Can OTs Treat the Cervical Spine Neck_ (1)
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[00:00:00] Hey there. So I got this question from a student of mine pretty much asking me, can occupational therapist treat the cervical spine and neck? And I'm going to give you a backstory in terms of the details of why she's asking this question. My name is Hoang. I'm an occupational therapist and certified hand therapist.
And over 10 years ago I started my own therapy clinic and realized like, yeah, there's a lot of therapists out there. in need of mentorship and developing their clinical skills. And so I started hand therapy secrets just to help students exactly like this and to, you know, help you feel comfortable and confident, like, Hey, I can do this.
And of course, as an occupational therapist, The answer is yes, I can treat the cervical spine and neck. I'm gonna give you a little bit more detail on that. Um, right now. So, um, she did an evaluation for somebody who's coming in with like hand weakness, grip strength issues, numbness of the long finger. [00:01:00] So through the evaluation process, there's definitely some indication that there are cervical issues, their shoulder issues could be nerve related thoracic outlet syndrome types of things.
And, um, there's a little, you know, back and forth with the physical therapists, um, within the company. And there, you know, Not so nice about it. So she said that she's like, I've always been told through my school that OTs can't treat cervical spine. And so she wanted to know, like, you know, can OTs treat, um, anyway.
The answer is yes. So if you actually take a look into um AOTA, everything really revolves around being independent, being functional and things like that. And then you can look at your state requirements. And so this was a big topic for me when I first started in my own [00:02:00] clinic because I've always treated.
You know, when I worked in the hospital system, people are going to tell you shit because they want to feel like they're the only ones who do it, right? And you have to, as you as an occupational therapist, you have to determine what you want to do and then look into the information. Like, really, honestly, it doesn't take that long.
Google the shit out of it. Look at what your state boards say you can and cannot do. And then look for the information specifically of what you, you want the answers to. If you automatically believe people that know you can't do anything, then you're going to look for every reason why you can't do it. So I kind of have the gene of like, if you tell me I can't, I want to look up like how I can, right?
So, but, I worked in hospitals. I've worked with other therapy, um, like in a private practice for a little while before going out on my own. And I always knew that there was a cervical component to some of the hand types of issues that I was, [00:03:00] I was treating. And at that time I didn't have the, You know, I was taking so many different classes that I hadn't had the chance to take cervical stuff until it really went out on my own.
And one of the reasons was because sometimes it's hard to take classes when you feel like you don't have the opportunity, right? I went from working in a hospital setting into working for a very busy outpatient clinic. So it wasn't like I could really naturally pick up a lot of the classes and say, Oh yeah, I'm going to treat that neck.
But when I went out on my own, um, and if you have any any aspirations of owning your own business. Like I really highly recommend you to really learn and treat the cervical spine and neck because the anatomy is all of the nerves that go down to your fingers come out of your neck, down your shoulder, down your elbow, down your wrist, [00:04:00] into your hands.
And, uh, if you are As an occupational therapist and you as a certified hand therapist, or, you know, you want to be a certified hand therapist, there's so many different hand and arm issues that really can radiate from the neck. If you have a hand issue, it can move itself all the way up into the neck, shoulder types of issues.
And you want to learn like, not just from a treatment perspective, but I think it's important to learn how to look for things so that it can ease your frustration and you can manage your. your outcomes, right? You've got to manage your outcomes because if you don't have an understanding of it and you don't know how to treat it, it's really hard to then manage the outcomes because you always feel like you didn't do enough.
Okay. So, um, When I went out on my own, I started to take cervical classes, and you have to find the ones that, like, fit you. I took a few courses that were absolutely [00:05:00] boring as shit, um, it was terrible, I couldn't even get through it. I bought a few, I bought a few, cause it's like, you know, I bought a few, like, series one, two, and it was so boring, I could not even finish it.
And then I started to take other courses, um, that treated the whole spine. And for me, that was most beneficial because in my clinic, I want to be able to treat everything. Like I, I believe that, um, like you have your lumbar spine, you have your thoracic, and then your cervical sit on top of it. Me saying, I will only treat one part of the spine tells it's like me saying, I only want to treat the DIP, but I'm okay with the PIP and the MP, not not like not treating it.
Right. So, um, so that's where I kind of come in and I started learning and studying all about the whole spine in order to make the biggest impact for the hand and upper extremity. And inside the mentorship program, I have a whole module, whole module on cervical and thoracic and [00:06:00] different movements and exercises that will then help the shoulder, the elbow, So, um, this, and this particular case, um, let me go through the question right now.
This was a young person involved in a motor vehicle accident. He was T boned stopped and his car flipped around. So definitely some weakness in the shoulder, some elbows, some grip strength issues, and some numbness of the law figure. So anytime you have something like a numbness that doesn't, uh, Sit any any time you have a numbness that doesn't follow the the each particular terminal tendon types of distribution then it might become it's probably a dermatome type of issue.
So dermatome is cervical root types of problems and It is it's funny because if you're studying for the CHT exam, you have to know it [00:07:00] But they don't really go into so much about treatment of it. So you have to study a certain amount when you're studying to become a certified hand therapist because you have to understand the nerves, the brachial plexus and all that good stuff and the clinical testing.
But in the real world, when you're treating it, um, you have to go beyond just knowing the dermatomes, understanding or memorizing them. Um, but you want to go and segments of how you're going to evaluate. So if someone comes in for a hand issue, then I actually will start at the hand level, and okay, where's the numbness, let me check for Simon's Weinstein, let me go through cubital, uh, carpal tunnel, cubital tunnel, radial tunnel, right?
So I'll check, not cubital tunnel, I'll check median nerve, ulnar nerve, radio nerve, right? And then I'll work myself up into the shoulder. And so then I'll check, okay, what muscles are weak and what muscles, um, uh, work on what muscles don't work. And then, um, [00:08:00] so you have to, so what I'm encouraging you to think about is, It's a go in the order of how you want to evaluate.
Now it's sometimes can be really tough because you're evaluating all of it and it's hard to do that whole comprehensive evaluation and then also provide the treatment. So, um, you have to pick and choose your assessments and provocative testing correctly. And then also know that you'll have the chance the next time as well if you didn't get to everything.
Right? Because it can be really impossible to check everything. So you want to start with a certain amount and then do some treatments and see what works and what doesn't work because what works on what doesn't work, what does not work is also very important information. of your next steps. And so sometimes it requires you to evaluate a certain amount on day one and say, when you come back the next time, what works or what doesn't work based on your [00:09:00] symptoms that you come in is going to tell me the next series of assessments or provocative testing on my test against.
Let me know if that makes sense to you. You could leave a comment or a follow up question below for me. And if you like more videos like this, where I'm answering your questions, then hit the like and subscribe button and I'll be able to answer more for you. Right? So in terms of this particular case, you, you want to go in that order.
And if you miss something, don't feel bad. You have a chance to go to them tomorrow. You have a chance to go to them next time. Um, and if you're not sure about referring them to another provider, then I would just encourage you to. You know to either Discuss on that same day or say you know what let me see them the following visit and then based off of what they see You know and [00:10:00] finish off those assessments, then you can make the You can make the recommendation.
Yes, can you treat cervical and spine and neck? But if you're not sure one that you have time for it Because if you're treating other things, um, on that person, you might not have full time to, to say I, I can provide that isolated treatment there. You can work collaboratively with a therapist, if possible, and say, okay, I suspect more of a, cervical spine, neck issue.
If you can have, if you can work on that part, then I can work on these other parts because, you know, if you are in an insurance based, um, clinic, it can be really, it can be tough because you have to follow the rules of that insurance now. And the rules of the insurance usually are like body parts, body parts, you know?
And so if you're treating different body parts, even though you know that it's a nerve issue, um, you, You know, you might need to just divide it up a little bit so [00:11:00] that, uh, you can, you're able to treat all the areas that are required. Um, but like in my case, I work in a private practice, um, a cash based therapy clinic, and I can treat whatever body part.
I just have to manage the, my patient's expectations, right? So if you're coming in, you have this, you have this, this, this, this, and this problem, it's going to take a hot minute. Right. It's going to take several sessions. It's not just like a one and done type of thing. You're going to need some time, um, to, you know, to really go through all the different parts and work, you know, make sure that the bones and joints are moving, making sure that muscles are getting long and getting short, and that they are working really well because the nervous system is.
being moved on working really well as well. So I really encourage you if you're an occupational therapist, um, to really include the cervical spine and neck as part of your ability to [00:12:00] evaluate and treat. It really has changed my praxis. I've been in business for over 10 years and I know the first 10 years was, you know, developing my skills and getting better with hand therapy and getting better with post surgical cases.
But really when I went out on my own, uh, cervical spine and neck issues has changed the game for me. And it is included inside my mentorship program. It's our month to month program. And I know that for the students that have been in it and me showing very specific things, me helping them think through their cases and giving them the key movements and exercise to incorporate has changed the game for them as well.
So it just brings me so much joy. It makes me so happy to be like, Oh my God, I never thought I would have treated like this. And I got so such great results so fast that now I'm able to focus my attention on this particular problem with the patient and this particular problem with the [00:13:00] patient. So, you know, I really encourage it.
If you don't take my class, take somebody's class, but I tell you what, mine has so much good stuff in it. I'm going to include the link below. Check it out if you want to, but if you like videos like this, if you like videos like this, hit the like and subscribe button and leave me a comment below and I could probably make your question my next video.
Until next time. See you soon.
