lecture 3: exercising after back sx and SI joint movements Flashcards
what is the main post op complications after back sx
local/systemic infection
what does PEACE and LOVE and when do u do it
Protection
Elevation
Avoid anti inflammation
Compression
Education
immediately after a injury
Load
Optimism
Vascularisation
Exercise
after the first days have passed
when do u usually want to load a ligament graft
around 6 weeks
when is the maximum protection phase for post op and what is it characterized by , time frame and things to consider
immediately after sx
characterized by tissue inflammation and pain
time frame : days to 6 weeks
things to consider
- possible immunization/ WBing stu’s
- bracing
- light loading
when is the moderate protection phase for post op , time frame and things to consider and what AROM do u return to
intermediate phase of healing , decreased tissue inflammation and pain allows for more mobility
time frame: 4-12 weeks
things to consider: Restore normal arthrokinematics
Gradually increase strength
Improve neuromuscular control and stability
full , pain free AROM
what is the minimum protection phase for post op , what is the time frame and what are things to consider
little to no protection of sx tissues requires
time frame: 6wk to 12 months
Things to consider:
Restore functional strength
Consider sport/activity specific training
Be specific in patient education
what is an absolute indication for sx
cauda equina syndrome
acute loss of function
what are post op precautions after lumbar spine sx
BLT’s
- No Bending
No Lifting (over 10 pounds)
No Twisting
extension instanteous axis of rotation comes with aging and the lumbar spine.. what is decreased and what is increased
decreased segmental control from the disc
increased stress on the facets and disc
side bendinginstanteous axis of rotation is from agin and the lumbar spine … what 2 things are increased
- increased shearing and increased facet chondral load
what is a major stabilizer of the spine and is key for appropriate mobility and helps create coupled motions
intervertebral disc
what is it called when they remove a small amount og vertebral disc
microdiscectomy
what is a fusion
bones used to fuse the vertebrae together
what is often resected in a laminectomy
ligamentum flavum
after a laminectomy when can a patient start using a stationary bike
not until 3 weeks
what is a decompression without fusion called
miscrodiscectomy
what is detached during a microdiscectomy
detach the lateral attachments of the flavum ligament from the lamina
what is a medial facetotomy compared to a lateral facetotomy
if they remove part of the superior facet for medial
if they cant get it with medial may also take some of the inferior facet for a lateral
if a pateint has microdiscectomy when can they use a stationary bike
not until 6 weeks
if a patient has a microdiscectomy when can they start spine ROM
6-8 weeks post op
if a patient had a lumbar fusion when can they ride a stationary nike
> 6 weeks
a posterior lumbar interbody fusion procedure gives posterior access thru whar 3 things
- bilateral mm strip dissection
- laminotomy
-dura is retracted
what is a Transforaminal Lumbar
Interbody Fusion (TLIF) ?
AKA posterolateral
unilateral laminectomy and inferior facetectomy
the Anterior Lumbar Interbody
Fusion (ALIF) allows what
adequate access to the
entire ventral surface of the disc
what is adjacent segment degeneration
when the adjacent segment becomes symptomatic causing pain or numbness
what can a spinal sx lead to
increased forces and compression on IVD
what is decompression with motion preservation
disc replacement
what is disc replacements contraindicated for
hypertrophic facet joints
translational deformity (spondylolisthesis)
in segmental autofusion (ankylosing spondylitis)
t/f: disc replacement is intended to stabilize the spinal column
false it is not intended to
what is the post surgical management stage of recovery for 6 weeks max protection , 6 weeks moderate protection and 12 weeks progression
6 week max: heavy on manual therapy not a lot of sensory/nm control
6 weeks mod: 50/50 on manual therapy and sensory/neuromotor control
12 weeks: heavy on sensory/ neuromotor contrl
what are 6 considerations for post surgical management for the back
- Disc hydration/dehydration
- Changing positions every 15-30 minutes
- Avoiding stretching and rotation of the lumbar spine
- Avoiding prone/flat sleeping
- Think about healing times
what are 3 ways to rehydrate a disc
sit in chair with something behind back in a little extension
laying supine with legs elevated on something
laying on side with pillow in between legs
all motions at the sacrum at SIJ are …
very small
all motions in SIJ (rotatory or translatory) as result of LE motions are ___ dimensional
3
what is sacral nutation
flexion at the sacrum
which ligaments become taut during sacral nutation
sacrospinous and sacrotuberous ligament
these ligaments also limit posterior rotation of the innomoiance
when is there sacral nutation
during
- stnading or landing side
- lordosis positions in standing or sitting
-occurs with spinal extension
- occurs with both innominates rotating posteriorly
what is sacral counternutation
extension of the sacrum
what ligament is taut during sacral counternutation
posterior sacroiliac ligament/long dorsal lig
there is SIJ counternutation during what 2 thins and what way does this move the pelvic floor and when does it become an issue
occurs with anterior rotation of both innominates and with spinal flexion (decrease in lumbar lordosis)
this will move the pelvic floor anteriorly
becomes an issues when the lumbar spine flexes and the sacrum doesn’t move
when does anterior rotation of the innominate occur (open chain)
with hip extension
posterior rotation of the innominates occur w what movement in open and closed chain
hip flexion and SLS w gait (this is during closed chain)
when does inflate and outflare of the innominates occur
inflate occurs when hip IR
outflare occurs when hip ER
what happens at the ASIS and PSIS during anterior rotation
ASIS goes down and PSIS goes up
what happens at the ASIS and PSIS during posterior rotation
ASIS goes up and PSIS goes down
If a pateint has a anterior innominates and u want to give them an exercise what kind would u prescribe
i would give them an exercise that bring them into hip flexion which would lead to a posterior rotation and turns on their extensors
