T-Spine and Ribs Intervention/ C-Spine Manip Flashcards
INTRO
INTRO
Scheuermann's Disease Interventions:
-\_\_\_\_\_\_\_ control muscle performance
-\_\_\_\_\_\_\_\_\_ of aggravating activities
-Strengthening and stretching of the ]\_\_\_\_\_\_
-Seated rotation
-Extension in lying (prone press up, prone on
elbows, etc.)
-Thoracic extensor strengthening
-Scapular abductor strengthening
-\_\_\_\_\_\_\_\_- Postural
- Modification
- trunk
- Bracing
With Ankylosing Spondylitis identify ___________/indicators for ________/interdisciplinary communication.
-risk factors/ indicators for referral
Ankylosing Spondylitis Interventions:
-______ exercises with _________ focus.
-Spine _________ & peripheral joint exercises
-________ exercises
-_______ lying several times/ day for spine/ hip
extension
-Sleeping on firm mattress & avoidance of ___
position
-Swimming
Active exercises with mobility focus.
- extension
- breathing
- prone
- SL
SCOLIOSIS
SCOLIOSIS
__________ __________ Scoliosis has limited/poor/no compelling evidence regarding “correction” or limiting progression of curvature.
Adolescent Idiopathic
With Adolescent Idiopathic Scoliosis we can have thoracolumbar bracing, which does what 2 things?
- Prevention of curvature progression
- Correction of abnormal curvature
What are the goals with exercise for conservative management of Adolescent Idiopathic Scoliosis?
- Strengthen postural muscles
- Address muscle length
- Maintain/Improve respiration and chest mobility
- Address back pain impairments
- Resume functional tasks
- Strengthen abdominals
T4 SYNDROME
T4 SYNDROME
T4 Syndrome is a controversial diagnosis with _____ evidence that supports standardized intervention.
poor
What interventions should we consider with T4 Syndrome (based on impairments)?
- Thoracic manual therapy techniques (mobs, thrust manips) followed by thoracic mobility exercises
- Scapulothoracic motor performance
- Thoracic extensor strengthening
THORACIC DISC LESIONS
THORACIC DISC LESIONS
What is the main intervention used for Disc Lesions?
Traction
Thoracic Disc Lesion Traction:
- Not established with the T-Spine, though common practice to address _________ symptoms
- ________ or __________
- Pt positioned sitting or lying
- Duration recommendation __ min – __ hours
- Contraindications: “acute lumbago, instability, respiratory or cardiac insufficiency, respiratory irritation, painful reactions, large [disc] extrusion, medial disc herniation, altered mental state; this includes inability of the patient to relax”
- radicular
- continuous or intermittent
- 2min-24hrs
What are the contraindications for mechanical traction?
- acute lumbargo
- instability
- respiratory or cardiac insufficiency
- respiratory irritation
- painful reactions
- large disc extrusion
- medial disc herniation
- altered mental state
What is acute lumbargo?
Low back pain
Z JOINT AND COSTOVERTEBRAL JOINT DYSFUNCTION
Z JOINT AND COSTOVERTEBRAL JOINT DYSFUNCTION
What are some common impairment with z-joint pain?
- muscle guarding
- joint hypomobility
- acute irritation/dysfunction
- pain
- ROM: commonly motions that close joint(ext/rot/lat flex)
What interventions may be used for z-joint pain?
Manual therapy interventions
- Mobilizations (oscillations, stretch mobilizations)
- Manipulation (neurophysiological effect, biomechanical theories)
Exercise
- pain and guarding inhibition
- neuro re-education
We want to begin with ________ type exercises.
coordination
What interventions may be done with Rib Dysfunctions?
Manual therapy interventions
- Rib mobilizations (oscillations, static stretch mobs)
- Rib manipulation
- STM
With rib manipulation, be careful not to manipulate ________ ribs.
floater
THORACIC OUTLET SYNDROME
THORACIC OUTLET SYNDROME
There is ____ evidence that supports standardized intervention for TOS.
poor
What are some interventions that can be done with TOS?
Work/ activity modification
Nerve glides
Shoulder, upper rib/ thoracic manual therapy techniques
Scapulothoracic motor performance
Address tissue extensibility anterior trunk musculature
IMPAIRMENT-BASED T-SPINE AND RIB INTERVENTION
IMPAIRMENT-BASED T-SPINE AND RIB INTERVENTION
Generally, in addition to your working diagnosis, think _________ vs. ________ with MSK health conditions.
Stability vs. Mobility
What are some other important things to address?
- Education
- Reduce Pain
- Address Impairments
- Improve Functional Activity Performance and Participation
What are some ways to reduce pain?
- Manual Therapy Intervention
- Exercise
- Improve Stability
Thoracic Mobility Exercise examples.
- Quadruped thoracolumbar AROM (flex/ext, rotationreaching diagonally in front of body/overhead)
- Lying thoracic extension
- Sitting rotation, extension
- Assisted extension with towel
- Prone on elbow/prone press up
Exercise interventions for Upper Quarter and Thoracic Extensor muscle performance
- wall splats
- seated thoracic kyphosis “straightening”
- resisted thoracic extension
List some Upper Quarter muscle performance exercises for:
- Mid Trap
- Lower Trap
- Rhomboids and Levator Scap
Mid Trap
-Prone row
-Prone horizontal abduction with 90 deg shoulder abduction & ER
Lower Trap
-Prone full can
-Prone shoulder ER at 90 deg of shoulder abduction
-Prone horizontal abduction with 90 deg shoulder abduction & ER
-Bilateral shoulder ER in shoulder neutral
Rhomboids & Levator Scap
-Prone Extension with shoulder ER
-Prone row
-Prone horizontal abduction with 90 deg shoulder abduction & ER
What is a second function of the thoracic extensors?
Control flexion ROM eccentrically
Modalities that can be used at the T-Spine.
- Ultrasound (thermal, pain relief)
- Cryotherapy (pain relief)
- E-stim (muscle activation/neuromuscular re-ed, pain relief (TENS), aid in healing)
T-SPINE AND RIBS MANUAL THERAPY
T-SPINE AND RIBS MANUAL THERAPY
Studies with thoracic ______ demonstrate better short-term results than mobs for mechanical neck pain.
thrust
Prone Thoracic P-A Mobilization:
-Rate of Force: \_\_\_\_ velocity
-Location in Range of Available Movement: \_\_\_-range
-Direction of Force: \_\_\_\_\_\_\_ force
-Target Force:
-Mobilizing: \_\_\_\_\_\_ process
-Stabilizing: N/A
Relative Structural Movement: spine segment on adjacent segments
Patient Position: \_\_\_\_\_\_\_\_- low
- end-range
- ventral
- spinous
- prone
Seated Thoracic Extension Mobilization:
- Rate of Force: ___ velocity or _______ hold
- Location in Range of Available Movement: ___-range
- Direction of Force: _______ force
- Target Force:
- Mobilizing: posterior aspect of bilateral upper arms for superior thoracic segments into relative ________
- Stabilizing: dorsal surface of _______ ________ (or spinous process) of thoracic segment of choice
- Relative Structural Movement: _______ segment on _________ segment
- Patient Position: ______, fingers interlocked behind head
- low velocity or static hold
- end-range
- anterior
- extension
- articular pillars
- inferior segment on superior segment
- sitting
Facet Gapping In Supine “Pistol”:
- Rate of Force: _____ velocity
- Location in Range of Available Movement: ___-range
- Direction of Force: ________ force
- Target Force:
- Mobilizing: cranial segment with relative _____ translation
- Stabilizing: dorsal surfaces of ______ _______ caudal segment
- Relative Structural Movement: _______ segment on _______ segment
- Patient Position: ______, arms crossed in “gator position”
- high
- end-range
- posterior
- trunk
- articular pillars
- cranial segment on caudal segment
- supine
Seated Lower Thoracic Traction Thrust:
-Rate of Force: _____ velocity
Location in Range of Available Movement: ___-range
Direction of Force: _______ force
Target Force:
Mobilizing: __________ elbows
Relative Structural Movement: ____-thoracic spine on _____ thoracic spine
Patient Position: sitting with “______” position of arms
- high
- end-range
- traction
- posterior
- mid thoracic spine on lower thoracic spine
- “gator”
Upper Thoracic Distraction Thrust:
- Rate of Force: _____ velocity
- Location in Range of Available Movement: ___-range
- Direction of Force: _________ force
- Target Force:
- Mobilizing: _______ cervical/ ______ thoracic
- Relative Structural Movement: upper thoracic/ lower cervical spine on ____-thoracic spine
- Patient Position: ______ with fingers interlocked behind head
- high
- end-range
- traction
- lower cervical/upper thoracic
- mid
- sitting
Supine 1st Rib:
-Rate of Force: ____ velocity for thrust, ____ velocity for oscillation
-Location in Range of Available Movement: ___-range for thrust, appropriate range for oscillation
-Direction of Force: ______,_____,______ force
-Target Force:
-Mobilizing: cranial surface 1st rib
-Relative Structural Movement: 1st rib on thoracic spine
-Patient Position: _______; c-spine
ipsilateral sidebending, contralateral
rotation, slight extension
- high, low
- end-range
- caudal, medial, ventral
- supine
Costotransverse Mobilization:
-Rate of Force: ___ velocity for oscillation
-Location in Range of Available Movement: ___-range for thrust, appropriate range for oscillation
-Direction of Force:
-Costal force: ventral, caudal, ipsilateral lateral
-Thoracic force: ventral, contralateral lateral, slight cranial
-Target Force:
-Mobilizing:
-Thoracic: dorsal surface contralateral articular pillar
-Rib: dorsal surface
-Relative Structural Movement: rib on
transverse process of thoracic spine
-Patient Position: prone
- low
- end-range
C-SPINE THRUST MANIPULATION
C-SPINE THRUST MANIPULATION
Are we allowed to do c-spine manipulations without a referral?
Yes
C0:C1 Traction:
- Rate of Force: ____ velocity
- Location in Range of Available Movement: ___-range
- Direction of Force: _______ force
- Target Force:
- Mobilizing: lateral aspect of _________ occipital protuberance
- Stabilizing: _______ with chin cradle grip
- Relative Structural Movement: ________ on c-spine
- Patient Position: _______, ipsilateral sidebend and contralateral rotation upper cervical spine
- high
- end-range
- cranial
- ipsilateral
- cranium
- cranium
- supine
