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Stiff neck

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.

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Stiff neck

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  1. Stiff neck

  2. 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.

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

  4. 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

  5. Acute cervical locking • Sudden onset • A snapping sound is heard • Sudden uncontrolled movement • Most common between C2/C3 • Synovial pinching • Localised to the mid-cervical area • Severe, sharp pain with proximal referral the patient should try to move out of the position

  6. 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

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

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

  9. Discogenic locked neck • Gradual onset • No specific movement • May awake with locked neck • Any level between C2-C7 • Disc • Neck pain • Worst pain is over medial scapula area (Cloward area’s) • Deep pain

  10. 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

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

  12. 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

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