Treatment of Cervical spine: Correct tissue being treated? Correct technique? What’s your Clinical Algorithm?

by Jason Myerson

 

Three subjects were evaluated and treated by Dewette V., et al. in a study entitled , “Articular dysfunction patterns in patients with mechanical neck pain: A clinical algorithm to guide specific mobilization and manipulation techniques.”  Subject’s report of pain and physical examination categorized them into a “Divergence Pattern,” pain provocation and restriction in cervical flexion and contralateral sidebending and rotation or “Convergence Pattern,” pain provocation and restriction with cervical ext and ipsilateral sidebending and rotation. For the goals of pain relief and functional improvement,  different manipulative techniques were used. This small case series developed a possible algorithm for determining which patient presentation/provocative tissue would most likely benefit from which specific technique.

The patient’s subjective report and patient’s physical exam findings presents similar to identifying the correct tissue in lesion: facet joint capsule vs facet cartilage. Information from this case study may be used to help identify the provocative tissue and help for treatment planning. Limitations of this case series were a very small sample size and the article did not state if the other soft tissue was addressed; fascia, muscle, etc.  It also does not state if areas remote to this location were assessed as well.  This article may be a building block to determine which technique may be the most beneficial toward the treatment of certain pain and/or restriction patterns.  There is no recipe for success, and not all patients fit perfectly into every algorithm, but pattern recognition is important. Even if we choose the correct technique, are we sure that the tissue we are treating is the exact tissue in lesion, or vice versa. This clinical algorithm may be a GUIDE for pattern recognition, but I also trust my clinical experience and patient’s response to treatment.

Review the full article here http://www.manualtherapyjournal.com/article/S1356-689X%2813%2900160-4/fulltext

Dewitte., et al. Articular dysfunction patterns in patients with mechanical neck pain: A clinical algorithm to guide specific mobilization and manipulation techniques. Manual Therapy.2014;19:2-9


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