PDF(Pubmed)
Abstract：
Despite the prevalence of neck pain, evidence is lacking regarding the relationship of pathophysiology to function in people with neck conditions. Although movement-based diagnoses based on directional preference (DP) are described for lumbar spinal conditions, how these diagnoses guide interventions is not supported in the Cervical Spine Clinical Practice Guidelines. To date, there are no case studies in the literature that demonstrate the efficacy of cervical spine management based on a rotation DP. This case series highlights patient response to repeated end-range neck movements to inform DP and how the cervical flexion rotation test (CFRT) was used as a clinical baseline to assess mechanical and symptomatic changes. Three consecutive patients were evaluated by a physical therapist fellow trained in orthopedic manual physical therapy and diplomaed in mechanical diagnosis and therapy. The patients\' baseline pain ranged from 3 to 7/10 on the Numerical Pain Rating Scale (NPRS), and disability scores ranged from 20% to 52.6% on patient-reported outcome (PRO) measures. All three cases demonstrated a limited and painful CFRT. Examination procedures included repeated end-range movement testing in the sagittal and frontal and transverse planes. Across five to six visits in five to eight weeks, a decrease in the primary outcome measures from baseline to discharge were observed: NPRS, 50-85%; PRO, 60-82%. The CFRT may be a key baseline when screening patients with neck pain for DP. Following repeated end-range sagittal and frontal plane movements, the rapid change in the CFRT following targeted upper cervical rotation techniques confirmed a rotation DP.
摘要：
尽管颈部疼痛很普遍，缺乏关于颈部疾病患者病理生理学与功能关系的证据。尽管针对腰椎状况描述了基于方向偏好（DP）的基于运动的诊断，《颈椎临床实践指南》不支持这些诊断指导干预措施。迄今为止,文献中没有案例研究证明基于旋转DP的颈椎管理的有效性.本病例系列重点介绍了患者对重复的末端颈部运动的反应，以告知DP，以及如何使用颈椎屈曲旋转测试（CFRT）作为临床基线来评估机械和症状变化。由接受过骨科手动物理疗法培训并在机械诊断和治疗方面获得文凭的物理治疗师研究员对三名连续患者进行了评估。患者的基线疼痛范围为3至7/10的数字疼痛评定量表（NPRS），患者报告结局(PRO)指标的残疾评分为20%~52.6%.所有三例病例均表现出有限且疼痛的CFRT。检查程序包括在矢状，额面和横向平面中进行重复的末端运动测试。在五到八周的五到六次访问中，观察到从基线到出院的主要结局指标下降：NPRS，50-85%；PRO，60-82%。当筛查患有DP的颈部疼痛的患者时,CFRT可能是关键基线。在重复的末端矢状面和额面运动之后，有针对性的上颈椎旋转技术后CFRT的快速变化证实了旋转DP.
