Table 1.
Decision model of treatment for selection of tailored treatment (for details, see Table 2 in Björklund et al [21])
| Main category | Test | Cut-off criteria | Treatment component |
|---|---|---|---|
| 1. Reduced cervical flexibility | 1.1 Upper cervical | ||
| a) Flexion-extension | a) < 68° | Upper cervical mobilization and ROM treatment and training | |
| b) Passive rotation in max flexion | b) <32° | ||
| Qualifier: a) or b) | |||
| 1.2 Lower cervical | |||
| a) Flexion-extension | a) <17° | Lower cervical mobilization and ROM treatment and training | |
| 1.3 Upper and lower cervical | |||
| a) Axial rotation | a) <109° | Upper and lower mobilization and ROM treatment and training | |
| 2. Impaired cervical muscle strength-endurance and functional strength | 2.1 Cranio-cervical flexion (CCF) | ||
| a) Maximal voluntary contraction (MVC) | a) < 2.5 Nm | CCF-exercises | |
| b) Endurance (50 % MVC) | b) < 20 s | ||
| Qualifier: a) or b) | |||
| 2.2 Cervico-thoracic | |||
| a) Flexion MVC | a) < 40 N | Strength training cervico-thoracic muscles | |
| b) Extension MVC | b) < 140 N | ||
| Qualifier: a) or b) | |||
| 2.3 Lifting ability | |||
| a) C-PILE | a) < 0.12 kg/kga | Strength training of shoulder-arm muscles | |
| b) Subjective ability to carry and lift | b) ≥ 4 on the scale 1-6…how do you manage to carry/lift? | ||
| 1 = very good; 6 = very bad [51] | |||
| Qualifier: a) and b) | |||
| 3. Impaired sensor-motor control | 3.1 Symptoms and activity limitations | Combinations of dizziness, balance disturbances, headache and difficulties to rotate the head [51]. | Cervical repositioning/movement control, oculomotor exercises |
| 3.2 Peak speed of cervical axial rotation | <170°/s | Peak speed training in cervical axial rotation | |
| 4. Trapezius myalgia | 4.0 | ||
| a) Physiotherapy assessment | a) Criteria according to Ohlsson and coworkers [26] with amendments [25] | EMG-biofeedback training, a progressive program with 8 standardized exercises | |
| b) PPT upper trapezius muscles | b) < 175 kPa right; < 168 kPa left | ||
| Qualifier: a) and b) | |||
| 5. Cervicogenic headache | 5.0 | ||
| a) Physiotherapy assessment | a) Criteria of the Cervicogenic Headache International Study Group [72] with amendment of reduced ROM for upper cervical and palpable upper cervical joint dysfunction [73] | Mobilization of upper cervical, CCF-exercise, endurance training for scapular muscles, postural correction | |
| b) Range of motion |
ROM range of motion, Nm newton meter, Sec seconds, N newton, C-Pile cervical progressive isoinertal lifting evaluation test, PPT pressure pain threshold, kPa kilopascal, EMG electromyography
amaximal lifted weight/adjusted body weight [74]