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| '''Original Editor '''- Your name will be added here if you created the original content for this page. | | '''Original Editor '''- Your name will be added here if you created the original content for this page. |
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| == Introduction == | | == Introduction == |
| Cervical pain is one of the most common complaints by patients represented to physiotherapy clinics.It disturbs the overall function and quality of life for most patients.it may occur because many different reasons and with many different forms so discussing the possible causes,changes occur with chronic pain and the best treatment modalities is very essential and mandatory .
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| '''Changes Occur With Chronic Cervical Pain.'''
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| 1.Pain Centralization
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| Reduced pain thershold is one of the findings that resaearchers have found in patients with chronic neck pain<ref>Sterling M, Treleaven J, Edwards S, Jull G. Pressure pain thresholds in chronic whiplash associated disorder: further evidence of altered central pain processing. Journal of Musculoskeletal Pain. 2002 Jan 1;10(3):69-81.https://www.tandfonline.com/doi/abs/10.1300/J094v10n03_05</ref>.The decrease in pain thershold is recorded both locally and distally in upper and lower limbs and this suggest that central changes occur with chronic cervical pain.
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| 2.proprioceptive changes
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| patients with chronic cervical disorders show deficit in the proprioceptive input which affect postural stability<ref>Malmström EM, Fransson PA, Bruinen TJ, Facic S, Tjernström F. Disturbed cervical proprioception affects perception of spatial orientation while in motion. Experimental brain research. 2017 Sep 1;235(9):2755-66.https://www.ncbi.nlm.nih.gov/pubmed/28623390</ref>
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| 3.Neuromuscular dysfunction
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| researches shown that patients with chronic cervical pain exhibit up to 90%deficit in cervical spine muscles strength<ref>Prushansky T, Gepstein R, Gordon C, Dvir Z. Cervical muscles weakness in chronic whiplash patients. Clinical Biomechanics. 2005 Oct 1;20(8):794-8.https://www.ncbi.nlm.nih.gov/pubmed/15996800</ref>.
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| deep neck flexors have reduced emg activity and delayed activation when performing arm movement so the feedforward mechanism is diturbed<ref>Falla D, Jull G, Hodges PW. Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain. Experimental brain research. 2004<nowiki/>https://www.ncbi.nlm.nih.gov/pubmed/14762639 Jul 1;157(1):43-8.</ref>
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| neck flexor muscles(SCM and anterior scalene) have shown side-specific weakness in unilateral cervical pain.<ref>Falla D, Jull G, Rainoldi A, Merletti R. Neck flexor muscle fatigue is side specific in patients with unilateral neck pain. European Journal of Pain. 2004 Feb;8(1):71-7.https://onlinelibrary.wiley.com/doi/full/10.1016/S1090-3801%2803%2900075-2</ref>
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| Assessment
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| assessment of chronic cervical pain should focus on different areas:
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| .posture assessement
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| done from three different positions:
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| from posterior:if you find elevated shoulder,it would be tightness of upper trapezius and levator scapula.
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| from lateral:you will find forward head posture.
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| from anterior:you will find cord like apperance at SCM .
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| .balance assessment
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| as explaind above,patients with chronic neck pain have impaired postural stability.
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| .gait assessment
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| in extreme cases of cervical dysfunction,gait pattern may be changed.
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| .flexibility and muscle strength assssment
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| physical therapy treatment
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| .stretching for tight muscles
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| [[File:Upper-trap-stretch.png|thumb|162x162px]]
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| upper trapezius
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| == Sub Heading 2 == | | == Sub Heading 2 == |
