30 Seconds Of Therapy: Movement-Driven Manual Therapy for the Cervical Spine

Jun 9

7 min read

The cervical spine refers to the upper portion of the spinal column, consisting of seven vertebrae (C1–C7) that support the head and allow for its movement.

START

Prioritizing Symptom Reproduction
1. First reproduce the patient’s primary complaint with a movement or position that reproduces the patient’s primary complaint. Think physiological movements, passive physiological, or passive accessory testing. Establish the dominant pain mechanism , to justify the manual intervention.
Applying the SINSS Model Consistently
1. The SINSS framework (Severity, Irritability, Nature, Stage, Stability) to shape your approach.
  1. High irritability → gentle mobilizations or education.
  2. Stable, chronic symptoms → more progressive manual techniques.
Letting Movement Drive Diagnosis and Treatment
1. The movement examination isn’t just a test—it’s an intervention. By observing within-session changes, ROM limitations, and symptom modulation, you can determine:
  1. Whether the condition is mechanical, Which structures may be involved (facet, disc, uncovertebral joint)
  2. Manual Therapy Technique of Cervical Spine

STOP

Relying on Pathoanatomy
1. Cervical spine pain can arise from multiple sources: disc, facet, nerve root, or even referred pain. Labeling a patient with “spondylosis” or “herniated disc” without functional examination misses the point.
Ignoring Risk Factors and Red Flags
1. Manual therapy to the cervical spine comes with serious considerations. Always screen for:
  1. Recent trauma
  2. Symptoms of vertebrobasilar insufficiency (e.g., dizziness, diplopia, dysarthria)
  3. Cervical myelopathy (e.g., hand clumsiness, hyperreflexia)
  4. Constitutional symptoms (e.g., infection, cancer, or a disease affecting the entire system.)
Manual Therapy as a Standalone Fix
1. Manual therapy provides short-term improvements—but sustainable change requires active care. Integration (HEP) that mimic your manual techniques. Use augmented movements like: (Assisted rotations , Belt-guided side flexion, Self-mobilization of upper cervical segments.

WHY

Focus on Identifying a Specific Diagnosis
1. Cervical conditions are highly variable ranging from cervicogenic headaches and uncovertebral joint arthritis to radiculopathy and myelopathy. Without a clear understanding of what structure is involved and what pain mechanism is dominant, you're guessing and guessing leads to poor outcomes.
  1. Specific diagnosis = targeted treatment = better patient outcomes
Movement Strategy Foundation
1. Movement reveals how the body interacts with pain. It not only identifies the problem but also often resolves it. Movement can: (Reproduce or reduce pain, Clarify the mechanism (nociceptive vs. neuropathic) ,Act as both assessment and intervention.)

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