Transcript Chapter 15 Spine Management - PHT 1228c Therapeutic Exercise II

The Spine: Management
Guidelines
Chapter 15
Part IV: Exercise Interventions by Body
Region
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SPINAL PATHOLOGIES AND
IMPAIRED SPINAL FUNCTION
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Injury and Degeneration of the
Disk
 Definitions
– Herniation
– Protrusion
– Prolapse
– Extrusion
– Free sequestration
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Injury and Degeneration of the
Disk (cont'd)
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Fatigue Breakdown and Traumatic Rupture
Axial Overload
Age
Degenerative Changes
Effect on Spinal Mechanics
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Disc Pathologies and Related
Conditions
 Tissue Fluid Stasis
– Symptoms may be similar to those of disc lesions
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Signs and Symptoms of Disk
Lesions and Fluid Stasis
 Etiology of Symptoms
– Pain
– Neurological signs and symptoms
– Variability of symptoms
– Shifting symptoms
– Inflammation
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Signs and Symptoms of Disk
Lesions and Fluid Stasis (cont'd)
 Onset and Behavior of Symptoms from Disk
Lesions
 Objective Clinical Findings in the Lumbar Spine
 Objective Clinical Findings in the Cervical
Spine
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Pathomechanical Relationships of the
Intervertebral Disk and Facet Joints
 Disc Degeneration
– Initial changes
– Altered muscle control
– Progressive bony changes
 Related Pathologies
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Segmental (clinical) instability
Stenosis
Neurological symptoms: radiculopathy
Dysfunction
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Pathology of the Zygapophyseal
(Facet) Joints
 Common Diagnoses and Impairments from
Facet Joint Pathologies
– Facet sprain/joint capsule injury
– Spondylosis, osteoarthritis, degenerative joint
disease
– Rheumatoid arthritis
– Ankylosing spondylitis
– Facet joint impingement (blocking, fixation,
extrapment)
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Pathology of the Vertebrae
 Compression Fracture Secondary to
Osteoporosis
 Scheuermann’s Disease
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Pathology of Muscle and Soft Tissue
Injuries: Strains, Tears, and Contusions
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General Symptoms From Trauma
Common Sites of Lumbar Strain
Common Sites of Cervical Strain
Postural Strain
Emotional Stress
Functional Activity Limitations and
Participation Restrictions
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Pathomechanics of Spinal
Instability
 Neutral Zone
– Neutral spine
 Instability
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MANAGEMENT GUIDELINES BASED
ON STAGES OF RECOVERY AND
DIAGNOSTIC CATEGORIES
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Principles of Management of the
Spine
 Examination and Evaluation
– History, systems review, and testing
– Stage of recovery
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Acute inflammatory stage
Acute stage without signs of inflammation
Subacute stage
Chronic stage
– Diagnosis, prognosis, and plan of care
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General Guidelines for Managing Acute
Spinal Impairments: Protection Phase
 Patient Education
 Symptom Relief or Comfort
– Extension bias: extension syndrome
– Flexion bias: flexion syndrome
– Non-weight-bearing bias:traction syndrome
 Kinesthetic awareness of safe postures and
effects of movement
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General Guidelines for Managing Acute Spinal
Impairments: Protection Phase (cont'd)
 Muscle Performance: Deep Segmental Muscle
Activation and Basic Stabilization
– Lumbar region: deep segmental muscle activation
– Cervical region: deep segmental muscle activation
– Basic stabilization
 Basic Functional Movements
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General Guidelines for Managing Subacute
Spinal Impairments: Controlled Motion Phase
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Pain Modulation
Kinesthetic Training
Stretching/Manipulation
Muscle Performance
Cardiopulmonary Conditioning
Postural Stress Management and Relaxation
Exercises
 Functional Activities
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General Guidelines for Managing Chronic
Spinal Impairments: Return to Function
Phase
 Emphasize spinal control in high-intensity and repetitive
activities
 Increase mobility in restricted muscles/joints/fascia/nerve
 Improve muscle performance; dynamic trunk and extremity
strength, coordination, and endurance
 Increase cardiopulmonary endurance
 Emphasize habitual use of techniques of stress
relief/relaxation and posture correction
 Teach safe progression to high-level/high-intensity activities
 Teach healthy exercise habits for self-maintenance
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Management Guidelines:
Non-Weight-Bearing Bias
 Management of Acute Symptoms
– Traction
– Harness
– Pool
 Progression
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Management Guidelines:
Extension Bias
 Principles of Management
– Effects of postural changes on intervertebral (IV) disk
pressure
– Effects of bedrest on the IV disk
– Effects of traction on the IV disk
– Effects of flexion and extension on the IV disk and fluid
stasis
– Effects of isometric and dynamic exercise
– Effects of muscle guarding
 Indications, Precautions, and Contraindications for
Interventions-Extension Approach
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Techniques Using an Extension
Approach in the Lumbar Spine
 Management of Acute Symptoms
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Extension
Lateral shift correction
Patient education
Lumbar traction
Joint manipulation
Kinesthetic training, stabilization, and basic functional
activities
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Techniques Using an Extension
Approach in the Lumbar Spine (cont'd)
 Management When Acute Symptoms Have
Stabilized
– Signs of improvement
– Intervention
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Interventions to Manage a Disk
Lesion in the Cervical Spine
 Acute Phase
– Passive axial extension (cervical retraction)
– Patient education
– Traction
– Kinesthetic training for posture correction
 Progression as Symptoms Stabilize
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Disc Lesions: Surgery
 Indications for Surgery
 Common Surgeries
– Laminectomy
– Fusions
 Procedures
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Disc Lesions: Postoperative
Management
 Maximum Protection Phase
– Patient education
– Wound management and pain control
– Bed mobility
– Bracing
– Exercise
– Contraindications
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Disc Lesions: Postoperative
Management (cont'd)
 Moderate and Minimum Protection Phase
– Scar tissue mobilization
– Progressive stretching and joint
mobilization/manipulation of restricted tissue
– Muscle performance
– Gait training
– Contraindications
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Management Guidelines: Flexion
Bias
 Principles of Management
– Effect of position
– Effect of traction
– Effect of trauma and repetitive irritation
– Effect of meniscoid tissue
 Indications and Contraindications for
Intervention: Flexion Approach
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Techniques Utilizing a Flexion
Approach
 Management of Acute Symptoms
– Rest and support
– Functional position for comfort
– Cervical traction
– Correction of lateral shift
– Correction of meniscoid impingements
 Management When Acute Symptoms Have
Stabilized
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Management Guidelines:
Stabilization
 Identification of Clinical Instability
 Principles of Management
– Passive support
– Deep segmental muscle activation
• Lumbar region
• Cervical region
– Progression of stabilization exercises
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Management Guidelines:
Mobilization/Manipulation
 Management: Lumbar Spine
 Management: Cervical Spine
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Management Guidelines:
Soft Tissue Injuries
 Management During the Acute Stage:
Protection Phase
– Pain and inflammation control
• Cervical region
• Lumbar region
– Muscle function
• Cervical region
– Reverse muscle action
• Lumbar region
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Management Guidelines:
Soft Tissue Injuries (cont'd)
 Management During the Acute Stage:
Protection Phase (cont’d)
– Traction
– Environmental adaptation
 Management in the Subacute and Chronic
Stages of Healing: Controlled Motion and
Return to Function Phases
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MANAGEMENT OF REGIONAL
DIAGNOSES
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Lower Thoracic and Lumbo-Pelvic
Region
 Compression Fracture Secondary to
Osteoporosis
 Spondylolisthesis
 Ankylosing Spondylitis
 Scheuermann’s Disease
 Rib Subluxation
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Lower Thoracic and Lumbo-Pelvic
Region (cont'd)
 Sacraoiliac Joint Dysfunction
– Identification of SI impairments
– Interventions
• Shot-gun technique
• Muscle energy technique to correct an anterior rotated
innominate
• Muscle energy technique to correct a posterior rotated
innominate
• HVT to treat an upslipped innominate
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Cervical and Upper Thoracic Region
 Tension Headache/Cervical Headache
– Etiology
– Presenting signs and symptoms
– General management guidelines
 Cervical Myelopathy
 Neck Pain
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Temporomandibular Joint
Dysfunction
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Structure and Function
Motions of the TMJ
Signs and Symptoms
Etiology of Symptoms
– Possible causes of TM joint pain
– Relationship to neck pain
– Mechanical imbalances
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Temporomandibular Joint
Dysfunction (cont'd)
 Principles of Management and Intervention
– Reduction of pain and muscle guarding
– Facial muscle relaxation and tongue
proprioception and control
– Control of jaw muscles and joint proprioception
– Stretching techniques
– Reduction of upper quarter muscle imbalances
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Independent Learning Activities
 Critical Thinking and Discussion
 Laboratory Practice
 Case Studies
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