L18: Pracs 13-14 Skills Flashcards
What are the 7 skills that are important in this practical?
- Full examination of 2 cases including manual examination of cervical region – C2-3 - T3-4 and LF PPIVMs
- Techniques:
- ↓ Gr III, ↓ Gr IV
- ↴ Gr III, ↓ Gr IV
- Progression of technique: eg C5 ↓ in Flex, Neut, Ext
- Technique C2-7 Rot Gr IV
- Technique C2-C7 LF Gr IV
- Cervical lateral glide technique
- Manual traction
What are the 5 tasks in the Full manual examination of cervical region - C0-1 - T3-4?
- Ensure the neck is relaxed
- Palpate soft tissues and feel down the soft tissues over the lamina.
- Note: multifidus spasm can be palpated over a painful joint (C2-7), will feel less compliance in deep tissue – signal for the dysfunctional level
- Examine Central PAs C2-T4, compare between levels
- Examine Unilateral PAs (C0-1 – T3-4) – non symptomatic side first
- Compare side to side to determine the most symptomatic segments
- Record any positive findings
What are the 2 characteristics of the techniques in treatment?
- Grade III technique is a larger amplitude movement to the end of range when the intention is to treat pain and resistance
- Note it induces overflow of movement
- Grade IV technique is a small amplitude movement to the end of range. It is used to treat pain and resistance and can be performed gently (IV-) to firmly (IV+)
- Techniques: ↓ Gr III
- ↓Gr IV
- ↓ Gr III
- ↓Gr IV
What are the 3 characteristics in the progression of techniques (eg. C5↓ in Flex, Neut, Ext)?
Progression of technique - in the framework of combined movements protocol is progression by position in range
- Examination movements in cervical region are Ext and LF
- In the CM examination, take first movement to P1 and assess pain response when adding the second movement
- Determine which sequence more accurately reproduces the patient’s pain
Is it (i) Ext + LF or (ii) LF + Ext
- Use the second movement of this sequence as the treatment movement. Can use the physiological or related accessory movement in Tx
- ie
- use LF as treatment movement
- use Ext or as the treatment movement
What is the starting position in the progression of techniques (eg. C5↓ in Flex, Neut, Ext)?
Starting position governed by the primary movement + pain state
ie
- (i) position is in sagittal plane
- (ii) position is in frontal plane
What are the starting position based on pain states in the progression of techniques (eg. C5↓ in Flex, Neut, Ext)?
- Severe pain – opposite painfree direction: (i)=in flexion (ii)=LF away from pain
- Moderate pain – neutral position
- Mild pain – move into painful direction: (i) = in extension (Harder to move), (ii) = LF towards
Practice C5 ↓ in Flexion, Neutral, Extension
What are the 4 steps in the examination of LF PPIVMs?
- Examine LF PPIVMs C2-7 on the left and right sides
- After initial examination, compare levels above and below and from side to side to determine segments with any hypomobility
- Record any positive findings
- Perform manual examination of PPIVMs on new partner, record
What are 3 clinical pointers in the C2-7 Rot Gr IV?
- Localise the rotation mobilisation to the segment
- Gain level from the spinous process and draw skin laterally so that side of index finger locks onto the lamina. (eg C4-5 ⟲ index finger on C4)
- The thumb gently locks onto the side of the face so that the occiput to C4 is a quasi rigid segment, to localise the movement to the C4-5 segment
- The rotation movement is produced by forearms and hands
- Position: Head off the bed (but can be hard with flexion/extension component)
- ON bed = better
- Can use for acute patients (for opening joint)
What are 4 clinical pointers in the C2-7 LF Gr IV?
⤴︎C 3-4 III
- Take skin from the lateral side of the neck to assist index finger locking in on the laminar of C3
- Support hand is on opposite side of the head and neck
- Movement is performed with forearms and body
- Think of a pivoting acting to slide the facet of C3 down the slope of the superior facet of C4 to induce the C3-4 lateral flexion
Oscillating technique –> use hips to guide movement
What are 6 clinical pointers in the management of a patient with nerve root irritation?
- Perform assessment (acute situation)
- Consider positioning for pain relief
- Consider how much assessment you can do
- what is the key information you need?
- Lateral glide
- Manual traction
- Sliders and tensioners
What are 6 clinical pointers in the cervical lateral glide technique?
- used in the management of nerve tissue mechanosensitivity
- should be a ‘soothing movement’
- the glide is performed away from the side of pain
- the shoulder girdle of the painful side is stabilised by the non-treatment hand in the neutral position – there is no scapular depression (will have a neurodynamic effect)
- the index finger of the treatment hand gently grips the lamina of C5
- the movement is performed as a grade III (with amplitude) using forearm and body movement
- Unable to do Gr4
What are 4 clinical pointers in the cervical manual traction technique?
- the segment to be tractioned should be in a mid position of flexion/extension
- the patient is positioned comfortably on pillows: one pillow is usually sufficient for segments between C0-4. Two pillows may be necessary for segments C4-7 to ensure mid Flex/Ext position
- the interlaced tips of the index fingers support the spinous process of C3 and the fingers themselves support the lamina so that the neck is cradled in the therapist’s two hands (Thumbs on SCM)
- the traction (longitudinal) movement is produced by the therapist’s body
- movement, gently rocking backwards
- Oscillate –> hold for few secs
- Sustained –> hold for 30secs
- Can also stretch suboccipital muscles
What is the automated cervical manual traction technique?
What are the 7 characteristics of the dosage for acute nerve root irritation/compression?
- test response to manual traction – indicates potential response to mechanical traction
- first application of traction is conservative until the response is evaluated
- set to +/- 5kg (depends on body size)
- stay with patients for the first minute or two to assess immediate response
- should be no increase in pain or sensory symptoms, which would suggest irritation of the condition
- trial 5 minutes of traction in the first application
- Provide patient with traction safety release button and a bell to call for
- attention if symptoms increase
What are the 3 progression of traction treatment?
-
2nd treatment occasion
- if a positive response, increase time in the first instance by 5 minutes
- if ISQ, increase by 1Kg + time (5 mins)
- if aggravated by traction, abandon the technique
-
Subsequent treatments
- progressively build up time and force
- Time, build up to 30 mins
- Force, build up to 10-15 Kg
-
Chronic nerve root condition
- can increase time and force more quickly
- start with 10 mins traction, 7Kg
- progress as patient tolerates
What are the 7 indications for home traction?
- can be useful for patients with cervical degenerative joint disease with chronic nerve root pain
- self maintenance program
- commercially available apparatus
- need to work with patient for suitable dosage
- check patient can apply safely and effectively
- evaluate effect
- follow-up phone interview
What are the different types of sliding techniques?
