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LEARNING OBJECTIVES
Upon completion of this chapter the student should be able to demonstrate the following competencies and proficiencies concerning the cervical and thoracic spine:
Have a basic knowledge and understanding of cervical and thoracic spine anatomy
Understand normal arthrokinematics and osteokinematics
Understand normal biomechanics of vertebral movement in the cervical and thoracic spine
Recognize pathomechanics and its relation to cervical and thoracic dysfunction
Recognize normal posture and abnormal posture
Have an understanding of common cervical and thoracic spine disorders
Have an understanding of exercises for the cervical and thoracic spine
Design a rehabilitation plan for the cervical and thoracic spine injuries
Implement a rehabilitation plan including proper stretching, strengthening, proprioception, and exercise technique in accordance with principles of basic exercise
Perform manual treatment techniques including basic stretching, joint mobilization, muscle energy, trigger point (myofascial), and soft tissue mobilization
Understand clinical prediction rules for the cervical and thoracic spine
Demonstrate and educate the patient on a comprehensive home exercise program
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The cervical spine has many boney articulations, soft tissue attachments, nerve roots, and vertebral arteries, which may make this an intimidating body part to evaluate and treat. With proper understanding of the cervical spine anatomy and biomechanics, however, the clinician will be able to effectively treat any condition associated with cervical spine dysfunction. The vertebral column consists of 7 cervical, 12 thoracic, and 5 lumbar vertebrae, which sit atop the sacrum (5 fused vertebrae) and the coccyx (4 fused vertebrae).1,2 Of the 24 moveable vertebrae, the cervical are the smallest and the lumbar are the largest. The cervical vertebrae are designed to allow for a large of range of motion in all directions, as evidenced by the increased amount of rotation occurring in this region.1,2 This rotation in accomplished by the unique design and articulation between C1 (atlas) and C2 (axis), which will be explained in greater detail later in the chapter. As a result of the large range of motion in the cervical spine, the potential for injury and pain are increased.1,2
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At some point in people's lives they will experience some form of neck and upper back pain or stiffness, and the frustrating part will be that the exact cause of the pain will be unknown or idiopathic. Cervical and thoracic pain can originate from many causes such as a car accident (whiplash), trauma during a sporting activity, poor posture, weightlifting, or just sleeping on it funny. Regardless of the cause, cervical and thoracic pain can shoot (radiate) down the upper extremity into the hand or upper back, around the rib cage, and up the back of the head. Cervical and thoracic pain can cause headaches and dizziness. Assessing and treating cervical and thoracic pain can be complicated because injuries to these areas can have symptoms that are similar with other conditions such as scapula dysfunction, shoulder ...