Cervical Spine Diagnostics
Overview
Any factor that results in an obstruction to the full range of motion is called a
restrictive barrier. Restrictive barriers have palpable characteristics that differ from normal anatomical, elastic, and physiological barriers. When a restrictive barrier is present, either the active range of motion is compromised or there is no passive range of motion beyond the active range, and the range of active motion is defined by the normal
physiologic barrier and the restrictive barrier. The goal of treatment is to move the restrictive barrier as far into the direction of motion loss as is possible.
Pathologic barriers to motion can be found within muscle, skin, fascia, ligaments, and joint capsules. A barrier may involve a single joint or spinal segment, or it may cross over more than one joint or spinal segment. The different pathological changes within these tissues result in loss of motion and/or characteristic endfeel sensations. As you develop palpatory skills, you will learn to differentiate between different types of restrictive barriers. Identification of the cause of the restriction is necessary in order to determine the treatment protocol that will be most effective in restoring normal range of motion to the affected joint.
Remember that structural diagnosis is specifically directed towards the identification of abnormalities in symmetry, range, and quality of joint motion in order to identify dysfunction and treat to restore maximal, pain-free movement of the musculoskeletal system.. You will be contnually asking yourself the following questions:
- Is the total range of motion symmetric?
- Is the total range of motion reduced from normal?
- What is the quality of the motion?
- What is the characteristic feel at the end point of motion?
Let's take a look at several kinds of
pathology that result in either a restrictive barrier or a change in the characteristic feel of motion.
- Normal: Smooth, spring-like
- Hypertonic: Tight
- Hypermobile: Little resistance until the very end, hard endfeel
- Fibrotic: Abrupt, hard endfeel
- Spasm: Jerky, guarding caused by pain
- Edema: Boggy, spongy
Another phenomena associated with a restrictive barrier is the shifting of the neutral resting position away from
midline neutral. This new resting position is called the
pathological neutral and is usually, but not always, at the midpoint of the available range of active motion. For example, a barrier that restricts right rotation of a cervical motion segment will often result in a shift in resting neutral from midline neutral to a pathological neutral that is rotated left of the midline.
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