Lecutre 4c: Thoracic Spne And Rib Interventions Flashcards
What is the clinical decision making process for thoracic spine
- Rule out referred pain from visceral or non-MSK causes
2.Categorize MSK dysfunction
- Somatic (ie. tissue damage)
-Biomechanical (ie. mechanical stress)
Effective treatment requires a ___ ___ and ___ ___ 2/2 complexity of thoracic region
multi-faceted
collective approach
What are teh 2 major things u want to do in the acute phase goasl from t spine
- promote correct breahing
- educate pts on activities to avoid and positions of comfort
What do u want to decrease , promote , increase and regain in the acute phase of the t spine
- decreased pain , inflammation and mm spasm
- promote healing of tissues
- increased pain free rom
- regain soft tissue extensibility and NM control
What do u want to introduce as an intervention for teh acute phase of the t spine
Sub maximal isometrics in pain free ranges
What does research support to do earlt in back pain rehab in the acute phase
Use of manual therapy techniques
What do u want full restration of in the subacute phase
Full anf pain free vertebral and costal ROM
How long does the subacute last
Depends on
• Injury severity
• Pt’s healing capacity
• How condition was managed acutely
• Pt compliance w/ rehab
What will pateints learn to do in the sub acute phase interventions of the t spine
- Initiate and execute functional activities w/o pain through static and dynamic control of spine
- Improve thoracic mm strength and endurance
- Encourage healing of injured segment
- Restore normal lumbo-pelvic and cervical posture and movement patterns
What is joint mobilization and HVLAT used to do for the t spine ? (Restore what and decreased what 4 things)
- Restore thoracic mobility
- ↓ stresses through both fixation and
leverage components of spine - ↓ stresses through hypermobile
segments - ↓ overall force needed by clinician = ↑ control
why is isolation of 1 thoracic segment extremely difficult
Bc the number of articulation at every segment
Pain befoer what ??
mobility and moblity before stabiltliy
What is postural reeducation for
Restore mobility
What kind of training should u do first for postural re ed
Isometrics 1st —> concentric —> eccentric
When should u do strength and endurance for postural re ed
Throughout entire ROM
Thoracic mobility exercises are used to work to increase what ? What is good to follow up with ? U should consider using what kind of movements to target specific segments of t spine
Work to increased extension and rotation
Follow up a manual therapy
UE and LE movements
What should u consider with thoracic spine stability exercises and how should the exercise dosage be
- Consider scapular, core and pelvic stability when selecting ex’s
- Exercise dosage specific to type of muscle performance targeted (ie. strength vs NM control vs endurance)
What are the 2 main ROM we are worried about in the t spine
Extension and rotation
What kind of intervention is commonly used for UQ dysfucntion
T spine HVLAT
Is the anterior or posterior approach more commonly used for thoracic spine
Posterior
What are common sx procedures for t spine
• Discectomy
• Spinal fusion
• Laminectomy
• Laminoplasty
• Instrumentation (ie. rods, screws, plates
What pateints are up for sx in the t spine
• Fx/instability
• Significant weakness
• Progressive neurological
deficits
• Severe, unremitting pain
• Persistent radicular pain
• Severe scoliosis
How is the sx approach different from the t spine adn c spine
T spine is more common w posterior approach and c spine more common in C spine
What is the difference between laminectomies and laminoplasties
laminectomies= used throughout the entire spine
Laminoplasties= used almost always in c spine
