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OPP Lect 19

Strains Muscular Injury
Sprains Ligamentous stretch injury
Flexion injuries from rapid acceleration-deceleration (Whiplash) 1.Posterior muscle strain. 2.Interspinous lig sprain (vertical b/w spinous processes that maintain stability, prevent slipped vertebrae: spondelocentesis). 3.Anterior vertebral body compression fracture. 4.Disc Herniation. 5.Spinal Stenosis.
Extesion injuries from rapid acceleration-deceleration (Whiplash) 1.Anterior muscle strain. 2.Brachial plexopathy. 3.Dens fracture (atlantoaxial subluxation due to rapid extension of occiput)
How do Shearing Injuries occur? When one part is stable and another part moves
Types of Shearing Injuries 1.Contusions (facet joint). 2.Sprains. 3.Fractures.
When do you order X-Rays? 1.Severe pain & spasm that doesnt normalize after a few min. 2.Restriction and spasm that doesn't normalize in hrs to few days. 3.Instability is suspected even after ruling out fracture (persistant gaurding, or different movements). Order fle/ext view
Head and neck symptoms with Whiplash? 1.Neck pain. 2.Neck Stiffness. 3.Loss of ROM. 4.Headache. 5.Shoulder pain. 6.Back pain. 7.Extremity pain.
What is the most important factor for chronic pain prognosis from whiplash? TIME OF INJURY. 1.56% asymptomatic @ 3 months. 2.82% recovered @ 2 years.
What worsens the prognosis of chronic pain from whiplash? 1.Age. 2.Female. 3.initial pain in neck. 4.higher initial pain intensity.
What can be used to distinguish b/w asymptomatic and chronic myofascial pain? Cervical range of motion
What would a reduced cervical ROM at 3 months indicate? chronic pain and disability for 2 years.
When testing the cervical spine, do you test active or passive ROM first? ACTIVE
Active interventions for whiplash? 1.Early physical activity (C-collar can make things worse if worn for too long). 2.Physical therapy and emotional therapy.
What is the major prognostic indicator at 3 months? Cervical ROM. **Manipulation reduces pain and improves ROM.
will exercise alone improve cervical ROM? NO
What type of techniques would you use for the first 2 weeks after whiplash (Acute) 1.INDIRECT techniques (NO DIRECT). 2.Sympathetic normalization (rib raising). 3.Lymph drainage (thoracic pump).
What type of techniques would you use for 2 weeks - 2 months after whiplash (Subacute) 1.DIRECT techniques. 2.Home flexibility.
What type of techniques would you use for 2 months after whiplash 1.Injections (trigger point and facet point)
With Cervical spine, how do you sidebend and rotate for counterstrain? AWAY from tenderpoint.
C2-7, side-bending and rotation occur in the SAME direction.
Starting position for Sidebending Muscle Energy C2-7 Flex/Ext and sidebend INTO restiction, rotate AWAY from restriction (this limits other joints).
Starting position for rotation Muscle Energy C2-7 Flex/ext and rotate INTO restriction, sidebend AWAY from restriction (this limits other joints).
2 main differences b/w treatment of cervical spine and thoracic/Lumbar 1.Not neutral or non-neutral (will be restricted in flex or ext). 2.only reversing 2 planes of restriction (taking the other into position of ease). **Works best for Cervical Muscle energy, articulatory, and HVLA
Somatic dysfunction: FRS Right. Treat with cervical sidebending muscle energy 1.Extend. 2.Sidebend Left. 3.Rotate Right (into position of ease)
Somatic dysfunction: FRS Right. Treat with cervical rotation muscle energy 1.Extension. 2.Rotate Left. 3.Sidebend Right (into position of ease)
Why would you choose b/w sidebending or rotation treatment? Sidebending could narrow the foramen of the nerve causing limb numbness, do rotation if this is the case.
Relative contraindications for cervical ME/LVHA/HVLA 1.Joint inflammation. 2.Acute sprain. 3.Acute fracture. 4.Undiagnosed cervical radiculopathy. 5.Vertebral Artery insuffiency. 6.Joint hypermobility.
What is the difference b/w neuritis and radiculopathy? Can treat neuritis with DIRECT techniques. Patient will have neurological symptoms but no sensory, motor, or deep tendon reflex loss.
Created by: WeeG