Understanding Landmark relationships Role In Cervicalgia

Landmark relationships are a valuable tool for physiotherapists to estimate the location of cervical vertebrae. These landmark relationships are helpful for providing an initial estimate of cervical vertebrae locations during assessment. The landmark relationship also aid in applying mobilization and manipulation techniques in patents that come with musculoskeletal conditions like Cervicalgia.

Mastoid Process and Atlas (C1):

The mastoid process is a bony projection located just behind the ear. When you move the neck into flexion, the mastoid process and the lateral aspect of the atlas (C1) vertebra align. This relationship can help identify the level of the atlas.

Angle of Mandible and Axis (C2):

The angle of the mandible (jawbone) is another helpful reference point. It aligns with the axis (C2) vertebra. This alignment can aid in locating C2 when assessing cervical vertebrae.

Hyoid Bone and C3:

The hyoid bone, a U-shaped bone in the neck, is located just above the level of the third cervical vertebra (C3). This relationship can provide an approximate location for C3.

Thyroid Cartilage and C4-C5:

The thyroid cartilage, often referred to as the "Adam's apple," is positioned at about the level of the fourth and fifth cervical vertebrae (C4-C5). This can help gauge the location of these vertebrae.

Carotid Tubercle and C6:

The carotid tubercle is a bony prominence located on the anterior arch of the transverse process of the C6 vertebra. It's a useful landmark for identifying the location of C6.

Vertebra Prominence (C7):

The seventh cervical vertebra, also known as the vertebra prominence (C7), is a prominent landmark that's often easily palpable. It's the most noticeable spinous process when the neck is flexed forward. Locating C7 serves as a reference point for counting the remaining cervical vertebrae both above and below it.

Spinous Process Palpation:

Palpating the spinous processes along the midline of the neck can help confirm the landmark relationships and provide a tactile sense of the vertebral levels. Counting up or down from C7 while palpating can help identify other vertebrae.

Mobilization and Manipulation techniques used for the cervical spine

These techniques are performed with utmost care, precision, and only by trained physiotherapists. It should be based on patient consent and comfort. Always adhere to safety guidelines. A few techniques are given below:

Cervical Spine Mobilization:

Mobilization involves gently moving the cervical spine through its available range of motion. Techniques include:

Grade I: Initial oscillatory movements within the patient's pain-free range of motion.
Grade II: Larger oscillatory movements, targeting mid-range of motion.
Grade III: Larger amplitude oscillations that reach the end of available range of motion.
Grade IV: Small-amplitude, high-velocity thrusts targeting the end range of motion.

Cervical Rotary Manipulation:

This technique focuses on the rotation of the cervical spine and should be applied with precision to avoid excessive strain.

Rotation with Translation: With the patient in a specific position, the therapist applies a controlled rotation combined with a gentle translation, targeting a specific cervical segment.

Cervical Side Glide Manipulation:

This technique involves applying a lateral glide force to a specific cervical segment, often addressing restricted motion,

Unilateral Lateral Glide: A controlled lateral force is applied to a cervical segment to restore joint mobility.

Cervical Distraction Manipulation:

Distraction manipulation is aimed at creating space between cervical vertebrae to relieve pressure on nerves or discs.

Manual Traction: Gentle, controlled force is applied to the head in a longitudinal direction, helping to decompress cervical joints.

Cervical Sustained Natural Apophyseal Glide (SNAG):

SNAG is a technique used for specific segmental mobilization.

Cervical SNAG: The therapist's hands stabilize one vertebra while the patient's head move through a specific range of motion while therapist applies a sustained pressure to the targeted facet joint.

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