PTA135-Unit5-Spine Flashcards
relate the difference between Correct and Faulty Posture
correct - the position in which minimal stress is applied to each joint
faulty - any position that increases the stress to the joints
describe Ideal Standing Postural Alignment
Sagittal view, the plumb line:
• Passes through the ear lobe, the bodies of the C-spine vertebrae, the tip of the shoulder
• Midway through the thorax, through the bodies of the lumbar vertebrae
• Slightly posterior/midpoint to the hip joint
• Slightly anterior/midpoint to the axis of the knee joint
• Just anterior to the lateral malleolus
identify the characteristics of Normal Sitting Posture
“neutral” – 90-90-90 • ears over shoulders • Shoulders relaxed • Wrists straight • Elbows kept close to the body • Natural curve to lower back maintained • Feet resting on the floor
how to Instruct a Patient on the mechanics of lifting
use the Five L’s of Lifting
- When you lift, make sure you stand close to the object you are lifting (lever) with a wide stance and feet firmly on the ground. Bend at the knees and hips and make sure you lift with your legs and not with your back (lordosis). Make sure you do not pick up anything that is too heavy for you. Keep the load (what you are lifting) as close to your body throughout the lift as possible. Make sure you breathe when you lift, do not hold your breath. (Lungs)
name the 5 L’s of Lifting
Load Lever Lordosis Legs Lungs
explain the Load of lifting
The amount of weight to be hoisted should be appropriate for the task and for the individual attempting to lift it.
explain the Lever of lifting
Keep the object as close to the body as is functionally possible throughout the lift
• Holding an object away from the body increases the spinal compressive forces 10x
o a 5 lb. dumbbell away from the body, feels like 50 lbs. of pressure on the spine
explain the Lordosis of lifting
Maintain a normal anatomic lordotic curve (normal inward curve of lower back) while lifting any object
explain the Legs of lifting
Instruct individuals to lift with their legs and not with their back
explain the Lungs of lifting
Use proper breathing techniques during lifting. Valsalva maneuver (closed glottis during attempted expiration) should be AVOIDED
discuss Body Mechanics
All these L’s together comprise proper body mechanics.
“Body mechanics refers to the way we move during every day activities. Good body mechanics may be able to prevent or correct problems with posture (the way you stand, sit, or lie.) Good body mechanics may also protect your body, especially your back, from pain and injury. Using good body mechanics is important for everyone.” (http://www.drugs.com/cg/using-good-body-mechanics.html)
describe Peripheralization
- Radicular pain symptoms are experienced further down the leg.
- Do not want!
describe Centralization
- Radicular pain symptoms are made to move away from the periphery and toward the mid-line of the spine
- As a result of the performance of certain repeated movements or the adoption of certain positions
- Good! Yay!
1) Effect on the nucleus pulposus with positional change from flexion into extension
The nucleus moves anteriorly
2) Effect on the nucleus pulposus with positional change from extension into flexion
The nucleus moves posteriorly
rehab for Lumbar Spine Ligament Sprain
- Treatment parallels that of muscular strains
- Managed similarly to muscle strains
- Individualized treatment based on each patient’s impairments
- Emphasize protecting the spine from unwanted forces and positions
rehab for Lumbar Spine Muscle Strain
- Individualized for patient’s impairments
- Address pain and inflammation
- Specific stabilization and back strengthening exercises
- Flexibility in hips and lower extremity
- Cardiorespiratory conditioning
- Patient education!! Prevent reinjury!!
- Emphasize protecting the spine from unwanted forces and positions
define Ergonomics
a quantifiable system of job or ADL modification[ or redesign that allows for continued productivity while reducing work-related physical stress
define Functional Capacity Evaluation
FCE
• Mimics the work environment for improved training, similar to “Back School”
• A group of physical and functional tests administered to a recovering patient before he or she returns to the job.
• An FCE can also be used as a screening tool to acquire data related to pre-employment risk assessment and management of back injuries.
MOI of muscle strains of cervical spine
- Common among young athletes
- In association with motor vehicle accidents with flexion-extension, later flexion and acceleration-deceleration “whiplash” type injuries
- Falls
Muscles most often involved in muscle strain of cervical spine
- Upper trapezius
- Levator scapulae
- Scalenes
- Sternocleidomastoid (SCM)
- Spinal erectors
- Rhomboids
rehab for Cervical Strain
- Similar to treatment of lumbar strains
- Address pain and its causes
- AVOID the direction of the strain initially
- After inflammation and pain decrease, isometric contractions in all planes
- Progress to cervical stabilization strengthening
- Postural strengthening
cause of Cervical Spondylosis
Chronic degenerative disc
- “wear and tear on the weight bearing structures of the cervical spine”
most common cervical segments involved in cervical spondylosis
C5-C6
C6-C7
rehab for Cervical Spondylosis
• Address pain (NSAIDs)
• Avoid aggravating positions
• Semi-rigid cervical collar for some
◦ hopefully short term
• Axial Extension-retraction exercises are effective for patients who drive pain relief from extension
• Flexion-type activities are reserved for patients who obtain pain relief from cervical flexion
• Mechanical or manual cervical traction
• Cervical mobilizations (by the PT, of course)
• Isometric cervical spine exercises
• Posture mechanics, flexibility exercises, and strengthening activities
• Patient Education:
◦ Move on a regular basis
◦ Stretch throughout the day
◦ Posture – good sitting posture, ergonomics
◦ Sleep
- one pillow under head in supine
- pillow between knees and two pillows under head in sidelying
- Neutral spine top to bottom
name the 2 layers of an intervertebral disc
- Annulus
- Nucleus Pulposus
describe Annulus
– outer wall
• 12-18 concentrically arranged rings of fibroelastic cartilage
• No blood supply, cannot heal itself
• Anueral (gets nutrients from movement) except outer fibers
• Provides stability and withstand tension-torsional forces and bending
describe Nucleus Pulposus
– water binding mucopolysaccharide gel
• Transmits forces
• Equalizes stress
• Promotes movement
what is important about Intervertebral Discs
They provide stability between vertebral bodies, permit movement within each vertebral segment and transmit motion.
name 3 categories of Herniated Nucleus Pulposus (HNP)
- protruded disc (disc protrusion)
- extruded disc
- sequestrated disc
define Disc Protrusion
- usually posterior or lateral
- the nucleus bulges against INTACT ANNULUS
define Extruded Disc
– nucleus extends thru the annulus, but the nuclear material remains confined by the posterior longitudinal ligament
define Sequestrated Disc
– the nucleus is free within the spinal canal
general rehab for HNP
Conservative management
• Decide what motions improve symptoms (extension?)
• Teach proper body mechanics
• General physical conditioning
• Stabilization exercises
• Safe lifting principles into their ADL’s
the significance of the Straight Leg Test
- Tests the Sciatic Nerve
- is considered positive if the radicular pain is increased
- the opposite leg is tested in the same manner
the significance of the Femoral Neural Tension Sign
- Tests the Femoral Nerve
- do for a paitent with anterior radiating thigh pain
- positive only if anterior thigh pain increasese
- negative if there is back pain
- Position = prone w/affected leg flexed to 90 and passively extend hip
define Neural Tension
positioning of the spine and extremities can put a stretch on peripheral nerves, thus affecting the perception of pain, causing radicular symptoms
the 4 phases of lumbar strain or sprain rehab
Phase I – Pain, edema control, early healing
Phase II – mobilization
• early active and passive motion
• Flexibility
Phase III - prevention of re-injury
• spinal stabilization techniques
• continuing education
Phase IV – Return to normalized activity
• Work, sports
• More challenging exercises and activitiesdefine Spinal Stenosis
- the narrowing of the spinal canal
- constricts and compresses nerve roots
the 3 symptoms of Spinal Stenosis
- radiating ache into lower extremity
- paresthesia into lower extremity
- disturbance in motor function
define Paresthesia
a sensation of pricking, tingling, or creeping on the skin that has no objective cause
Most Common Cause of Spinal Stenosis?
degenerative arthritic changes
Management of Spinal Stenosis?
- flexion exercises
- encourage slightly forward trunk positions
- encourage a general exercise program
- partial direct and oblique sit-ups
- body mechanics education (lifting, sitting and sleeping postures)
define Spondylosis
degeneration in spine
define Spondylolysis
- bony defect in the pars interarticularis (part of the lamina btw inferior and superior facets)
- usually occurs at L4-L5 and L5-S1
define Spondylolisthesis
- forward slippage of one superior vertebra over an inferior one (caused by unstable fractures)
- most common L4-L5
5 Types of Spondylolisthesis
Type I - congenital or dysplastic (common in kids)
Type II - mechanical stress/microtrauma (ages 5-50)
Type III - degenerative/loss of stability (elderly)
Type IV - traumatic w/fratcure (young and active)
Type V - pathologic, bone tumors affect the pars
4 Grades of Spondylolisthesis
Grade I - 0-25%
Grade II - 25-50%
Grade III - 50-75%
Grade IV - 75-100%
Spondylolisthesis, Grade I
- treatment is preventing progression
- avoid extension and vertical loading
- abdominal strengthening /stabilization
- stretching for trunk and LE
Spondylolisthesis, Grade II
- address the pain and spasms (ice, heat, NSAIDS)
- avoid extreme lumbar extension
- orthosis to create slight flexion
Spondylolisthesis, Grade III
- usually treated with surgery
- rehab depends on type of surgery
Spondylolisthesis, Grade IV
- surgery for high grade slippage w/neurologic signs (decompression laminectomy and fusion)
- orthosis until bony fusion
- gentle ROM for all extremities
- once bones have healed, abdominal and trunk strengthing, lumbar ROM, general conditions
- avoid extension because it will push vertebrae forward and cause more slippage
manage Vertebral Compression Fracture clinically
- pain relief interventions
- NSAIDs
- avoid thoracic or lumbar flexion activities
- once pain is gone, increase out of bed opportunities and walking
define Kyphosis
- Increased posterior convexity
- Rounded back and protracted scapula
- Muscles and ligaments are stretched and weakened = PAIN
rehab for condition of kyphosis
- Patient education
- Postural awareness
- Stretch anterior shoulder and pectorals
- Strengthen spinal extensors
- Scapular retraction
Idiopathic Scoliosis
– unknown, 80% of cases
Myopathic Scoliosis
- result of muscle weakness
- osteoporosis, RA, and Spinal TB
Osteopathic Scoliosis
– result of spinal disease or bony abnormality
Neurogenic Scoliosis
- result of CNS disorder
- CP, Polio, MD
Functional Scoliosis
– Caused by factors other than vertebral involvement
• Poor posture
• Pain
• Leg length discrepancy
• Muscle spasm secondary to HNP or spondylolisthesis
*functional curve will disappear once the cause is treated
*if untreated, can become a fixed structural curve
*once we find why – we treat it and it’ll go away
* different positions you will not see the scoliosis
Structural Scoliosis
– a structural scoliosis curve will NOT change or correct with motion or position change • Forward flexion test • Will still see the curve • “Rib-hump” *you can always see it
Medical Treatment for Scoliosis
Curves:
• Less than 20 degrees – brace
• Less than 25 degrees – observe and monitor for progression every 4-6 months
• Between 25-45 degrees – spinal orthosis
• Greater than 45 degrees – surgical fusion (Harrington rods)
PT treatment for Scoliosis
• Exercise does not stop the progression of or correct a structural scoliosis
• Functional Scoliosis
* Stretches for muscles on concave side
* Axial stretching or elongation
* Strengthen muscles on convex side
* General conditioning
* General core and postural strengthening
* Hip extensors and rotators
Defince Thoracic Outlet Syndrome
TOS – Proximal compression of the
• Subclavian artery
• Subclavian vein
• Brachial plexus
TOS caused by:
be caused by
• “Cervical rib” (C7 transverse process)
• Shortened or hypertrophied anterior scalene muscle(will squeeze brachial plexus nerve)
• Malunion of clavicle fractures
• Subluxed first thoracic rib/elevated first rib
TOS Symptoms:
- Radicular signs – pain, numbness, tingling, weakness
- Skin and temperature changes
TOS rehab
- Stretching of involved muscles
- Strengthening cervical extensors
- Education about posture
- Cervical postural correction
- First rib mobilization
- Lots of soft tissue work
Temporomandibular Joint anatomy
- Synovial, condylar, and hinge-type joint
- fibrocartilaginous surfaces vs hyaline cartilage and an articular disc (also called a meniscus).
- The articular disc completely divides each joint into two cavities
- Consider both sides when assessing.
TMJ upper jaw movement
- Gliding
- Translation
- Sliding
TMJ lower jaw movement
rotation or
hinge movement
TMJ disorder Etiology
- Missing teeth
- Overbite
- Malocclusion faulty bite (deviation from normal)
- Trauma
- Bell’s palsy
TMJ disorder Treatment
- Stress and pain reduction techniques
- Avoidance of movements that cause symptoms (yawning, singing, and chewing gum)
- Gently stretching or massage to the muscles – Pt education in how to perform these and to perform relaxation of the TMJ muscles
- Resisted isometric movements in all directions
- Joint mobilizations as indicated
- Night mouth sploint to place jow in resting position to reduce “clenching” of teeth
- Maybe surgery
