 Be familiar with the clinical presentation of an acute cervical locking and a discogenic locked neck.  Be familiar with the most widely used physiotherapy treatment protocol for a patient with a typical acute cervical locking and a discogenic locked neck.

 Postural  Atlanto-axial rotation fixation  Spasmodic torticollis  Hysterical torticollis  Stiff neck as a result of muscles

 Painless contracture of one of the sternocleidomastoïd muscles  Gives rise to the neck fixating in side flexion towards the affected side and rotation away from it  Lack of treatment may lead to permanent deformity

 Sudden onset  A snapping sound is heard  Sudden uncontrolled movement  Most common between C2/C3  Synovial pinching  Localised to the mid-cervical area  Severe, sharp pain with proximal referral the patient should try to move out of the position

 Noticeable lateral flexion, slight flexion/rotation away from the pain  During PAIVMS’s any movements which decreases the articular space would evoke the familiar pain

 Try to unlock the joint as soon as possible  Longitudinal in position of deformity  Rotation and lateral flexion Grade IV-  Joint MUST be unlocked on day 1  Further treatment must be directed towards pain relief, muscle spasm and gaining full joint mobility

 History of trauma eg. bump against head  If not unlocked on day 1: Manipulation Strengthening Muscle spasm

 Gradual onset  No specific movement  May awake with locked neck  Any level between C2-C7  Disc  Neck pain  Worst pain is over medial scapula area (Cloward area’s)  Deep pain

 Noticeable flexion, lateral flexion away from the pain  Extension, lateral flexion and rotation towards the painful side is stiff but not blocked

 Intermittent constant cervical traction  Transverse movement  Unilateral PA  Rotation and lateral flexion  Longitudinal cephalad Grade I, II and IV-

 With distal symptoms the treatment must be of a longer duration  Slower recovery if other structure eg. dura and nerve roots also show symptoms  Restriction of extension is often one of the remaining signs after treatment  Central PA Grade IV often clears this sign