Advanced Cervical Spine Post-Fracture Rehabilitation

Vertebral fracture site shows radiographic evidence of healing on follow-up imaging,Pain at rest ≤2/10 on VAS scale,Cervical range of motion within pain-free limits (minimum 50% of age-normative flexion/extension),Deep cervical flexor recruitment demonstrates isolated activation without compensatory sternocleidomastoid overuse,Tolerance to 6 hours of cervical orthotic wear if prescribed,No neurological signs including radiculopathy, hyperreflexia, or motor weakness in C1-C8 myotomes

→ Advance to: Early Mobility Phase

Cervical flexion/extension ROM >70% of age-normative values,Rotation and lateral flexion ROM within 20° of asymptomatic side,Isometric cervical musculature hold for 10 seconds at 40% MVC without exacerbation,Scapular stabilization demonstrated in prone (scapular retraction/elevation against gravity),Tolerance to 20 minutes of functional desk work without symptom exacerbation,No reproduction of neurological symptoms with Spurling's test or Valsalva maneuver

→ Advance to: Intermediate Strengthening Phase

Full pain-free cervical ROM in all planes (flexion, extension, rotation, lateral flexion),Cervical flexor endurance test >30 seconds (modified craniocervical flexion test),Cervical erector spinae and scalene strength 4/5 on manual muscle testing,Proprioceptive awareness: cervical repositioning accuracy within 5° of neutral in all planes,Tolerance to sustained static postures (sitting/standing) for 45+ minutes,No recurrence of symptoms with graded exposure to provocative loading patterns

→ Advance to: Advanced Functional Phase

Cervical muscle strength ≥5/5 on manual muscle testing for flexors, extensors, and lateral flexors,Endurance testing: cervical flexor hold >45 seconds, extensor hold >60 seconds,Functional tolerance: ability to perform occupational/sport tasks requiring cervical loading for 30+ minutes,Dynamic cervical stability demonstrated during functional movements without compensatory patterns,Return to low-impact sport-specific activities without regression,Neck Disability Index score <15% (or <10 points on 0-100 scale)

→ Advance to: Return to Full Function Phase

Full return to pre-injury occupational or athletic activities,Cervical proprioception: joint position sense within 2° of asymptomatic baseline,Exercise tolerance: ability to complete full training/workout session without post-activity symptom exacerbation,Patient-reported outcome measures at or near pre-injury baseline,No limitations in activities of daily living related to cervical spine function,Maintenance of cervical ROM within 5° of asymptomatic side in all planes

→ Advance to: Discharge - Independent Maintenance Program