Cervical spine

History: MOI
Direct trauma
Posterior aspect (strong muscular protection) * Contusion protected by strong muscular structure and muscle spasm often make it hard to determine * Fracture easier fracture if the force receive with the neck in forward bending * Transitory paralysis blow directly to the cord, rare, return quickly
Anterior (poor muscular protection) * Contusion RED FLAG hospital immediately unable to speak or breath due to muscle spasm return quickly(breath and talk)
Lateral (poor muscular protection but a neck roll can help) * Damage the brachial plexus or transverse processes of the cervical spine with referred symptom
Direct axial compression * Axial loading of the cervical spine occurs when the neck is slightly flexed, so that the cervical lordosis is straightened the intervertebral disc, the vertebral body, the surrounding ligament, the facet.
Overstretch
* Overstretching is usually occur in combined movement (e.g. forward bending + rotation) 1. Cervical Forward Bending (hyperflexion) * Major stress occurs at C5-C6 (where mobile vertebrae meet less mobile bertebrae C7-T1) * Worst injury is between the flexion and compression injury to C4-C7 2. Forward blending with rotation

3. Cervical back bending (hyperextension) * Contact or collision sport * Anterior muscle weak overextend the spine * Usually involve C5-C6 * ALL, anterior fibre of the annulus fibrosis of the intervertebral disc, and by the impact of
Insidious Onset
The athlete’s daily head carriage position may subject the neck and undue stress and contribute to degeneration change.
An athlete with true postural pain complains of a dull ache after prolonged training or working
The pain may be generalised in the cervical area or referred into the arms. He or she may not have a mechanism of injury or previous trauma.
A faulty compensatory cervical posture maybe result of more distal alignment pathology.
Daily activities or posture
If the mouth is habitually open then the weight of the mandible causes a continual forward force that pulls the cervical spine into excessive lordosis. This open mouth will eventually lead to muscle imbalance of the whole upper quadrant with a typical forward posture.
Repeated neck extension can lead to impingement of the facet joints and nerve roots, anterior ligament stretch, or disc degeneration. Repeated or prolonged side bending can lead to unilateral facet problems e.g telephone receptionist.
Occupation
Occupations requiring constant lifting can aggravate lesion (especially an intervertebral disc herniation) because of the compressive force.
Prolonged static work positions with a forward head posture have a high incidence of neck and shoulder pain and muscle spasm.
Sleeping position
Pillow too thin or too thick stress in cervical joint
Sleeping in prone position subject’s cervical are prolonged hyperextension and rotation.
Tension and stress
Tension in trapezius or erector spinae can put compressive force to the cervical spine.
Fatique from stress can affect the athlete’s posture and add to his or her problems.
Chronic problem
Recurring problems are common with cervical postural problems and may lead to degenerative change in the facet joint or intervertebral disc.

Pain
Where is the pain?
Local
A specific facet joint problem, muscle strain, or ligament strain may cause local pain but muscle spasm may potential obscures the exact location.
If the patient can pin point the pain will often indicate a trigger point rather than the lesion site.
Referred
Cervical refer pain can be classified in two basic form 1. Somatic pain syndrome
Somatic pain syndrome is the pain from musculoskeletal element of cervical spine. * Structures such as cervical and shoulder muscle(myofascial trigger point) * Trapezius, sternocleidomastoid, semispinalis cervicis and capitis, spenius capitis and