That is, flexion, extension, lateral flexion (both left and right), and rotation (both left and right) all appear fine, with little or minimal discomfort. Neck Extension; Lever (selectorized) Neck Extension; Weighted . Tip 15 How to Palpate Scalenes on a Client Slowly draw your right ear toward your right shoulder stopping when you feel the stretch. Measure the distance from the mastoid process to the acromion process. Ensure that the arm of the goniometer that is to be stationary is perpendicular to the floor. Locate the occipital protuberance and spinous processes of thoracic vertebrae. The information here is not designed to replace any training you have had. Standing in front of your client, you have the advantage of being able to observe their facial expressions. This section is not designed to help you assess people with cervical trauma. That is, some of the vertebrae can remain “stuck,” while others move more freely, so the movement we observe is not coming equally from each of the seven cervical vertebrae. As they were performing the movements you found yourself asking, “How do I know what is a ‘normal’ ROM in the neck?” Well, there are many books in which normal ranges of movement can be found. 3. Using these kinds of open-ended questions encourages the client to search for words that best describe their symptoms and can help you discover more about the nature of the problem. For example, was it easier for me to measure rotation than lateral flexion? Would helping to alter ROM improve my client’s quality of life in any way? “What sort of discomfort is it?” Where special caution is needed, this has been stated, so please read the whole tip before attempting the assessment. A degree of Thoracic / Lumbar Spine lateral flexion is typical involved in this movement. These are arbitrary selections, but you get the idea. Remember from Tip 7 (p. 22) to identify the exact words the client uses to describe any discomfort, words such as “pulling,” “pinching,” “sticking,” “catching,” or “squashing.”. Position the center of your goniometer over C7, with the stationary arm over the spinous processes of thoracic vertebrae and the moveable arm over the occipital protuberance. For example, flexion, then extension and back to neutral; right rotation, then left rotation and back to neutral; right lateral flexion, then left lateral flexion and back to neutral. Move the stationary arm of the goniometer as they do this, keeping it aligned with the nose. Also, there may be a small group of people for whom caution is needed when asking them to perform active movements involving the head and the neck. “When you say it is uncomfortable, can you be more specific?” Document these findings. Tip 1: Assessing Range of Movement This has clear illustrations and focuses only on this topic, so it is easy to follow. Ask your client to take their head as far back as possible, trying to get the back of their head to touch the top of their back. TIP: Make sure that your client does not move their shoulders when performing ROM tests. Also, there may be a small group of people for whom caution is needed when asking them to perform active movements involving the head and the neck. TIP: Assess 10 people who drive for a living or who do a lot of driving; 10 people who are older than 70 years; 10 people who have sustained a whiplash injury in the past 5 years (providing they are safe to be assessed now, of course); 10 people who maintain a static posture for long periods of time; and 10 people who regularly perform yoga. Question: Does it matter where you stand when carrying out this assessment? Question: Does it matter which movement the client performs first? 4. “When did you first notice it?” (rather than “When did you first get the pain?”) Therefore, if with passive elevation of the shoulders, pain/stiffness/discomfort is reduced, and ROM is increased, there is a strong likelihood that muscles such as upper trapezius, levator scapulae, or rhomboid minor are contributing to the client’s problem. For example, if rotation was decreased by what you thought was 5 degrees you could write –5 degrees with a line representing rotation. Then, perform an isometric hold using your hand as resistance and sidebend your head a little more. (“Cervical spine rotation and lateral flexion combined motion in the examination of the thoracic outlet”). Stretching your neck can have a positive impact on your pain, posture, and overall mobility. How good was I at giving instructions to my subject? Tip 9 Measuring Neck and Shoulder Distance The scalenes are muscles of the neck, but are also classified as being in the lateral vertebral region.

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