Cervical Spine Tendon Repair Intermediate Program

Pain level ≤3/10 at rest with cervical collar use as needed,No neural tension signs (negative Spurling test),Cervical ROM limited to pain-free range within physician restrictions,Ability to perform basic deep cervical flexor activation (chin tucks) without increased symptoms,Normal sleep patterns with appropriate cervical pillow support,No signs of cervical disc herniation worsening (no radicular symptoms into upper extremities)

→ Advance to: Early Mobilization Phase

Continued pain ≤3/10 with gentle ADL activities,Cervical flexor endurance >10 seconds in neutral supine position,No exacerbation of facet joint symptoms with gentle cervical rotation to 30° each side,Tolerance of prone lying with cervical support for 5 minutes,Normal cranial nerve function (no diplopia, dysphagia, dysarthria),Isometric cervical musculature activation without compensatory patterns

→ Advance to: Early Mobilization Phase

Cervical ROM improved to 50% of normal in flexion/extension,Ability to perform cervical retraction and protraction against gravity,No reproduction of nerve root symptoms with cervical deviation,Paraspinal muscle spasm reduced on palpation of cervical extensers,Tolerance to sitting upright without cervical support for 20 minutes,Scalene and upper trapezius muscle tone normalized (no hypertonicity)

→ Advance to: Intermediate Strengthening Phase

Cervical ROM 60% of normal with minimal pain,Deep cervical flexor endurance >15 seconds in loaded position,Successful completion of scapular stabilization exercises without cervical compensation,No dizziness or vestibular symptoms with cervical motion,Tolerance to neck isometrics in all directions (flexion, extension, lateral flexion, rotation) at 30% effort,Facet joint mobility improved (no joint restrictions on segmental mobility testing)

→ Advance to: Intermediate Strengthening Phase

Cervical ROM 70% of normal functional range,Deep cervical flexor strength grade 4/5 on manual muscle testing,Cervical extension endurance >20 seconds in prone position,No radicular symptoms with overhead activities,Tolerance to functional workplace tasks requiring sustained cervical posture for 30 minutes,Proprioceptive awareness of cervical position sense within 10° accuracy

→ Advance to: Intermediate Strengthening Phase

Cervical ROM 80% of normal in all planes,Ability to perform resisted cervical exercises with 2lb weight without symptom exacerbation,Normal cervical lordosis restored on lateral radiograph if obtained,No trigger points in sternocleidomastoid or upper trapezius on palpation,Tolerance to computer work for 45-minute sessions with microbreaks,Patient-reported outcome measure improvement >15 points on NDI

→ Advance to: Advanced Strengthening Phase

Full cervical ROM in all planes with only mild discomfort,Cervical muscle strength 4+/5 in all directions,Return to light recreational activities (walking, swimming),No recurrence of discogenic symptoms with loaded cervical flexion,Endurance of cervical musculature sufficient for 60-minute activity,Patient demonstrates proper cervical posture during prolonged sitting

→ Advance to: Advanced Strengthening Phase

Cervical strength 5/5 in deep flexors and extensors,Tolerance to high-velocity cervical manipulations (if appropriate for condition),No neural sensitivity to upper limb tension tests (median, radial, ulnar),Functional capacity assessment at 75% of pre-injury level,Cervical proprioception within 5° of normal on position sense testing,Sleep quality normalized without cervical support devices

→ Advance to: Return to Function Phase

Full return to work without restrictions if appropriate,Cervical endurance sufficient for sport-specific activities,No facet joint irritation with end-range cervical movements,Patient confident in self-management of symptoms,Balance and coordination exercises completed without cervical symptoms,NDI score <15 points indicating minimal disability

→ Advance to: Return to Function Phase

Full cervical ROM equal to contralateral side (if unilateral),Tolerance to contact sport training with cervical protection if applicable,No positional vertigo or Barré-Liéou syndrome symptoms,Return to driving with full cervical ROM and reaction time,Cervical muscle strength and endurance within normal limits,Patient education completed on ergonomics and injury prevention

→ Advance to: Return to Function Phase

Complete functional activities without cervical compensation,Sport-specific or occupation-specific training at 90% intensity,No recurrent symptoms with activity progression,Cervical stability demonstrated on segmental stabilization tests,Psychological readiness for full return to activity,Maintenance of NDI score <10 points

→ Advance to: Final Phase

Full return to pre-injury activity level,Asymptomatic with all activities of daily living,Normal cervical spine examination (ROM, strength, sensation, reflexes),No restrictions on repetitive cervical motion or loaded activities,Patient discharged with home exercise program,NDI score <8 points indicating no disability

→ Advance to: Discharge