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PHTY3260 > L28: Skills Prac 19-20 > Flashcards

L28: Skills Prac 19-20 Flashcards

1
Q

What are the 3 main clinical pointers in the thoracic spine?

A
  1. C7-T4
    1. The head cannot move fully in the presence of hypomobility in the upper thoracic region
    2. examine with neck movements
    3. examine with unilateral arm movement
    4. treatment movements (passive, active)
      • Consider using head or arm movements
  2. T4-8 - bilateral arm elevation → 15˚ thoracic ext
    1. restriction of rib movement can restrict segmental movement
    2. utilize breathing pattern when treating rib dysfunction
  3. T8-L1
    1. transitional area- behaves a bit more like lumbar
      • note rotary instability
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2
Q

What are the 3 main clinical pointers in the thoracic spine (C7-T4)?

A

The head cannot move fully in the presence of hypomobility in the upper thoracic region

  1. examine with neck movements
  2. examine with unilateral arm movement
  3. treatment movements (passive, active)
    • Consider using head or arm movements
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3
Q

What are the 2 main clinical pointers in the thoracic spine (T4-T8)?

A

bilateral arm elevation → 15˚ thoracic ext

  1. restriction of rib movement can restrict segmental movement
  2. utilize breathing pattern when treating rib dysfunction
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4
Q

What are the 2 main clinical pointers in the thoracic spine (T8-L1)?

A
  1. transitional area- behaves a bit more like lumbar
  2. note rotary instability
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5
Q

What are 4 characteristics of rib movements?

A
  1. Breathing
  2. Accompanies movements of the vertebrae
  3. effect of rib cage on thoracic movements
  4. inter-dependence of arm and thoracic motion

No problem –> angle mobilisation on costal transverse to facilitate that

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6
Q

What is the Th flexion of rib movement?

A

Th Flexion: anterior rib rotation

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7
Q

What is the Th extension of rib movement?

A

Th Extension: posterior rib rotation

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8
Q

What is the Th rot (R) of rib movement?

A

Th Rot (R): posterior rotation (R) rib

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9
Q

What is the Th LF (R) of rib movement?

A

Th LF (R): anterior rotation (R) rib

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10
Q

What is the direction of movement restriction (C, Th spine)?

A
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11
Q

What is the indication of segemental rotation mobilisation?

A

Th LF (R): anterior rotation (R) rib

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12
Q

What is the indication of segemental lateral flexion?

A

loss of LF or Rot

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13
Q

What is the indication of cervical lateral glide?

A

nerve tissue technique - treatment of painful C5, C6 nerve roots

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14
Q

What is the indication of transverse glide (thoracic region)?

A

deficits in thoracic segmental rotation

  • Lateral flexion??
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15
Q

What is the indication of traction?

A

in relation to NR pathology or general hypomobility

  • Enhance flexion or extension
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16
Q

What are 3 techniques for the CV, CT joint in thoracic motion segement influenced by mobility of the ribs?

A
  1. PA glides: performed over the joint or angle of the rib
    • The PA performed in a caudad direction for a rib restriction in external rotation (inhalation) and in a cephalad direction for a restriction in internal rotation (exhalation)
  2. Technique for SC joints: AP glides
  3. Note: at least 15 of thoracic extension is used in full shoulder elevation
    • Active arm elevation can assist manual therapy treatment of the thoracic region
17
Q

What are the 7 managements of this patient?

A
  1. Techniques:
    1. accessory movements
    2. physiological movements
    3. Long axis movement
    4. Combined movements
  2. Position in range
  3. Grade
  4. Specific treatment for CT,CV joints
  5. Use of arm movements
  6. Progression
  7. Exercise

Accessory:

  • PA unilateral
  • Transverse glide (towards the head –> ant rotation or can be done when breathing in)

Physiological:

  • Rotation PPVIMS (towards or away depending of pain)
  • LF

High velocity manipulation (for thoracic spine) –> segmental (useful)

18
Q

What are 3 indications of high velocity manipulation (HVT)?

A

Can be overused —> not necessarily used (need to open sometimes instead of compressing joint)

  1. When subtle spasm is not allowing movement of a joint and mobilisation is aggravating pain
  2. Residual hypomobility not responding to mobilisation
  3. Some thoracic areas become hypersensitive, too much local discomfort with mobilisation
    • Make sure to test out the segment prior to manip
19
Q

What are 10 contraindications to manipulation?

A
  1. Non-musculoskeletal causes of pain
  2. Systemic/inflammatory disease – e.g. RA, ankylosing spondylitis
  3. Neoplasms, metastatic disease (Can exercise (challenging) but cannot manipulate)
  4. Spinal cord, cauda equina compromise
  5. Pregnancy
  6. Osteoporosis, or treatment likely to cause eg long term steroids, anticoagulants
  7. Severe nerve root pain
  8. Fractures
  9. Vertebral or internal carotid artery compromise
  10. Usually not for older population
20
Q

What are 7 precautions to manipulation?

A
  1. Pregnancy, post-partum period
  2. Adolescents or children (Due to epiphyseal plates & psychological reasons)
  3. Muscle spasm or pain positioning
  4. Patient unable to understand
  5. Patient not relaxed
  6. Recent trauma
  7. Older patients
21
Q

What is the grade 5 (manipulation) of a thoracic PA manipulation?

A

small amplitude of movement at the end of range performed with an impulse

Note: A manipulation is NOT performed with force, the key element is speed

22
Q

A manipulation is NOT performed with _____ , the key element is______

A

force; speed

23
Q

What is the indication of thoracic PA manipulation?

A

the presence of general hypomobility over several thoracic

segments

Ensure there are no contra-indications to manipulation

24
Q

What are 3 technical aspects of thoracic PA manipulation?

A

Example T5-6 ↓ ∞ lv

  1. Refer prac notes for hand positions
  2. Once joint/hands are in position, gently take segment to end of range
  3. Apply a small impulse in the PA direction
25
Q

What are the 2 Thoracic mobilisation with assisted active movement (MWM)?

A

Effective techniques with added proprioceptive effects

  1. Th → with active rotation
  2. Th ↓ with active extension
26
Q

What are the 3 clinical pointers of Th →with active rotation as Thoracic mobilisation with assisted active movement (MWM)?

A
  1. Technique is a transverse glide with an assisted active rotation (+ slight extension)
  2. Performed in sitting, use soft area of hypothenar region - pisiform grip
  3. Can be a progression of Transverse glides, or choose as an initial technique
27
Q

What are the 3 clinical pointers of Th ↓ with active extension as Thoracic mobilisation with assisted active movement (MWM)?

A
  1. Technique is a ↓ caudad with an assisted active extension
  2. Performed in sitting, use space between thenar and hypothenar on spinous process
  3. Can be a progression of ↓, or choose as an initial technique

PA-caudad glide

28
Q

What are 7 technical aspects of thoracic PA manipulation (eg. T5-6 ↓ lv)?

A
  1. Always mark segment that aiming to manipulate
  2. Ask patient to assist in flexing and rotating thorax to position posterior hand (Able to localise segment (when use hand)
  3. Critical that hand supporting T6 is comfortable and the spinous process is supported between flexed fingers and thenar eminence (Base of thumb and PIP of index finger (can support fingers with tissue))
  4. Ask patient to assist in maintaining flexion as rolling back on hand
  5. Gently lower patient onto thrusting hand and do not allow them to extend over hand (or rotate) as means therapist has lost the position
  6. Place your hands on patient’s elbows for padding
  7. Apply a small impulse through the elbows (Thrust back through line of the elbows)
29
Q

What are the 3 clinical pointers of T1-4 → with Rot as Thoracic mobilisation with assisted active movement?

A
  1. effective technique for hypomobility, use in conjunction with → glides
  2. reinforce with active mobilisation exercise
  3. must use thumb pad as contact as thoracic spinous processes can be naturally tender
30
Q

What are the 3 clinical pointers of T1-4 ↓ with flexion as Thoracic mobilisation with assisted active movement?

A
  1. technique can be performed at any level of the thoracic spine
  2. use thumbs as contact point in upper thoracic region
  3. use thumbs or space between thenar or hypothenar eminences for mid/low thoracic levels
31
Q

What are thoracic exercises?

A
32
Q

What are 4 characteristics of thoracic exercise to increase/maintain range?

A
  1. Thoracic extension over roller
  2. Yoga poses
    • Downward dog, cat/camel (4 point kneel –> focuses on tsp)
  3. Adding resistance with theraband, weights
  4. Sport specific training
33
Q

What are characteristics of thoracic exercise to increase mobility; adding resistance?

A
34
Q

What are characteristics of thoracic exercise incorporating motor control exercise?

A

Incorporate axioscapular and lumbopelvic control into functional tasks

PHTY3260 (27 decks)

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