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O Spine

notes

TermDefinition
flexion good for extremely painful problems, acute problems, prolapsed disks, stenosis, spondylolisthesis
extension good for bulging disc, flat lordosis, pain decreases with, leg pain centralizes with
straight leg raising in supine bring straight leg into 90 degrees at hip. positive test if pain in sciatic distribution. dorsiflexion of ankle creates increased tension on nerve. bilateral test also down. indicates HNP. do on leg that has pn
instruction in proper posture including, sleeping, sitting, standing acute/protected phase
log rolling acute/protected phase
postures for pn relief (prone, prone on elbows/or sidelying flexion) acute/protected phase
positional traction acute/protected phase
cervical pillow or lumbar roll acute/protected phase
AROM painfree range acute/protected phase
knee rocking acute/protected phase
chin tucks/axial ext acute/protected phase
body mechanics acute/protected phase
frequent position change acute/protected phase
TrA-drawing in acute/protected phase
manual mechanical traction acute/protected phase
pelvic tilting/Williams flexion acute/protected phase
neutral spine acute/protected phase
bracing acute/protected phase
standing ext acute/protected phase
gentle isometrics/mm setting acute/protected phase
multifidus activation/supine acute/protected phase
diaphragmatic breathing acute/protected phase
LE strength (mini-squatting, wall sits) subacute/controlled motion
abdominal bracing subacute/controlled motion
controlled stabilization (bridging, cat/cow, birddogs) subacute/controlled motion
hamstring stretching subacute/controlled motion
balance in standing- 1 leg subacute/controlled motion
walking subacute/controlled motion
press-ups subacute/controlled motion
multifidus activation all positions (supine, quadruped, std) subacute/controlled motion
teach body mechanics/back school chronic/min protection & return to function phase
ergonomic assessment chronic/min protection & return to function phase
stretching all tight spinal structures chronic/min protection & return to function phase
strengthening Er Spinae (supermans, prone over Swiss ball) chronic/min protection & return to function phase
endurance activity-biking, swimming chronic/min protection & return to function phase
dynamic stabilization- Swiss ball) chronic/min protection & return to function phase
Roman Chair chronic/min protection & return to function phase
abdominal strengthening chronic/min protection & return to function phase
hip flexor stretching chronic/min protection & return to function phase
limb loading with multifidis/TrA activation chronic/min protection & return to function phase
can try McKenzie press ups (see how pt tolerates) acute/protected phase
ALL- anterior longitudinal ligament limits ext
PLL- posterior longitudinal ligament limits flex
ISL- interspinous ligament limits flex- span only 1 vertebral section- can be easily palpated
ligamentum flavum yellow ligament- very strong stabilizer- connects lamina
SSL-supraspinous ligament limits flexion
ITL- intertransverse ligament between TPs-limits lateral bending
intervertebral foramina nerves exit-located btw each vertebral segment in the post pillar (ant boundary:intervertebral disc/post boundary: facet jt/superior & inferior boundaries: pedicles of the superior & inferior vertebrae of the spinal segment)-size is affected by spinal mot
flexion will help... open facet jt & intervertebral foramina
extension will help... if disc is protruding
nucleus pulposus when you're young... is like jelly/part water
nucleus pulposus when you're older, 30's 40's 50's... gets drier & harder w/age, more like playdoh
splenius capitis & cervicis neck ext/rotation
SCM neck flex/rotation (we never ex.-always strong-usually tight so we stretch)
scalenes neck flex/lateral flexion (we never ex.-always strong-usually tight so we stretch)
erector spinae (spinalis, longissimus, iliocostalis)- extension (to exercise, either put pt in prone or bend & then std like a bent over dead lift)
active control in the lumbar spine... abdominal mm, transverse abdominis stabilization activity, erector, multifidus stabilization activity
passive control in the lumbar spine... thoracolumbar (lumbodorsal) fascia, lumbar & abdominal aponeurosis, ligaments
multifidus deep mm in spine, important stabilizer, spans only a single segment, pts w/ LBP have a delay in recruitment, atrophies quickly if sedentary
motions of the spine... 6 degrees... flex/ext, side bending, rotation
postural pain signs resolves when pt moves, gets worse longer they stay in posture, pain in areas of stress, pain usually relieved w/activity, negative x-rays, CT scans, adaptive shortening & lengthening, adaptive wkness
PT goals for postural pn decrease pn & mm guarding, restore normal flexibility, restore normal mm strength & balance, retrain body awareness & posture, teach body mechanics
rx for postural pn modalities, therapeutic ex, posture edu
sprain occurs in jt
strain occurs in mm
spine mm strain caused by overstretching, overloading or overuse (poor postural habits included), inflammatory process due to micro-tears of mm tissues, often occurs w/jt sprain as a result of trauma, no clinically proven way to see strain, tests come up negative, have to palpate
spine mm strain S&S pn w/contracture or elongation of injured tissues, tenderness to injured area, edema in injured area, posture/body mechanics may be a contributor, neuro, x-rays and scans are normal
spine mm strain rx modalities, therapeutic ex, posture edu
spine joint sprain traumatic or chronic over stretching of capsule & ligaments & subsequent inflammatory response. rx is same as for mm strain
spine facet jt impingement a mechanical dysfunction where synovium folds or capsular "menisci" get stuck in jt & cause a locking (bend fwd & can't return) rx w/traction or manipulation in addition to rx for inflammation & strain
DJD/OA/spurring/spondylosis chronic degeneration & inflammation that commonly results in narrowing of IV foramen (stenosis)
spine jt sprain is caused by long term compression from postural syndrome, hypermobility (rx w/stabilization ex, bracing), prolonged stiffness due to poor jt nutrition (rx w/flexibility) exercises, normal aging, overuse
spine sprain signs AM stiffness & pn (or after any prolonged posture), relieved w/mild activity, worsens w/strenuous activity, xrays & other tests reveal abnormal spurring on vertebral segments, possible radicular symptoms due to nerve comp, generally occurs w/DJD, DDD
DJD- degenerative joint disease jt degenerates
DDD-degenerative disc disease disc degenerates-loses water, gets thinner & flakey- like old worn out tire
whiplash most common in MVA, won't show up unless lig completely torn, hyperflex/hyperext trauma to the cervical area w/tearing/ microtearing of ligaments and mm
DJD/OA/DDD of spine mostly over 40 crowd, spurring, spondylosis, significant loss of disc fluid/narrowing, may result in radiculopathy
rx of sprains flex ex, flexibility/stabilization ex, modalities, walking program often helpful for jt nutrition, anti-inflammatory meds. general rule-if it hurts, don't do it.
disc lesions from repeated trauma, mostly younger pts
bulge/protrusion annular fibers weak: allows disc to bubble, early prolapse, will show up on MRI, pn, numbness, wk, radiates down leg or arm
prolapse annular breakdown but still intact: disc protrudes out of normal area
extruded annulus is broken & part of nucleus is out of annulus (nothing can put that back in)
sequestered or fragmented part of nucleus is broken off and floats in spinal canal, almost always requires sx, depends on where nucleus migrates after getting snipped off
degeneration the annulus wears thru out, loses water and becomes thin such that facet jts now touch, and IV foramen narrows
etiology of disc problems prolonged poor postures and/or body mechanics, history of activity that increases disc pressure, possible hypermobility as cause, then can become hypomobile in time
disc lesions are most commonly L4-5 or L5-S1/ C5-6 or C6-7- most mobile areas
disc lesions goals/rx address pn w/modalities, posture/maintain mobility & strength/decrease disc pressure-tx, positioning, no fwd bend, ab strengthening or isometrics in acute or subacute/improve body mechanics & posture/address any LE probs/mk pt as Ind as possible/sx
sacralization/lumbarization congenital defect, often assymtomatic
lumbarization sacral vertebra 1 does not fuse-results in extra movement available and 6 lumbar vertebra
sacralization one or both sides of 5th lumbar vertebra fuses w/ sacrum. result is asymmetrical mvmt. no disc present. result is less mvmt
spina bifida occulta (often assymtomatic) absence of full closure of bony elements of spine, may or may not result in neurological defect, commonest congenital deformity of spine
spondylolysis refers to bilateral fx thru the pars interarticularis
spondylolisthesis refers to displacement of the vertebral body as result of fx
spondylolysis/spondylolisthesis occurs in lumbar spine, can be congenital or acquired, usally occurs w/ increased lordosis, back pn increases w/ bkwd bending, pn may or may not occur & may or may not be significant, can lead to OA, nerve root compression, may need sx
rx for spondylolisthesis extension is contraindicated but strengthening of the extensors is not (can bridge or do small superman), back brace may be helpful, abdominal strengthening
compression fx (also called crush fx) happens in hip & spine the most, may occur spontaneously w/OA & more common in throacic spine, may occur w/trauma
S&S of compression fx usually does not cause harm to spinal cord & does not require fixation. local pn over site of fx-maybe edema if acute
rx of compression fx modalities, ex to improve posture (ext), bracing (TLSO)
ankylosing spondylitis uncommon (horrible), begins at SI w/synovium & lig becoming inflamed, thick & ultimately calcified. finally results in total spinal fusion
pagets dx (osteitis deformans) accelerated resorption & regeneration of bone tissue in long bones & spine. begins age 40-60.
pagets dx (osteitis deformans) S&S pn, thickening/deformities of cranium, spinal & LE deformities
TOS- thoracic outlet syndrome compression on the neurovascular bundle that runs thru the throacic outlet & carries the brachial plexus, subclavian artery & subclavian vein
TOS S&S pn in the shd and/or UE, tingling, numbness, coldness in the arm or hand, loss of biceps jerk, triceps jerk, positive Adson's test
TOS common areas of compression include ant & middle scalene, 1st rib, clavicle, pec minor
TOS causes tight scalenes, cervical rib (a congenital anomaly), trauma, postural changes, clavicular fx
idiopathic non-structural scoliosis curve reverses w/fwd bending, always mm imbalances in strength or length that need to be addressed
TOS rx exercise(pec stretching), posture education
myelogram dye introduced into canal (usually btw L4 & L5) so that disc can be visualized on xray (not that common anymore, risk of headache & infection)
MRI can't do w/metal (Beth says excellent test tho)
discogram dye injected into disc & xrayed (older procedure, rare now)
bone scan rules out CA or fx (common)
epidural injection cortisone & an anesthetic injected into outer dural sac for pn relief
laminectomy lamina removed & extruded disc material removed
foramenotomy for stenosis-increase size of IV foramen
fusion for severe instability after several laminectomies or fx. graft taken from iliac crest & braced for 4-6 wks
flexion is good for ... extremely painful probs, acute probs, prolapsed discs, stenosis, spondylolisthesis
extension is good for... bulging disc, flat lordosis, pn decreases with ext, leg pn centralizes with ext
best -> worst position for bulging disc ext in prone, ext in std, sitting w/lumbar (better in PM)
best -> worst position for DDD, DJD supine, flex w/o compression (sidelying, supine flex), flex w/sitting, standing (better in AM)
extension approach pn usually caused by disc lesion or flexed postures/bending, lifting. pn increases w/flex. pn decreases w/ext. rx w/ext/McKenzie type protocol
flexion approach pain caused by DDD, DJD, spurring, stenosis. pn relieved w/flex. rx w/unweighted flex & flex posture positions
hypermobility approach pn caused by lack of good neuromuscular control, wk ligaments. activity in increases symptoms, relieved by rest. treat w/ Kinesthetic Awareness Ex. treat w/Core Stabilization Ex
hypomobility approach caused by lack of mobility and stiffness. rx w/stretching/joint mob which relieves pn quickly (we can fix them fast)
cervical exercises axial ext (cervical retraction), scalene mm stretch, inhibitive distraction, manual traction/traction, mm energy to increase ROM, isometrics
lumbar spine exercises drawing-in maneuver (abdominal hollowing ex) for TrA, ab bracing, post pelvic tilt, multifidus activation & training, ext, Williams flex, stabilization training
functional activities: basic ex techniques wt bearing ex- modified bridging ex, push-ups w/trunk stabilization, wall slides, partial lunges, partial squats & steps
compression test apply compression thru lumbar or cervical, pt in sitting. pn/radicular signs are positive test: indicates disc pathology
distraction test done in sitting. examiner applies distraction & if pn relieved, positive test. indicates disc pathology
Adsons test in sitting, palpate radial pulse. rotate head toward test shd. ask pt to take breath & hold. examiner takes arm into ER & ext. decreased pulse indicates compression at TO. also look for reproduction of symptoms (looking for TOS)
Created by: jessigirrl4