Physiotherapy Management for Cervical Root Syndrome Conditions

MODULE 6 PHYSIOTHERAPY MANAGEMENT FOR CERVICAL ROOT SYNDROME CONDITIONS Cervical Root Syndrome is a disorder of the nerve roots such as disc herniation, spondylosis, or cervical osteophytes which is accompanied by complaints of pain, numbness, tingling, upper extremity weakness and often results in functional limitations. Cervical Root Syndrome most often arises as a result of degenerative changes that occur in the spine. Cervical Root Syndrome can be caused by compression of the cervical nerve roots resulting in spondylosis, instability of the cervical structures, trauma, or tumors. a. Physiotherapy Problems Symptoms of neck pain include stiffness in the neck area, pain in the neck muscles in the neck, headaches and migraines. Neck pain will tend to feel like burning. Pain can radiate to the shoulders, arms, and hands, feeling thick or like pins and needles. Sudden and continuous pain can cause an abnormal neck shape, the head facing the opposite side, which is known as torticollis. Unilateral neck pain often occurs in cervical root syndrome. Pain transmission varies depending on the nerve roots involved although some distributions may overlap. The absence of pain radiating to the extremities does not rule out the possibility of nerve root compression for some time. The pain may be isolated to the shoulder girdle. DysfunctionSensory and motor can also occur without significant pain. The symptoms that arise are often aggravated by extension and rotation movements in the neck (spurting sign) reducing the size of the neural foramen. b. Intervention Physiotherapy a. MWD b. TENS c. Massage d. Stretching e. Calliet Neck Exercise A. Equipment Required 1. Bed Treatment 2. MWD 3. TENS 4. Training Module B. Practical Activities. 1. MWD Preparation of equipment, test equipment, pre-warming 1-2 minutes, distance <10cm from skin Patient preparation: free from clothing and metal, position the patient as comfortably as possible, do a sensibility test, applicator distance 5-10 cm with frequency 2456 MHz, intensity 50- 100 watts or up to the patient's tolerance limit, dose intensity can also be determined by the actuality of the pathology (low actuality: thermal, medium actuality: subthermal, high actuality: a thermal). In acute conditions the therapy time is 5 – 10 minutes, while for chronic conditions the therapy time is 15 – 30 minutes. The power provided is around 200 watts, so it can raise body temperature in the range of 38 – 40 ̊ C 2. TENS TENS Implementation Procedure: a. Patient position: lying on his stomach b. Implementation procedure: the physiotherapist places one electrode pad on the cervical segment and another electrode pad on the lateral side of theupper arm along the brachial flexus path, then the TENS machine is turned on, the current frequency is selected as 200 Hz, the phase duration is 60 Hz, the therapy time is set to 10 minutes, and The intensity is slowly increased until a subtle vibration (mitis) is felt where the patient feels comfortable with the current 3. Massage a. Stroking is carried out first to adapt the patient's skin to the massage that will be carried out next. Given to all areas that will be given other types of massage (cervical, trapezius, rotator cuff and rhomboid b. Effleurage Deep pressure follows the direction of the muscle fibers in the cervical region (scalenius, SCM, rectus capitis, semispinalis cervicis, splenius cervicis, rhomboideus) Repeat 5-8 times 4. Stretching The patient's position is sitting with the neck hanging relaxed on a chair or standing relaxed. After that the patient is asked to: Bend the neck forward and backward (extension movements should not be done if there is nerve compression). ➢ ➢ Bend the head to the right and left side, rotating the head to each side. ➢ Rotate the shoulders, elevate, retract, then relax the scapula. Rotate your arms around your shoulders. Performed with the elbow flexed and extended, using large and small circular movements. Arm position forward or slightly to the side. ➢ 5. Calliet Neck Exercise This exercise can be done standing, sitting or lying on your back: a. Neck Flexion Bend your neck slightly forward and place your hands on your forehead. Bend your head forward while pushing your hands forward b. Neck Extension Straighten your neck and place your hands behind your head.Push your head back while pushing your hands behind your head. c. Lateral Flexion of the Neck Keep your head straight, place your hands on the right or left side. Pushing the head up to the shoulders with the right or left hand (alternately) d. Neck Rotation Place your left hand at chin level, turn your head slightly to the right. Turn your head while pushing with your hands