Download Instability Syndrome

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Be familiar with the mechanism of a instability /
traumatic syndrome.
To be familiar with the clinical presentation of a
typical patient with acute instability syndrome.
Be familiar with the most widely used medical as
well as physiotherapy treatment protocols for a
patient with a typical acute / sub-acute and
chronic instability syndrome.
Be familiar with the possible pathological
changes associated with an instability syndrome.
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Be familiar with the clinical presentation of a
typical patient with an instability syndrome.
Be familiar with the associated symptoms
experienced by a patient with a typical
instability syndrome.
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Trauma as a result of a motor-vehicle accident
or sport injury
Degenerative in the articular complex
Leads to irregular patterns of comparable signs
and a variety of signs and symptoms
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Acceleration when a car is hit from behind
The seat with the lower body accelerates forwards
The neck is unstable and can not control the
movement of the head
The neck moves into sudden extension – reflex
contraction of the neck flexors causes the neck to
go into flexion
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Deceleration when a car is brought to a stand
still due to the collision
Head and neck continues to move forwards
causing hyperflexion until the chin bumps
against the chest
Reflex contraction of the extensors causes
extension
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If the neck is rotated when the collusion occurs
an excessive amount of lateral flexion and
rotation will take place
Normal physiological ranges is exceeded and
this leads to damage and anatomical changes of
the soft tissue
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Ligaments
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Intervertebral disc
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Facet joints
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Surrounding muscles
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Haematoma of especially the m sternocleidomastoïd
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Pain during rest especially if the structures are
placed on stretch
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Pain through entire range of movement
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Muscles are painful during stretch and contraction
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Ligaments are painful when placed on stretch
(except the interspinal ligament which is painful
during extension)
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Total bed-rest for first 2-3 days
Supportive, soft neck support (when patient is in
an upright position)
Ice for first 24 hours
Heat is contra-indicated for first 48 hours
(Afterwards damp heat)
Anti-inflammatory medication and muscle
relaxants
Careful, active non-weight bearing exercises
(except rotation and lateral flexion)
Gentle massage
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Symptoms become more specific
Wean from neck support – still use support in a
vehicle of when neck feels tired
Ultrasound and damp heat/ice
Mobilisations – short of pain
Cautious isometric exercises
Increase active exercises (introduce flexion and
extension into exercise programme)
Commence with PNF patterns if pain will allow
Cautiously commence with distal neural
mobilisations
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Treat according to signs and symptoms
Pain at end of range (6-8 weeks after injury)
Totally wean from neck support
Isometric exercises are progressed into
standing
Evaluate for muscle imbalance and treat
accordingly
Make use of combined movements and neural
mobilisation techniques for final rehabilitation
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Ligament injuries: Anterior longitudinal
Posterior longitudinal
Interspinal
Disc herniation
Fracture : Spinous process
Vertebral bodies
Tear of the capsule and facet joints with acute
synovitis
Tear of the neck muscles
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Tempomandibular joint injuries
Retropharingeal heamatoma
Oesophageal haemorrhage
Sympatic chain injuries
Concussion and minor head injuries
Vertebral artery damage
Thoracic outlet syndrome
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Pain and tenderness over affected structures
Referred pain – irritation of nerve root
miofascial trigger points
scleretome referral (deep
burning pain which feels like it is in the bone itself)
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Neck muscle spasm
Headaches (experienced as a deep pressure
with pounding , nausea , vomiting and
photophobia)
Normal range of movement restricted
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Dysphagia with hoarseness in the acute phase
Sympathetic signs: Intermittent weak vision
Headaches
Horner’s syndrome
Dizziness: Vertebral artery symptoms
Middle ear injuries
Oedema
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Miosis (constriction of the pupil)
Pytosis (drooping eye)
Enophthalmia (sunken eye)
Anidosis (loss of perspiration on the one side of
the face)
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Anterior chest pain: presents as angina
becomes worse with
exercise
tender anterior
nausea
sleeps poorly
becomes worse with
coughing and sneezing
Oedema
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Thoracic outlet syndrome
Lower backache
Head injuries such as concussion
Tempromandibular joint injuries
Fibromialgia (chronic pain and stiffness in
muscles with local tenderness)
Psychosis
Depression
Difficulty with acceptance
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Anxiety
Rage
Frustration (financial and family)
Personality changes and interference in daily
living
Post-traumatic stress syndrome
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Analgesics
Anti-depressants
Surgery
Psychiatric treatment