STIFF NECK Outcomes Be familiar with the clinical

STIFF NECK

Outcomes � � Be familiar with the clinical presentation of an acute cervical locking and a discogenic locked neck. Be familiar with the most widely used physiotherapy treatment protocol for a patient with a typical acute cervical locking and a discogenic locked neck.

Types � Postural � Atlanto-axial rotation fixation � Spasmodic torticollis � Hysterical torticollis � Stiff neck as a result of muscles

History � � � Painless contracture of one of the sternocleidomastoïd muscles Gives rise to the neck fixating in side flexion towards the affected side and rotation away from it Lack of treatment may lead to permanent deformity

Acute cervical locking � � � � Sudden onset A snapping sound is heard Sudden uncontrolled movement Most common between C 2/C 3 Synovial pinching Localised to the mid-cervical area Severe, sharp pain with proximal referral the patient should try to move out of the position

Acute cervical locking (cont) � � Noticeable lateral flexion, slight flexion/rotation away from the pain During PAIVMS’s any movements which decreases the articular space would evoke the familiar pain

Treatment � � � Try to unlock the joint as soon as possible Longitudinal in position of deformity Rotation and lateral flexion Grade IVJoint MUST be unlocked on day 1 Further treatment must be directed towards pain relief, muscle spasm and gaining full joint mobility

Traumatic onset � History of trauma eg. bump against head � If not unlocked on day 1: Manipulation Strengthening Muscle spasm

Discogenic locked neck � � � � Gradual onset No specific movement May awake with locked neck Any level between C 2 -C 7 Disc Neck pain Worst pain is over medial scapula area (Cloward area’s) Deep pain

Dicskogenic locked neck (cont) � Noticeable flexion, lateral flexion away from the pain � Extension, lateral flexion and rotation towards the painful side is stiff but not blocked

Treatment � Intermittent constant cervical traction � Transverse movement � Unilateral PA � Rotation and lateral flexion � Longitudinal cephalad Grade I, II and IV-

Treatment (cont) � With distal symptoms the treatment must be of a longer duration � Slower recovery if other structure eg. dura and nerve roots also show symptoms � Restriction of extension is often one of the remaining signs after treatment � Central PA Grade IV often clears this sign