2018 published systematic review* which looked at the role of self-efficacy on the prognosis of chronic musculoskeletal pain concluded that high levels of self efficacy increased 1-5 listed in the infographic above☝🏻 _ πŸ’»*Ref: The Role of Self-Efficacy on the Prognosis of Chronic Musculoskeletal Pain: A Systematic Review. Martinez-Calderon, Javier et al. The Journal of Pain, Volume 19, Issue 1, 10 - 34 _ πŸ‘‰πŸ»Big thanks to @shoulder_physio for bringing this paper to my attention at recent ‘Shoulder Rehabilitation’ workshop πŸ’‘ _ πŸ“ŒTAKE HOME: if injured be aware that your beliefs in your ability to contribute to a positive rehabilitation outcome matter. It’s important to work with a practitioner who promotes & fosters higher levels of self efficacy through their language & guidance πŸ—£✅
A post shared by Brad_Beer Running.Physio πŸƒ‍♂️ (@brad_beer) on



Want to learn in person? Attend a #manualtherapyparty! Check out our course calendar below!

Learn more online!


Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!

Keeping it Eclectic...

In this video, I go over ways to desensitize a painful or irritated TMJ. There are 3 simple steps you can take that will go a long way toward pain relief. 

Typically when someone thinks of a concussion, a picture below comes to mind.