 Pain or discomfort when trying to turn or move the neck.

1. Postural 2. Atlanto-axial 3. Spasmodic Torticollis 4. Hysterical Torticollis 5. Stiff neck as a result of muscles

 Secondary to auditory and visual disturbances.

 Due to torticollis which is still present. Condition in which the head becomes persistently turned to one side.

 Patients experience repeated attacks of painless rotation or lateral flexion of the head.  Gradual onset from age 40.  Most common movement= rotation to the left side. MOBILISATION DOES NOT PLAY A ROLE IN THE MANAGEMENT OF THESE PATIENTS.

 Repeated movements while the patient moves the head to one side

 Post traumatic,  Post viral and;  torticollis

Painless contracture of 1 of sternocleidomastoid muscles Neck fixates in side flexion- towards affected side + rotation away from it. Lack of treatment= patient developing a permanent postural deformity + facial asymmetry

 Injury  Osteoarthritis  Rheumatoid arthritis  Pinched nerve  Fibromyalgia  Muscle spasm  Meningitis Identified by means of X- ray, MRI or CT

 DEPENDANT ON CAUSE Include:  Non-steroidal anti-inflammatory drugs to relieve pain.  A cervical collar to keep the neck still so that muscles can rest.  Limitation of activities that could strain the neck.  Physiotherapy

 Massage  Ice or heat therapies.  Maintaining a good posture Advice for at home:  Patient should sleep on a firm mattress and designed neck pillow or without a pillow.

 Onset of a sudden, sharp pain near the midline of the cervical spine on the affected side that appears as a result of an unguarded movement and that is accompanied immediately by an inability to return the head to a straight position.

 Occurs mainly in adolescence  Sudden onset  Snapping sound is heard  Sudden uncontrolled movement  Patient may be awakened by the pain  Most common between C2/3  Synovial pinching  Localised to mid-cervical area  Severe, sharp pain with proximal referral if the patient should try to move out of the position.  Noticeable lateral flexion, slight flexion/rotation away from pain-commen protective deformity. CAUSE

 Unlock the joint as soon as possible (try).  Use longitudinal movement in the position of deformity, rotation and lateral flexion-Grade IV- to IV to open side that is locked. TECHNIQUES ◦ Longitudinal cephalad ◦ Rotation away from pain ◦ Transverse thrust manipulation  Joint must be unlocked on day 1.  Pain still present on day 2- treatment directed towards relieving pain, muscle spasm + regaining full joint mobility.

 Mostly affects ◦ Atlanto-occipital ◦ Atlanto-axial Bump against the head Patient has unilateral sub- occipital pain + movement towards painful side. Lateral flexion and rotation feels stiff. History

MAITLAND MOBILISATIONS  If not unlocked on day 1 ◦ Manipulation ◦ Strengthening ◦ Reduce muscle spasm.

 Gradual onset  No specific movement  May awake with locked neck  Any level between C2-C7  Disc  Neck pain  Worst pain-medial, scapulae area (Clowards area’s)  Deep pain  Noticeable flexion, lateral flexion away from pain  Extension, lateral flexion and rotation towards the painful side is stiff but not blocked

 Prolonged poor posture  Repetitive neck movements  Slouching  Heavy lifting with poor technique  Poor posture during sleeping  Neck joint stiffness  A sedentary lifestyle  muscle weakness or tightness  a lifestyle or occupation involving large amounts of sitting (particularly at a computer or driving), bending, slouching or heavy lifting Prolonged repetitive movements stretch tissue in the neck over time, predisposing the facet joint to injury. May originate from traumatic hyperextension injuries e.g. whiplash

 Non-steroidal anti-inflammatory medications  Corticosteroid injections into facet joints  Physiotherapy: ◦ Intermittend constant traction (ICCT) ◦ Transverse movement ◦ Unilateral PA ◦ Rotation and lateral flexion ◦ Longitudinal caudad ◦ Grade I, II and IV- ◦ TENS ◦ ice/heat modalities

 Literature clearly highlighted the success of manipulations and Maitland’s mobilisation techniques, as well as the combination of the two in treating acute cervical locking.  The preferred techniques are described as well as importance placed on accurate assessment of patients before treatment  There is also a clear explanation of the differences between acute cervical locking and cervical spondylosis.

Assessment VariableAcute Cervical Joint LockSpondylosis Age of occurrencelate adolescenceusually over 35 Typical historysudden onset associated with a quick movement but no trauma gradual onset that may be related to minor trauma Common protective deformity rotation and lateral flexion away from the side of pain with slight flexion rotation and lateral flexion away from the side of pain with significant flexion Area of painlocal cervical (C4 to C6 area) near the midline on the affected side away from which the head is tilted more lateral (C4 to C7 area), may spread to ipsilateral scapulae, and often referred to ipsilateral limb and to occipital area

McCoy, K Stiff Neck: A Look At Possible Causes. Retrieved on 16 July 2012 Sprague, R. B The Acute Cervical Joint Lock. Journal of the American Physiotherapy Association 63: Kirpalani, D. and Mitra, R Cervical Facet Joint Dysfunction: A Review. Division on the Physical Medicine and Rehabilitation 89: