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Unraveling the Mysteryof Cervical Pain #3:

TP7 Ligament Sprains

Unraveling the Mysteryof Cervical Pain #3:

TP7 Ligament Sprains

Instructor: Ben Benjamin, Ph.D.Instructor: Ben Benjamin, Ph.D.

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Instructor: Ben Benjamin, Ph.D.Instructor: Ben Benjamin, Ph.D.

ben@benbenjamin.comben@benbenjamin.com

Webinar GoalWebinar Goal

Explore the assessment and treatment of one of the most common neck injuries.

Explore the assessment and treatment of one of the most common neck injuries.

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LogisticsLogistics

• Time: 1 hour

• Schedule:

• Presentation 30–40 min

• Questions 15–20 min

• Ongoing questions: Use chat box

• Time: 1 hour

• Schedule:

• Presentation 30–40 min

• Questions 15–20 min

• Ongoing questions: Use chat box

PretestPretest1. What is the function of the intertransverse

ligaments of the neck?2. Where does the majority of neck rotation

occur?3. What is the cause of most pain at the medial

border of the scapula?4. Which ligament can cause pain in the neck,

scapula, upper arm, and chest?5. What finding(s) will help you tell the

difference between a muscle injury and a ligament injury?

6. The TP7 ligament connects C7 and C8. True or False?

1. What is the function of the intertransverse ligaments of the neck?

2. Where does the majority of neck rotation occur?

3. What is the cause of most pain at the medial border of the scapula?

4. Which ligament can cause pain in the neck, scapula, upper arm, and chest?

5. What finding(s) will help you tell the difference between a muscle injury and a ligament injury?

6. The TP7 ligament connects C7 and C8. True or False?

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AnatomyAnatomy

Anatomy of the Neck: TP7

Intertransverse Ligament

Anatomy of the Neck: TP7

Intertransverse Ligament

• Limits side-flexion

• Intersection between neck and thorax

• Vulnerable area in the neck

• Limits side-flexion

• Intersection between neck and thorax

• Vulnerable area in the neck

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Locating the 7th Transverse ProcessLocating the 7th Transverse Process

Referred Pain Patterns in the Neck Referred Pain Patterns in the Neck

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Referred Pain Patterns in the Neck Referred Pain Patterns in the Neck

Referred PainReferred Pain

Definition: Pain felt at a distance from its source.Definition: Pain felt at a distance from its source.

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Four Rules of Referred PainFour Rules of Referred Pain

Rule #1. Pain refers distally.Rule #1. Pain refers distally.

Four Rules of Referred PainFour Rules of Referred Pain

Rule #2. Pain does not cross the midline.Rule #2. Pain does not cross the midline.

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Four Rules of Referred PainFour Rules of Referred Pain

Rule #3. Pain is referred within the dermatomes.Rule #3. Pain is referred within the dermatomes.

Four Rules of Referred PainFour Rules of Referred Pain

Rule #4. The distance the pain refers is directly proportional to the severity of the injury.

Rule #4. The distance the pain refers is directly proportional to the severity of the injury.

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Areas that refer painAreas that refer pain

• Neck

• Thorax

• Low Back

• Shoulders

• Hip Joints

• Neck

• Thorax

• Low Back

• Shoulders

• Hip Joints

Areas that do not refer painAreas that do not refer pain

• Elbows

• Wrists

• Hands

• Knees

• Lower Leg

• Feet

• Elbows

• Wrists

• Hands

• Knees

• Lower Leg

• Feet

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AssessmentAssessment

Active Rotations(Pain & Limitation)

Active Rotations(Pain & Limitation)

At least 50% of neck rotation occurs at C1 and C2, the atlas and axis

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Active Side-Flexion(Pain & Limitation)

Active Side-Flexion(Pain & Limitation)

Resisted Side-Flexions(Muscle Pain)

Resisted Side-Flexions(Muscle Pain)

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Passive Rotations(Pain & Limitation)

Passive Rotations(Pain & Limitation)

Passive Side-Flexion(Pain & Limitation)

Passive Side-Flexion(Pain & Limitation)

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TheoryTheory

Assessment Test Resultsfor TP7 Ligament SprainsAssessment Test Resultsfor TP7 Ligament Sprains

• Passive rotations are painful

• Side-flexion away from the injured side is painful

• Passive rotations are painful

• Side-flexion away from the injured side is painful

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Referred Pain Patterns for the TP7 LigamentsReferred Pain Patterns for the TP7 Ligaments

Referred Pain Patterns for the Cervical Ligaments

Referred Pain Patterns for the Cervical Ligaments

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Causes of Pain at the Medial Border of the Scapula

Causes of Pain at the Medial Border of the Scapula

1. TP7 ligament sprain

2. Rhomboid muscle strain

3. Thoracic ligament sprain

4. Subluxated rib head

Primary Structures Injured in Different Parts of the Body

Primary Structures Injured in Different Parts of the Body

Different parts of the body have areas that are more vulnerable.

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Foot and Ankle: Muscles and Ligaments

Primary Structures Injured in Different Parts of the Body

Primary Structures Injured in Different Parts of the Body

Thigh: Muscles

Primary Structures Injured in Different Parts of the Body

Primary Structures Injured in Different Parts of the Body

Hamstring Quadriceps

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Hip: Joint

Primary Structures Injured in Different Parts of the Body

Primary Structures Injured in Different Parts of the Body

Neck: Ligaments

Primary Structures Injured in Different Parts of the Body

Primary Structures Injured in Different Parts of the Body

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Differentiating Scalene Muscle Injury from a Ligament Injury

Differentiating Scalene Muscle Injury from a Ligament Injury

Resisted test vs. Passive testResisted test vs. Passive test

Direct & Indirect Causes of PainDirect & Indirect Causes of Pain

Examples:

• Direct — ligament sprain in the neck

• Indirect — misalignment of neck, limited neck flexibility, chronic contraction of the neck muscles, poor movement habits, etc.

It is important to address both types of causes.

Examples:

• Direct — ligament sprain in the neck

• Indirect — misalignment of neck, limited neck flexibility, chronic contraction of the neck muscles, poor movement habits, etc.

It is important to address both types of causes.

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TreatmentTreatment

• Friction Therapy

• Myofascial Therapy

• Massage Therapy

• Stretching and Strengthening Exercises

• Cranio-sacral Therapy

• Friction Therapy

• Myofascial Therapy

• Massage Therapy

• Stretching and Strengthening Exercises

• Cranio-sacral Therapy

Friction Therapy: The video will be shown at the end of the Webinar

Friction Therapy: The video will be shown at the end of the Webinar

Friction Therapy works on the Direct Cause of the pain.

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Massage TherapyMassage Therapy

Reduces occipital muscle tensionReduces occipital muscle tension

The Neck Relaxer DeviceThe Neck Relaxer Device

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Flexibility ExercisesAaron Mattes’ Active Isolated Stretching Method

Flexibility ExercisesAaron Mattes’ Active Isolated Stretching Method

Flexibility Exercises

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Neck Strength ExercisesNeck Strength Exercises

Myofascial Therapy

Craniosacral Therapy

Myofascial Therapy

Craniosacral Therapy

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Correct Movement PatternsCorrect Movement Patterns

ReferralsReferrals

• Alexander Technique or Feldenkrais practitioner

• AIS practitioner to increase flexibility and strength

Works on the Indirect Causes of the Pain

• Alexander Technique or Feldenkrais practitioner

• AIS practitioner to increase flexibility and strength

Works on the Indirect Causes of the Pain

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QuestionsQuestions

Facebook.com/DrBenBenjaminFacebook.com/DrBenBenjamin

Post-testPost-test1. What is the function of the intertransverse ligaments of

the neck?

2. Where does the majority of neck rotation occur?

3. What is the cause of most pain at the medial border of the scapula?

4. Which ligament can cause pain in the neck, scapula, upper arm, and chest?

5. What finding(s) will help you tell the difference between a muscle injury and a ligament injury?

6. The TP7 ligament connects C7 and C8.

True or False?

1. What is the function of the intertransverse ligaments of the neck?

2. Where does the majority of neck rotation occur?

3. What is the cause of most pain at the medial border of the scapula?

4. Which ligament can cause pain in the neck, scapula, upper arm, and chest?

5. What finding(s) will help you tell the difference between a muscle injury and a ligament injury?

6. The TP7 ligament connects C7 and C8.

True or False?