2. 1- Avoid high-impact activities, such as running and high-impact aerobics. 2- Doing exercises to maintain neck strength, flexibility and range of motion. and range of motion. How to prevent cervical pain

3. 3-Taking breaks when driving, watching TV or working on a computer to keep from holding your head in the same position for long periods in the same position for long periods.

4. Good posture Poor posture

5. How to prevent cervical pain 4-Practicing good posture, with your neck aligned over your shoulders 5-Protecting your neck from injury by using a seat belt when in a car and avoiding activities that strain your neck 6-Reduce the physical and mental stress.

6. How to prevent cervical pain

7. Neck pain is a common reason pushs peoples visit their doctor. Neck pain typically doesn't start from a single injury. Instead, the problem usually develops over time from the stress and strain of daily activities. Eventually, the parts of the spine begin to degenerate. The degeneration can become a source of neck pain.

9. Causes of cervical pain Degenerative Disc Disease Spondylosis Mechanical Neck Pain Radiculopathy (Pinched Nerve) Herniated Disc Spinal Instability Trouma and Muscle Strain Spinal Stenosis (Cervical Myelopathy)

10. Neck stiffness and reduced range of motion Neck stiffness and reduced range of motion pain spreading into the upper back or down the arm back or down the arm Neck pain and headache Age More common elderly subjects (> 40 years) Cervical spondylosis is significantly higher in patients who carry loads Clinical picture Muscle weakness in the shoulder, arm, or hand Sensory changes (numbness, prickling, or tingling) in the forearm, hand, or fingers

12. Rehabilitation Team Will do the following Assessment Treatment

13. 1.Physician 2.physiotherapist 3.Social workers 4.Psychologist 5.Nurse 6.Occupational therapist 7.Vocational counselor

14. AssessmentAssessment

15. The evaluation should be early as much as possible The clinic should be cleaned, suitable temperature of room, suitable temperature of room, and ready instrumentation to use. and ready instrumentation to use. Plinths should be wide, suitable height, clean blankets. Notice patient from head to ankles.

16. Discover disabilities that responsible for restriction of motion during assessment. motion during assessment. Discover abilities that are suitable for ADL during assessment. Explain to patient what you what you will do. Behavior and social social aspect should be noticed. be noticed.

17. Considerations during assessment Assessment should be within the limit of pain. Assessment should be within the limit of pain. Relax patient before assessment, specially if patient has done a an effort. Relax patient before assessment, specially if patient has done a an effort. Removing tight clothes during upper limb muscle strength assessment. Removing tight clothes during upper limb muscle strength assessment. Good fixation of target joint during assessment. Good fixation of target joint during assessment. Explain the pain test procedure before assessment. Explain the pain test procedure before assessment. Close communications during assessment. Close communications during assessment.

19. Personal history Age *Young people are more likely to have acute trauma such as disc injuries or spondylolisthesisdisc injuriesspondylolisthesis *Middle aged patients tend to have conditions in which degeneration predisposes to injury such as a sprain, herniation, or degenerative disc disease sprainherniationdegenerative disc disease *Older patients are more likely to have chronic or degenerative conditions Name

20. Personal data Sex: Females is two to three times as common as in males. Marital status: (single – married). Dominant side: should be known. Style of life : Should be known, specially if the patient is hard worker. Environmental assessment: (floor: can be modified or not). (using assistive devise or not). if there are weakness of certain muscles (weight and height relation: it can affect this pathology if there is a bad relation). (occupation: interests and hobbies can be modified or not).

21. Past history Hereditary diseases: ---- Hereditary diseases: ---- Genetic diseases: ---- Genetic diseases: ---- Previous and multiple trauma: if present, can affect rate of cervical degeneration. Previous and multiple trauma: if present, can affect rate of cervical degeneration. Diabetes: ---- Diabetes: ---- Hypertension: ----- Hypertension: -----

22. Present history Onset of symptoms Sudden ( acute disc lesion) ( acute disc lesion)Gradual (chronic degeneration )

23. Pain History Exacerbating and alleviating factors Unilateral or bilateral Local and diffuse or radiating or radiating

24. Cervical radiating pain

25. Functional activities of daily living What are problems interfere with ADL: *Transfer activities,Hygiene Dressing and undressing and Feeding: (all this can be affected with sever muscle weakness

26. Functional activities of daily living *Gait ambulation: ( if there are cervical myelopathy). * Grades of ADL: ( can do the activity alone or with assistance or can not do it). *Types of assistance (partial or complete). *Types of assistance (partial or complete).

27. Vocational assessment If the patient can return to his job or not ?

28. spreading into the upper back or down the arm movement neck stiffness and reduced range of motion Sensory changes (numbness, prickling, or tingling) in the forearm, hand, or fingers muscle weakness in the shoulder, arm, or hand pain

29. Drugs: (anti-inflammatory – pain killer – muscle relaxants drugs). Reports: (all reports from other physician- previous investigations). Laboratory tests: (ESR test indicate inflammation,ASOT,RF to exclude Rheumatic fever and rheumatoid arthritis). Vital signs: ---- Vision, hearing, speech records: ---- Cardiopulmonary reports: ---- Type of surgery : (cervical and shoulder surgery may cause neck pain).

30. Radiographic images X-rays show problems with bones, such as tumor,infection, fracture,degeneration Special X-rays called flexion and extension X-rays may help to determine if there is instability between vertebrae.

31. MRI and CT scan The MRI scan shows the cervical spine bones, as wel as the soft tissue structures such as the discs, joints, and nerves.

32. Other test for cervical pain Bone scan and myelogram are special test for investigation of bone problem as tumor and infection Electromyogram is a special test used to determine if there are problems with any of the nerves going to the upper limbs.

33. Physical examination 1-Screening and scanning examination; A- General inspection: General health. General health. Wearing glasses, hearing aids Wearing glasses, hearing aids Relation between family. Relation between family. Proportion of body parts. Proportion of body parts. Weight& height. Weight& height. Functional activity and gait ability Functional activity and gait ability

34. Physical examination B- Local inspection *posture, guarding, splinting--if chronic, these behaviors may compound and exacerbate the pain problem, as the patient places abnormal stresses on the body. *Atrophy or weakness--may indicate guarding and lack of use, or myelopathy.

35. Physical examination 2-palpation *Feel along the spinous processes checking for alignment ), "step-offs" (spondylolisthesis), and tenderness (fracture). *Palpate the paraspinal muscles along the entire vertebral column, checking for spasm (feels firm) and tenderness.spondylolisthesis Mobility of the skin. * Mobility of the skin.

36. 3-Range of motion Physical examination CROM Inclinometer Cervical flexion and extension Lateral flexion and rotation

37. Cervical range of motion Cervical flexionCervical extension Side bending Lateral rotation

38. Physical examination 4- Muscle strength test: (either manually or mechanically with dynamometer ) Motor dysfunction--Assessment of motor strength can help in identify neural injury and the probability for nerve roots involved. (either manually or mechanically with dynamometer )

39. Physical examination 5-Neurologic examination *Cranial nerve assessment--is especially very important in the evaluation of head and neck pain. * Physical examination for radiculopathy for upper extremity using dermatome, reflexes, and myotome

41. Physical examination : Differential Diagnosis : Do the signs and symptoms indicate the nature of the pain ? Nociceptive--suggesting tissue injury or inflammation Neuropathic--indicating central or peripheral dysfunction of the nervous system Pain with mixed features --such as migraine or possibly myogenic or myofascial pain

42. Pain Assessment Algometer Algometer

43. Posture Analysis Posture Analysis 3D/4D Formetric Moire Topography

45. Compression test Adeson test

46. Multi cervical unit The Multi Cervical Unit is a digitally interfaced system that allows for the real-time recording of cervical spine movement and isometric strength in more than 1,000 unique positions. The system also features a dynamic strengthening program for cervical spine rehabilitation. New technique for cervical pain assessment

47. Multi cervical unit