We have previously discussed the issues with the pathoanatomical approach in regards to assessment or treatment, however, occasionally it can be of use. Due to the potential benefits, I advocate for a gross motion assessment/treatment followed by segmental assessment/treatment if necessary. With the cervical spine, I typically use segmental sideglides to identify a local restriction. While it can be an efficient way to identify segmental restrictions into either flexion or extension, it can offer conflicting results if a restriction is located in the uncovertebral joints.
The uncovertebral joints are located between C3-T1 and are made up of the uncinate processes above and below each vertebra. They are one of the first locations of degeneration in the cervical spine and can significantly restrict cervical sidebend. One of the primary signs of uncovertebral joint involvement is relatively normal rotation, flexion, and extension, but significantly restricted sidebend. In cases like these, segmental sideglide assessment should still be used to identify a restricted region, but then follow it up with segmental flexion/extension assessment of each facet.
With a true uncovertebral joint restriction, we'll note normal flexion and extension segmental mobility on each facet but hypomobile sideglides. Were you to try utilizing mobilizations/manipulation/MET's to address flexion/extension restrictions at the facet joint, you likely would notice some improvement but still have pain and restriction remaining. Treatment of the uncovertebral joints requires a gapping mobilization/manipulation of the segment. I typically use the lateral break technique (coming soon on the Insider Access Page!).
Are there other methods that can address this dysfunction? Absolutely. While a manual technique is quick and effective, the patient can lock in the changes and treat themselves with repeated motions. Due to this being a unilateral issue, it likely will respond best to repeated cervical retraction with sidebend. The issue, as always, is with patient compliance and communication. For success, a patient has to be able to communicate exactly what they are feeling with the exercise and then be compliant with the prescribed frequency. Regardless, the uncovertebral joints should be considered in your patients with painful and limited sidebend.
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