When we are assessing and treating patients 'hand's on', patients often ask “What is it you’re doing?”

To help explain one aspect of how we treat our patients' individual issues, we focus here on a man who came to see us complaining of a year long history of right sided neck pain and stiffness. When he moved his neck, his ability to turn to the right was extremely limited. He couldn’t bend his neck sideways to the right either.

The patient had a stiff neck - as a physiotherapist, what does that lead us to investigate as the cause?

Our knowledge of the spine and how it moves is referred to as biomechanics. Physiotherapists are like human engineers, trying to identify movement dysfunction in the neuromusculoskeletal system, and apply techniques aimed at resolving the dysfunction and restoring normal biomechanics.

What does the structure of the spine look like, and what are our considerations when assessing a patient?

Within the spine, different vertebra and different spinal areas move in different ways. When we assess a patient, we are comparing what we see and feel with our expectations in relation to their age, gender and general health.

What range of movement was expected of the patient in question?

We expected for him to be able to turn to the right about 80 degrees, and side bend to the right about 40 degrees. His movement measured about 30 degrees turning to the right and about 15 degrees side bending.

How do the neck joints correlate to this assessment?

The way the neck joints move means that if turning and side bending in the same direction are problematic, it is likely that the middle and lower joints are at fault - it was possible to test the neck more closely in order to support or contradict this initial hypothesis, as Caroline explains here:

"I was able to use my hands to apply local pressure to the neck, so that when the patient moved to the side, bending was focused on one part of the neck more than another. This revealed that the restriction was indeed coming from the middle/lower joints in the neck.

"I could also feel the neck movement with my hands while the patient lay on his tummy. If you think of the spine as being like a linked chain, as the patient moves you are looking at a whole chain movement. By applying rhythmical pressure to each of the individual links in the spine, we can assess how each individual link is moving and compare this, once again, with expectations of ‘normal’ as ascertained in biomechanical studies."

In the case of this particular man, there were several joints spanning the middle to lower areas of the neck that weren’t moving through the full expected range, and had a greater degree of resistance to the movement.

How did Caroline's knowledge of spinal biomechanics help guide and inform her treatment decision-making process?

The treatment in this case was aimed at enhancing the way the joints in the neck glide during turning and side bending – rhythmical pressure could slide the joint surfaces in the direction required for movement, and as treatment progressed, this could be done with the patient's neck in a turned position, to further enhance the restoration of movement.

She explained: "With the patient laying on his back, I could also turn and side-bend his neck. This is different to asking the patient to carry out these movements actively, as I could use my handling to apply therapeutic stresses to the problematic joints, while taking the neck through ‘whole chain’ movement."

Crucially, because Caroline understands how the spine moves theoretically, she was able to assess the neck accurately, and treat the neck successfully to restore full movement.