Spinal Influences to the Extremities

Spinal Influences in the Extremities

Mark Z. Jamantoc, PT

      If you are a patient who is seeing a clinician (PT / Osteopath / Chiro), it is so important that you let these individuals know if you have any neck symptoms. Whenever I would see a shoulder patient, I almost always screen the cervical spine. 

SEGMENTAL FACILITATION

       "Excited nervous system" is the term for this. It has also been proposed that Cervical Segmental Facilitation secondary to somatic dysfunction is a common cause of scapular dyskinesia. Oftentimes, we see a patient with a very hypertonic rotator cuff (C4-C5 areas perhaps). This, in turn, causes some imbalance in the synergistic ability of the shoulder girdle muscles, thus causing scapular dyskinesia

       How do we define Somatic Dysfunction? According to The Educational Council on Osteopathic Principles, somatic dysfunction is defined as impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, or myofascial structures, and related vascular, lymphatic and neural elements. 

       Ever seen a hypertonic upper trapezius or even the biceps long head that just would not relax no matter how much you stretch it out or Massage it out? Ever palpated a tight piriformis or gluteus medius that no matter how much you"roll it out", it still stays tight? That may be caused by segmental facilitation. 

       To explain it in easier terms: segmental facilitation happens when there is increased sensory input from a specific part of the spinal cord AND it keeps that area in an "excited state."This, in turn, allows the motor nerves to produce a slightly weaker stimuli that results in increased motor output - and thus causes the skeletal muscles and visceral organs to sustain a state of incremental activity.  

       In relation to this, let's talk a little bit about hypermobility of the spine. If you have heard of selective tightening, this does mean that the muscles surrounding the vertebrae tighten up to support the spine. Think of a building whose foundation is not entirely 100% that it is needing external forces to enhance its stability. The spine is much like a building. Loosen it too much and it will need to "grab" on surrounding muscles to keep it stable. It has been hypothesized that spinal hypermobility may actually cause segmental facilitation. 

SEGMENTAL FACILITATION - WHAT SHOULD YOU BE LOOKING FOR?

1. Hypertonic muscles - palpation of the muscles surrounding the area you are suspecting of being hypermobile. You may also need to check on the transverse processes. 

2. Hyperactive reflexes - related to the segment you are checking

3. Non-Fatiguable weakness - inherent, if you test the muscle 3-4 times, you will get the same "weakness", not an increasing fatigability like those found in neuropathies 

4. Increased sensitivity to touch - when you palpate the area supplied by the segment, there is increased tenderness. 

5. Symptoms of Sympathetic responses (a little fight or flight response) - increased sweating, pupil dilation, blood pressure increase, blood vessels constriction, lungs dilation, and peristalsis of digestive tract among others. 

PATIENT EXAMPLE:

       I once had a patient referred to me by a family physician for evaluation and treatment of bilateral carpal tunnel syndrome AND bilateral tennis elbows. WOW. This immediately made me suspect of the cervical spine. This patient, apparently had been with two or three other physical therapy clinics and have been seen for at least 4-8 visits with massage, modalities and exercises for Tennis Elbow and Carpal Tunnel Syndrome but symptoms have stayed consistently the same. So, during the initial assessment, after taking down the history, I went straight to cervical assessment. Sure enough, the muscles surrounding the cervical spine were so spasmic that touching them produced a twitch in the upper trapezius on bilateral sides. Can you guess the occupation of the patient? He was a 36 year old builder and painter and looks upward (with the neck in full cervical extension) 5-7 hours a day. After about 3-4 visits of PT, he reported 80% improvement on the elbow and wrist symptoms. 

       Never forget the spine. It is so important to include it in the screening. If you're a patient, always inform your clinician about certain neck symptoms (if any).