Download stiff neck

Pain
or discomfort
when trying to
turn or move the
neck.
Postural
2. Atlanto-axial
3. Spasmodic Torticollis
4. Hysterical Torticollis
5. Stiff neck as a result of
muscles
1.
Secondary
to
auditory and visual
disturbances.
 Due
to torticollis which is
still present.
Condition in which
the head becomes
persistently turned
to one side.
Patients experience repeated attacks
of painless rotation or lateral flexion
of the head.
 Gradual onset from age 40.
 Most common movement= rotation to
the left side.

MOBILISATION DOES NOT PLAY A ROLE IN
THE MANAGEMENT OF THESE PATIENTS.
 Repeated
movements
while the patient moves
the head to one side
 Post
traumatic,
 Post viral and;
 torticollis
Painless contracture of 1 of
sternocleidomastoid muscles
Neck fixates in side flexiontowards affected side +
rotation away from it.
Lack of treatment= patient
developing a permanent postural
deformity + facial asymmetry
 Injury
 Osteoarthritis
 Rheumatoid
arthritis
 Pinched nerve
 Fibromyalgia
 Muscle spasm
 Meningitis
Identified by
means of Xray, MRI or
CT
 DEPENDANT
ON CAUSE
Include:
 Non-steroidal anti-inflammatory drugs to
relieve pain.
 A cervical collar to keep the neck still so that
muscles can rest.
 Limitation of activities that could strain the
neck.
 Physiotherapy
 Massage
 Ice
or heat therapies.
 Maintaining a good posture
Advice for at home:
 Patient should sleep on a firm
mattress and designed neck
pillow or without a pillow.
 Onset
of a sudden, sharp pain
near the midline of the cervical
spine on the affected side that
appears as a result of an
unguarded movement and that is
accompanied immediately by an
inability to return the head to a
straight position.
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Occurs mainly in adolescence
Sudden onset
Snapping sound is heard
CAUSE
Sudden uncontrolled movement
Patient may be awakened by the pain
Most common between C2/3
Synovial pinching
Localised to mid-cervical area
Severe, sharp pain with proximal referral if the
patient should try to move out of the position.
Noticeable lateral flexion, slight flexion/rotation
away from pain-commen protective deformity.

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Unlock the joint as soon as possible (try).
Use longitudinal movement in the position of
deformity, rotation and lateral flexion-Grade IV- to IV
to open side that is locked.
TECHNIQUES
◦ Longitudinal cephalad
◦ Rotation away from pain
◦ Transverse thrust manipulation
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Joint must be unlocked on day 1.
Pain still present on day 2- treatment directed
towards relieving pain, muscle spasm + regaining full
joint mobility.
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Mostly affects
◦ Atlanto-occipital
◦ Atlanto-axial
History
Bump against the head
Patient has unilateral suboccipital pain + movement
towards painful side. Lateral
flexion and rotation feels stiff.
MAITLAND MOBILISATIONS

If not unlocked on day 1
◦ Manipulation
◦ Strengthening
◦ Reduce muscle spasm.
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Gradual onset
No specific movement
May awake with locked neck
Any level between C2-C7
Disc
Neck pain
Worst pain-medial, scapulae area (Clowards
area’s)
Deep pain
Noticeable flexion, lateral flexion away from pain
Extension, lateral flexion and rotation towards
the painful side is stiff but not blocked
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Prolonged poor posture
Repetitive neck movements
Slouching
Heavy lifting with poor technique
Poor posture during sleeping
Neck joint stiffness
A sedentary lifestyle
muscle weakness or tightness
a lifestyle or occupation involving large amounts of
sitting (particularly at a computer or driving),
bending, slouching or heavy lifting
Prolonged repetitive movements stretch tissue in the neck over
time, predisposing the facet joint to injury.
May originate from traumatic hyperextension injuries e.g.
whiplash
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Non-steroidal anti-inflammatory medications
Corticosteroid injections into facet joints
Physiotherapy:
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Intermittend constant traction (ICCT)
Transverse movement
Unilateral PA
Rotation and lateral flexion
Longitudinal caudad
Grade I, II and IVTENS
ice/heat modalities
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Literature clearly highlighted the success of
manipulations and Maitland’s mobilisation
techniques, as well as the combination of the
two in treating acute cervical locking.
The preferred techniques are described as
well as importance placed on accurate
assessment of patients before treatment
There is also a clear explanation of the
differences between acute cervical locking
and cervical spondylosis.
Assessment Variable
Acute Cervical Joint Lock
Spondylosis
Age of occurrence
late adolescence
usually over 35
Typical history
sudden onset associated
with a quick movement
but
no trauma
gradual onset that may
be related to minor
trauma
Common protective
deformity
rotation and lateral
flexion
away from the side of
pain
with slight flexion
rotation and lateral
flexion
away from the side
of pain with significant
flexion
Area of pain
local cervical (C4 to C6
area) near the midline on
the affected side away
from which the head is
tilted
more lateral (C4 to C7
area), may spread to
ipsilateral
scapulae, and
often referred to
ipsilateral
limb and to occipital
McCoy, K. 2009. Stiff Neck: A Look At Possible
Causes.
www.EverydayHealth.com
Retrieved on 16 July 2012
Sprague, R. B. 1983. The Acute Cervical Joint Lock.
Journal of the American Physiotherapy Association
63: 1439-1444.
Kirpalani, D. and Mitra, R. 2008. Cervical Facet Joint
Dysfunction: A Review. Division on the Physical
Medicine and Rehabilitation 89:770-773.