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Test 1: Treatments Flashcards

1
Q

In treatment for Rotation

if pull right pelvis for rotation the bottom vertebrae is going _____ so the opening occurs on the ____ 


A

if pull right pelvis for rotation the bottom vertebrae is going right so the opening occurs on the opposite side. 


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2
Q

PPIVM to Improve SB

If the problem is at L3/L4: WHAT DO YOU STABILIZE?

A

L3

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3
Q

PPIVM to Improve SB: Prone:

L3/L4

  1. Stabilize
  2. Mobilize
A

STABILIZE

  • -SP of L3 with Thumb
  • -Stabilize on the same side of the SP
  • –Get onto the spinous process, roll off to the soft tissue, stand on that same side of that SP

MOBILIZE:

  • -Abduct Leg
  • -As leg is abducted, pelvis is abducted
  • –Create a fulcrum by stabilizing one SP and moving the SP below
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4
Q

PPIVM to Improve SB: Side-Lying: lumbar SB:

pt position
stabilize
mobilize

A

PATIENT POSITION: side-lying, legs in 90-90

STABILIZE: SP above (L3)

MOBILIZE: Rotate Lower Extremities to the ceiling

  • ->Stand on the side to which you are side bending
  • ->Lift legs up to the ceiling: to tilt the pelvis and create opening

(Sustained stretch is easier since legs are heavy)

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5
Q

Treat PPIVM: how much motion?PPIVM to Improve SB: Side-Lying: lumbar SB:

A

The openings that occur below segment of interest we don’t worry about,

the sustained stretch or the grade 3-4 oscillation is only at the end range of that particular motion segment,

so you wont see a lot of flopping of the leg because only need to do it in that small interspace,

the thumb stays static and the movement comes from below

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6
Q

PPIVM to Improve SB: Side-lying: using Pelvis:

STABILIZE

MOBILIZE

A

Stabilize: SP above (L3)

Mobilize: Rock pelvis cranially/caudally

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7
Q

PPIVM to Improve SB: Sitting:

1) Stabilize
2) Mobilize

A

perhaps for lower thoracic segments

1) Use thumb as fulcrum against SP
2) Sidebend Trunk

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8
Q

How to treat: facet joints are stuck ?

A

Facet joints are stuck: issue in closing on one side or in opening on the opposite side

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9
Q

How to treat: ?

Pain when side bending left and in extension, but side bending right and flexion didn’t cause pain

A

CLOSING ISSUE Pain when side bending left and in extension,

but side bending right and flexion didn’t cause pain

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10
Q

How to treat?

Pain on the right side when side bending left, and pain on right when flex forward

A

OPENING ISSUE

Pain on the right side when side bending left, and pain on right when flex forward

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11
Q

How to treat?

Extension dysfunction where cannot extend

A

Extension dysfunction where cannot extend, close, treat them to get more extension, try to make their facets slide down on each other, the focus is on the sliding down or the closing

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12
Q

PPIVM to Improve Rotation:

What will this help with?

A

This will help with opening

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13
Q

PPIVM to Improve Rotation

PATIENT POSITION

STABILIZE

MOBILIZE

where does opening occur?

A
  1. Patient prone, knees flexed to 90 degrees
  2. Stabilize: Spinous Process
  3. Mobilize: Roll Legs (or can lift from the pelvis)
  4. Sustain stretch or oscillations
  5. Opening occurs on the side to which you rotate the leg to: so if legs are rotated towards me on the left side, opening will be occurring on the left

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14
Q

PPIVM to Improve Rotation: explain the mechanics: in prone moving legs

I am on the left:

A

Roll Legs (or can lift from the pelvis) to me

Pelvis rotates to you

Sacrum rotates right and bumps into L5 and facets lock up

L5 into L4 and facets lock up
There is an opening on my side - feel for it

I stabilize the SP and sustain a stretch or a tiny oscillation

Sustain stretch or oscillations

Opening occurs on the side to which you rotate the leg to: so if legs are rotated towards me on the left side, opening will be occurring on the left

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15
Q

PPIVM to Improve Rotation:

Sitting

  1. stabilize
  2. mobilize
A

Stabilize: SP
Mobilize: Rotate Trunk

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16
Q

Positions:

PPIVM to Improve SB (4)

A
  1. Prone: Abduct Leg
  2. Side-lying: Lift legs up to the ceiling
  3. Sidelying using pelvis: Rock pelvis cranially/caudally
  4. sitting: Sidebend Trunk
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17
Q

Positions

PPIVM to Improve Rotation

(2)

A
  1. Prone: roll legs

2. Sitting : rotate trunk

18
Q

PAIVM

why we use it in treatment?

A

these are movements the patient cannot do on their own: passive accessory intervertebral movements

  1. use grades to achieve goal of pain relief
  2. increasing motion at the motion segment

PAIN RELEIF: grades 1-2 oscillation

INCREASE MOTION: grades 3-4 oscillation, sustained stretch
(I am staying at the barrier, it is not graded)


19
Q

PAIVM to Improve Rotation:

3 options

A
  1. Rotation aginst SP
  2. Rotation using Unilateral TP
  3. Rotation using bilateral TP of adjacent vertebrae with dummy hand technique
20
Q

PAIVM to Improve Rotation:

Rotation against SP

  1. what to do
  2. what to asses
  3. how to implement the grades
A
  1. Isolate the SP, get on the top of it, roll the soft tissue out of the way,

get forearms level with the bed,

push away from me to get rotation towards me

  1. Assess the play
  2. Now implement grades: go to the barrier and come back halfway for a 3, go to the barrier and stay for a 4

21
Q

PAIVM to Improve Rotation:

Rotate Using Transverse Processes: UNILATERAL

What to do

How to incorporate breathing

A

Single TP:
find the TP towards the upper part of the SP, put the heel of hand (can reinforce) there so you can do a gentle downward pressure

Feel what play is available
Break that down to the grades 1, 2, 3, or 4

Breathing: have patient take deep inhale, as patient exhales go into the barrier, deeper into the barrier, deeper into the barrier, deeper into the barrier, hold at end of barrier, as the person inhales ride it back up : push the physiological barrier to the anatomical barrier: then repeat

22
Q

PAIVM to Improve Rotation:

what to do

incorporate breathing

progressive oscillations

A

opposite TPs of adjacent vertebrae

use ulnar border of my hand over my two fingers 


Timed with breathing: push down on the exhale (when doing a P/A, it needs to be in that plane)
since direction of force is P/A we can time the oscillations with breathing

Progressive Oscillation: go into the barrier, deeper into the barrier, deeper into the barrier, deeper into the barrier, hold at end of barrier, as the person inhales ride it back up : push the physiological barrier to the anatomical barrier

23
Q

Which PAIVM to improve rotation do we not time with breathing?

A

Rotation against SP because it is in the transverse plane

24
Q

PAIVM :

how to implement grade 3
how to implement grade 4

A

GRADE 3: go to the barrier and come back halfway for a 3

GRADE 4: go to the barrier and stay for a 4


25
PAIVM to Improve Rotation: if i push SP away from me, to which way is the vertebrae moving?
push away from me to get rotation towards me
26
How to time mobilization with breathing
push down on the exhale (when doing a P/A, it needs to be in that plane) since direction of force is P/A we can time the oscillations with breathing have patient take deep inhale, as patient exhales go into the barrier, deeper into the barrier, deeper into the barrier, deeper into the barrier, hold at end of barrier, as the person inhales ride it back up : push the physiological barrier to the anatomical barrier: then repeat
27
How to do mobilization with progressive oscillations
Progressive Oscillation: go into the barrier, deeper into the barrier, deeper into the barrier, deeper into the barrier, hold at end of barrier, as the person inhales ride it back up : push the physiological barrier to the anatomical barrier
28
What part of breathe cycle push down in mobilization when time with breathing?
push in at the exhale, release at the inhale
29
3 ways to open the Left facet jt?
1. on SP: (contact is on SP, reinforce with my thumb, forearms level to the bed, push away from me) rotate the UPPER vertebrae so that its inferior facet comes away from the superior facet of the vertebrae below: get into the soft tissue and be on the side of the vertebrae, forearm level with the bed, reinforce, push across the table, get an opening this creates rotation towards me and creates the opening 2. Be on opposite TP: do a simple P/A: heel of my hand and create the rotation 3. Dummy hand technique: go across stay on upper vertebrae on the right and finger on lower vertebrae on the left and create opening between the two on the left: dummy hand and come over it, press down, and create rotation to make the opening
30
When we talk about opening, which facet are we talking about? Top? Bottom?
Rotation, inferior facet of the vertebrae above is coming away from the superior facet of the vertebrae below (so we are talking about the inferior facet of the vertebrae that is moving, the top one, the reference one)
31
PAIVM using P/A:
1. Standard P/A 2. P/A with bilateral Transverse Process 3. P/A spinous process using a flexion angulation 4. P/A spinous process using an extension angulation
32
PAIVM using P/A Standard P/A 1. PURPOSE 2. How to do it (glide between L5 and S1)
1. General joint mobility (Flexion and Extension) introduces some play, not directional 2. Edge of hand on SP of L5 and press downwards to get glide between L5 and S1, not specific to a direction

33
PAIVM using P/A P/A with Bilateral Transverse Processes 1. PURPOSE 2. How to do it
1. For Flexion Adds Flexion: Bows the vertebrae forward: OPEN Since TP sits on upper half, P/A will bow the vertebrae forward when we use bilateral TP we are adding flexion 2. Dummy hand on TP This will open the interspace
34
PAIVM using P/A P/A Spinous Process using a Flexion Angulation 1. PURPOSE 2. HOW on L5
1. For Flexion Go from underneath it and bow it forward: OPEN 2. Divot space between thenar and hypothenar eminenceon SP of L5 from bottom P/A with forearm is at an angle It will bow forward

35
PAIVM using P/A P/A Spinous Process using an Extension Angulation 1. PURPOSE 2. HOW on L5
1. For Extension Come from the top of the SP and bring it into extension: CLOSE Since forearm is at an angle, you will get this by just pushing down 2. Divot space between thenar and hypothenar eminenceon SP of L5 from top P/A with forearm at an angle to get the extension moment
36
Positional Traction:
PATIENT IS HAVING TROUBLE OPENING Set the Patient in Side-Lying: put into position that sustains opening for a period of time: sidebend away rotation towards and flexion [do this prolonged stretch for 2-4 minutes] Lateral Flex to Symptom Relief Flex to the Desired Motion Segment Rotate toward involved side
37
What position for positional traction?
sidebend away, rotation towards, and flexion Lateral Flex to Symptom Relief Flex to the Desired Motion Segment Rotate toward involved side
38
Sidelying demo of positional traction
Isolate the segment of interest, get a pillow under thorax/lumbar spine or blanket roll to open the top side Take bottom leg and flex it up until get opening at that segment Then switch my hands and come from underneath an grab hold of back of back of scapula and draw it forward to rotate him until rotate at my level of interest upper spine is flexed : hand under scapula and draw it anterior Pull from underneath and brought scapula forward to maintain the flexion He stays there: i can do soft tissue work, stimulation, heat, ice, breathing, relaxation: sustain the stretch at that capsule of that facet pair to give us opening
39
Segmental Distraction PURPOSE HOW TO DO IT WHAT POSITION SHOULD PATIENT BE IN
1. In order to see whether it helps at this level 2. Trying to grip 2 adjacent spinous processes, grasp the 2 spinous processes and distract 3. Do not want him in flexion, want natural lumbar lordosis because want the ligaments to be as lax as possible in order to feel the segments
40
Segmental Distraction: DEMO
Demo: Patient sidelie with neutral spine: pillow under head, pillow under thorax, pillow between legs Find the spinous process: stabilize the spinous process on top and mobilize the bottom, use the purchase I have on the sacrum to help with the stretch Stabilize one Grasp the bottom vertebrae Pull along line of the spine Get the distraction Hold for 15-20 seconds and let it back slowly, ease off

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