Everyday, physical therapists are striving to be better at clinical decision making. But in patients with chronic neck pain, it can be challenging for therapists to select the right treatment at the correct time for optimum outcomes for the patient. Motor vehicle accident whiplash-associated disorders or chronic neck pain from other ‘traumas’ can be evaluated by selected manual techniques and evidence based questionnaires to select the patients best suited for consideration of a cervical facet injection (cRFN or cervical radiofrequency neurotomy). Earlier studies, have shown that paraspinal tenderness, positive mechanical exam of spine segment can be combined with > 50% relief of familiar pain symptoms with a medial branch block injection to the ‘culprit’ segment, to be significant indicators of a positive response to a subsequent cRFN. Smith et al. 2016 has now established that in WAD Grade II patients, low scores on the pain catastrophization scale and neck disability scale, show a higher likelihood of success to the cRFN versus those patients who had higher pain focus, a tendency to catastrophize their condition and rated their level of function lower.
Also, in 2015, these same investigators found that WAD Grade II patients symptoms were not solely maintained by changes in the central nervous system (central sensitization only), but central sensitization was influenced by peripheral nociception (ie. Pain coming from other, peripheral sources such as the zygopophyseal joint).
So consider applying these clinical subjective and objective tests to help you determine if the facet joint is the ‘driver’ of your patient’s neck pain symptoms. Discuss these findings with the patient and a physician skilled at applying cRFN injections, to determine if proceeding to a segmental injection will give your patient the best outcomes possible.
Want to go even further? Our new online Cervicothoracic MVA Regional Interdependence course addresses regional interdependence influences, selected evaluation and treatment practices and recently proposed research based clinical prediction rules. You will earn 7 Contact Hours upon completion of required coursework, quizzes and final exam. We also offer live Cervical Spine and Thoracic Spine courses across the country. Let us know if you have any questions at all!
–Karen Walz, PT, DPT, OCS, COMT, FAAOMPT
Faculty CFI and Examiner NAIOMT
NAIOMT Clinical Fellowship Instructor/Faculty and Examiner
Karen has practiced for nearly 30 years in Central Oregon and works at Therapeutic Associates Bend Physical Therapy in Bend, OR. Karen completed her Master’s degree in Physical Therapy from Stanford University Medical School, and she has earned the esteemed designation of Orthopedic Certified Specialist through the American Board of Physical Therapy Specialties.
Smith et al 2016
Smith AD, Jull G, Schneider GM, Frizzell B, Hooper RA, Sterling M. Modulation of Cervical Facet Joint Nociception and Pain Attenuates Physical and Psychological Features of Chronic Whiplash: A Prospective Study. 2015. PM R. Sep; 7(9):913-21.
Smith AD, Jull GA, Schneider GM, Frizzell B, Hooper RA, Sterling MM. Low Pain Catastrophization and Disability Predict Successful Outcome to Radiofrequency Neurotomy in Individuals with Chronic Whiplash. 2016; Pain Pract. Mar;16(3):311-9.
-Karen Walz, PT, DPT, OCS, COMT, FAAOMPT
Naiomt Faculty-Clinical Fellowship Instructor and Examiner
Board Certified Orthopedic Specialist
Certified Orthopedic Manual Therapist
Fellow American Academy of Orthopedic Manual Physical Therapists
Therapeutic Associates Bend Physical Therapy