Intermediate Cervical Spine Tendon Repair Rehabilitation

Pain at rest less than 3/10 on VAS scale,Cervical collar usage as prescribed with proper fit,No active neck flexion or extension beyond neutral,Axial loading of cervical spine avoided,Proper posture with chin tuck in neutral cervical alignment,Neurological exam stable with no worsening radicular symptoms

→ Advance to: Phase II

Incision/tendon site healing without signs of infection,Pain with passive neck movement less than 4/10,Tolerance of supine positioning with cervical support,No reproducing nerve root symptoms with gentle palpation,Deep cervical flexor activation with pressure biofeedback (baseline 20mmHg),Shoulder and upper extremity strength maintained with no resisted cervical motion

→ Advance to: Phase III

Cervical active range of motion: flexion 30 degrees, extension 20 degrees,Side-bending 20 degrees bilaterally, rotation 30 degrees bilaterally,Tolerates cervical isometrics in neutral position (2-3/10 discomfort max),Facet joint mobility assessment shows no hypermobility,Longus colli and longus capitis activation with chin tuck hold 5 seconds,No increase in radicular symptoms with movement

→ Advance to: Phase IV

Cervical ROM: flexion 40 degrees, extension 30 degrees,Rotation 45 degrees bilaterally, side-bending 30 degrees bilaterally,Deep cervical flexor endurance test greater than 30 seconds hold,Tolerance of cervical retraction in sitting,Scapular stabilization without cervical compensation,Postural awareness with occipital condyle to wall distance improving

→ Advance to: Phase IV

Full pain-free cervical ROM in all planes within 80% of contralateral side,Cervical proprioception: repositioning accuracy within 5 degrees,Transversospinalis muscles (multifidus, semispinalis) activation in prone,No pain with sustained postures for 30 minutes,Tolerance of low-resistance isometric holds (2-3 kg max),Patient demonstrates proper cervical spine mechanics during ADLs

→ Advance to: Phase V

Cervical flexor strength: 4/5 on manual muscle testing,Cervical extensor strength: 4/5 on manual muscle testing,Deep cervical flexor endurance greater than 60 seconds,No provocation of symptoms with resistance up to 2 kg,Cervical lateral flexion and rotation strength improving,Patient reports decreased frequency of neck pain episodes

→ Advance to: Phase V

Cervical flexor strength: 4+/5 with resistance 3-4 kg,Cervical extensor strength: 4+/5 with resistance 3-4 kg,Tolerance of functional neck movements without compensation,No radiating symptoms with overhead activities,Cervical repositioning accuracy within 3 degrees,Endurance of cervical muscles during prolonged postures

→ Advance to: Phase V

Cervical muscle strength 5/5 in all directions with functional resistance,Cervical endurance equal to contralateral side,No facet joint irritation with end-range movements,Cervical proprioception intact with eyes closed testing,Upper trapezius and levator scapula length adequate,Patient able to sustain computer work 30-45 minutes without symptoms

→ Advance to: Phase VI

Full cervical ROM equal to contralateral side,Return to light work duties without restrictions,No reproduction of symptoms with sustained positions,Cervical muscle endurance adequate for 60-minute activity,Cervicogenic dizziness resolved with positional changes,Patient demonstrates proper ergonomics during work tasks

→ Advance to: Phase VI

Cervical strength and endurance within normal limits,Tolerance of high-demand functional activities,No recurrence of symptoms with physical exertion,Cervical spine tolerance of static flexion postures,Neurological examination completely normal,Patient reports return to 75% of pre-injury activity level

→ Advance to: Phase VII

Full cervical ROM without pain,Neck Disability Index score less than 15%,VAS at rest 0/10, with activity less than 2/10,Cervical muscle strength and endurance symmetric,Tolerance of full work day and recreational activities,Patient demonstrates independent home exercise program