title: Articular dysfunction patterns in patients with mechanical neck pain: a clinical algorithm to guide specific mobilization and manipulation techniques.
abstract: In view of a didactical approach for teaching cervical mobilization and manipulation techniques to students as well as their use in daily practice, it is mandatory to acquire sound clinical reasoning to optimally apply advanced technical skills. The aim of this Masterclass is to present a clinical algorithm to guide (novice) therapists in their clinical reasoning to identify patients who are likely to respond to mobilization and/or manipulation. The presented clinical reasoning process is situated within the context of pain mechanisms and is narrowed to and applicable in patients with a dominant input pain mechanism. Based on key features in subjective and clinical examination, patients with mechanical nociceptive pain probably arising from articular structures can be categorized into specific articular dysfunction patterns. Pending on these patterns, specific mobilization and manipulation techniques are warranted. The proposed patterns are illustrated in 3 case studies. This clinical algorithm is the corollary of empirical expertise and is complemented by in-depth discussions and knowledge exchange with international colleagues. Consequently, it is intended that a carefully targeted approach contributes to an increase in specificity and safety in the use of cervical mobilizations and manipulation techniques as valuable adjuncts to other manual therapy modalities.
authors.affiliation: Ghent University, Department of Rehabilitation Sciences and Physiotherapy, De Pintelaan 185 3B3, 9000 Ghent, Belgium. Electronic address: vincent.dewitte@ugent.be.
authors.forename: Vincent
authors.initials: V
authors.lastname: Dewitte
authors.affiliation: Ghent University, Department of Rehabilitation Sciences and Physiotherapy, De Pintelaan 185 3B3, 9000 Ghent, Belgium. Electronic address: axel.beernaert@skynet.be.
authors.forename: Axel
authors.initials: A
authors.lastname: Beernaert
authors.affiliation: Ghent University, Department of Rehabilitation Sciences and Physiotherapy, De Pintelaan 185 3B3, 9000 Ghent, Belgium. Electronic address: bart.vanthillo@ugent.be.
authors.forename: Bart
authors.initials: B
authors.lastname: Vanthillo
authors.affiliation: Ghent University, Department of Rehabilitation Sciences and Physiotherapy, De Pintelaan 185 3B3, 9000 Ghent, Belgium. Electronic address: tom.barbe@ugent.be.
authors.forename: Tom
authors.initials: T
authors.lastname: Barbe
authors.affiliation: Ghent University, Department of Rehabilitation Sciences and Physiotherapy, De Pintelaan 185 3B3, 9000 Ghent, Belgium. Electronic address: lieven.danneels@ugent.be.
authors.forename: Lieven
authors.initials: L
authors.lastname: Danneels
authors.affiliation: Ghent University, Department of Rehabilitation Sciences and Physiotherapy, De Pintelaan 185 3B3, 9000 Ghent, Belgium. Electronic address: barbara.cagnie@ugent.be.
authors.forename: Barbara
authors.initials: B
authors.lastname: Cagnie
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D002574:Cervical Vertebrae / Q000503:physiopathology*; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis / Q000534:rehabilitation*; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D016059:Range of Motion, Articular / Q000502:physiology*; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Articular dysfunction patterns; Cervical spine; Clinical reasoning; Spinal manipulation