Information for medical professionals 2018: Rehabilitation, part 4

Treatment and rehabilitation measures at Firda Physical Medicine Centre

An important question: Who says it is not possible to take functional and useful pictures of short C0-1-2 stabilizing musculature? Here at Firda Physical Medicine Centre we do just that!

A useful tool for the testing of a person's neck function is the Multi Cervical Unit (btetech.com).

If we focus on basic, deep stability I am able to visualize lig. alaria and lig. transversum as a part of cruciatum. These are examples of structures among many important stabilizing ligaments, membranes and capsules, present in the area neck between the neck and head.

Without a fundamental, deep stability (ie when these ligaments are damaged) great strain will be placed on nerves, veins, arteries and on the short, deep and outer, longer muscle groups.

x - lig. alaria

xx - lig. transversum

large cross - lig. cruciatum


In the example of this patient, with the skull-first vertebra bending too far over to the side, right to left, we must also assume that there is damage to the joint capsule surrounding the joint. Here shown from the inside, in green.


Finally, we see joint capsules on the outside of the joints C0-1 and C1-2. The joint capsules make up the spaces between the joints and are the insertion points of capsular ligaments and membranes.

Trauma involving side bending can give tissue damage in the joints, shown here with vertical, orange arrows. Trauma in which rotation is involved may result in rotation damage to tissue, here shown by horizontal, orange arrows.

We could continue in this vein with a detailed review of findings and dysfunction. As mentioned previously and for the purposes of patient anonymity, this case study is a compiled study, put together from the facts and clinical findings of four different patients. What I wish to illustrate is the importance of accurate information. I would expect to receive this information from GPs, neurologists, specialists in internal medicine etc, and also chiropractors, physiotherapists and osteopaths. Without accurate information we would continue to perform the following:

- masssage - but for what purpose?

- manipulation - yes, but why, and is this a good idea?

- treatment with Sarotex - why?

- supervise exercises in our large training room and advise on exercises to be done at home - yes, but what exactly should be trained and how?

- If we lack a precise understanding of the patient's condition, how can we at all be goal-oriented in our treatment?

Ultrasound

A clinical test will be followed up by performing an ultrasound examination of the neck. We have tried several ultrasound apparatuses, and have ended up with those made by GE. We currently have two of these, from their higher price range. We have chosen to have the higher-end apparatuses for the simple reason that they give the best images of segmental soft tissue in the neck.

Why ultrasound?

  • We have always had an apparatus in the examining room. Should we have need for ultrasound then it is there, saving the time it would take to make an appointment, wait your turn etc.
  • What is the condition of the tissue at the start and in the ensuing days - for example, ligaments/capsules C0-1-2-3 joints, as seen laterally (straight in from the side). The patient may lie completely still, or I may move the joints a little, carefully, in order to see how the tissue behaves.
    • Oedema - does the amount of oedema present in the tissue increase or decrease?
    • The regeneration of tissue - the consistency of tissue - does the direction of the fibres change? When the tissue is stimulated do we see changes in the tissue in relation to the growth of cell clusters? Does the tissue model itself naturally and as we would wish? Or, do the fibres with time arrange themselves in non-functional directions and formations?
  • The testing of the neck in the Multi Cervical Unit - apparatus for the testing and rehabilitation of necks.
  • Do clinical and ultrasound findings correspond? Do the findings agree with the patient's experience of her condition? We are able to get immediate answers, pertaining to the actual situation there and then, and so are more hands-on with regard to tissue status. In this way we are able to take the most appropriate measures each day.
  • We face a treatment dilemma:
    • Acute symptoms following probable tissue damage C0-1-2-3 together with obvious negative consequences: increased middle and upper thoracic kyphosis; rigid joint and soft tissue function; considerable tissue resistance to segmental, manual joint and soft tissue techniques, as well as to careful tissue mobilizing through gentle training with a wedge (Firda mobilizing wedge, grey).
  • The stiffened joint and soft tissue areas in the thorax are now the source of many symptoms in themselves, in addition to functionally dragging C0-1-2-3 forward, thereby making a desirable joint position C0-1-2 difficult to obtain and causing increased tension towards the soft tissue.
  • We now have a period of treatment in which the focus is on the principal injury findings/reactions and subsequent secondary negative changes to joints and soft tissue. There are several areas that are active at the same time in showing soft tissue and neurological symptoms.

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