Ped spine 2

Question 1

What is kyphosis

Answer 1

abnormal posterior spinal convexity
wide variety for what is considered normal (20-40°)
excessive is used for curves greater than 50o

Question 2

What is a postural position that is an example of kyphosis

Answer 2

round back

Question 3

What are the causes of structural kyphosis

Answer 3

trauma
congenital anomaly
Scheurmann disease
spina bifida
abnormal bone metabolism 
-rickets, osteogenesis imperfecta

Question 4

What are the clinical presentation of scheuermann disease

Answer 4

Angular thoracic kyphosis
Often compensatory ↑ lordosis and forward head (gooseneck)
 ↑ deformity with forward bending
Deformity remains with hyperextension
Tightness HS common
Tight pecs
Weak thoracic extensors
pain common described intermittent activity related and often localized over the curve apex; in the thoracolumbar it is a more constant pain

Question 5

What are the PT interventions of Scheuermann disease

Answer 5

Posture instruction
Exercise: individualized tx impairments
-Stretch tight
-Strengthening weak: extensors, core, hip etc.
-Functional training
-Aerobic conditioning
Modalities helpful in decreasing pain 
PT not shown to effective in preventing progression

Question 6

define spondylolysis

Answer 6

defect in one or both sides of the neural arch: pars interarticularis but no slip or anterior displacement
most in L5

Question 7

spondylolysis interventions

Answer 7

Patient education (see later slide)
Decrease pain: MHP, soft tissue mob, grade I/II mob into flexion CAREFUL
Flexibility /stretching-common tight HS
Increase lumbopelvic stability*****
-Strengthen hip girdle
-Core strengthening: rectus, transverse and oblique
Lumbosacral brace

Question 8

Define spondlylolisthesis

Answer 8

forward slippage of one vertebral body in relation to the vertebral segment immediately below
most common level L5 /S1

Question 9

spondlylolisthesis grade 1 or 2 minimal slippage

Answer 9

Lumbar range and gait usually unaffected
active hyperextension may produce discomfort
1 less than 25% 2 25-50% slipage

Question 10

spondlylolisthesis grade 3 and 4

Answer 10

higher grade slips
usually constant pain
restricted lumbar motion
H/S tightness

Question 11

Spondylolisthesis: Non-surgical Intervention

Answer 11

1. Annual clinical check-ups
2. Non-surgical most common if less than 50% slippage and min/mod back pain
   Activity restriction: can participate in sports if asymptomatic avoiding gymnastic, ballet and football
3. Medication: Acetaminophen for pain; NSAIDS for pain or inflammation
   Stabilitization with dynamic trunk exercises
   no mobilization

Question 12

Spondylolisthesis: Non-surgical Intervention of education

Answer 12

anatomy and pathology
avoid activities and exercise that puts them in end-range hyperextension
posture
body mechanics
pt. needs to avoid self mobilization

Question 13

Spondylolisthesis: Non-surgical Intervention musculoskeletal based

Answer 13

Positioning: no hyperextension
Strengthening: core; hip, upper back
Stretching things that are tight
Functional training
Ergonomics: need to practice these
Posture during session; postural exercises
Soft tissue work as needed : not primary intervention
Brace for acute pain and for higher level activities to help avoid pain and fatigue during the day (1-2 hour) (TSLO)