Test 2 Flashcards
Acute Low Back Management.
Patient can be seen 2 times per day (6 hours apart) until they are out of antalgia.
Next, adjust 1x /day until and as the patient improves
keep reducing the frequency until the subluxation is corrected
They are instructed to: ice 20 minutes/ hour
walk at least for 5 minutes each hour
No sitting
Mild stretching of the lower back and buttocks
Sponylolesthesis-
typically spondolytic- spondylolisthesis
Physical signs
Patient presents with hyperlordotic posture Tight hamstring musculature Lumbar muscle spasms
Sponylolesthesis-
typically spondolytic- spondylolisthesis
Symptoms
*Sometimes there will be no symptoms
Soreness/achiness in the low back, especially after exercise
Pain and/or weakness in one or both thighs or legs
Unlikely to have paresthesias or radicular pain
Possible reduced ability to control bowel and bladder functions
Sponylolesthesis-
typically spondolytic- spondylolisthesis
Exam findings
Motion is restricted at the spinous of the involved segment
Spinous is more prominent because of the posterior migration of the spinous
Edema around and inferior to the spinous
Spondylo grade 1 or 2..
How to adjust?
side posture, contacting the segment below the spondylolisthesis
Spondylo grade 3 or 4
How to adjust?
prone on the hi-lo table with the abdominal/ thoracic piece locked, contacting the segment below the spondylolisthesis
How do we manage a Spondy?
Adjust only when symptomatic about every other day until the patient is out of pain presentation.
Core stabilization and functional movement exercises
Healing time for Spondy
Varied results for time of correction
Usually less than 2 weeks to see a significant reduction in pain.
Facet Syndrome Symptoms
- Hip and Buttock pain- (diffuse, achy, stiff, tight, sore)
- Cramping leg pain- Primarily above the knee
- Low back stiffness, especially in the morning or with inactivity
- Absence of paresthesia
Facet Syndrome Physical Findings?
1. Pain on hyperextension of the lumbar spine 2. Absence of neurologic deficit 3. Hip, buttock or back pain on SLR 4. Absence of root tension signs 5. Local paralumbar tenderness especially around the facets joints.
Facet Syndrome Exam findings
Nervoscope reading at the involved level.
Restricted motion at the involved segment
x-ray shows a vertebral segment in an extension malposition with possible facet sclerosis
or
x-ray may show a degenerated disc and facet sclerosis
How do we adjust a facet Syndrome?
Side posture is preferred for the lumbar facet syndrome.
Cervical chair preferred for cervical facet syndrome.
What is the management for Facet Syndrome?
Adjust
2-3x / week until the subluxation is corrected.
Patient must perform exercises to reduce extension loading.
Core stabilization and function movement exercises
Healing time for facet syndrome
Facet joint motion will increase and end the pain presentation in 3-5 visits.
This subluxation should take about 8-12 visits to make the full correction
What are the causes for FUNCTIONAL scoliosis?
Postural Scoliosis
Hysterical Scoliosis
Nerve Root Irritation
Herniation
Tumors
Segmental and Postural Positional Dyskinesia
Inflammatory (appendicitis)
Related to leg length inequality
Related to contracture about the hipLeg length inequality
This can be functional or structural
but most commonly what?
Functional
What are the 5 heel lift rules?
- The subluxation is unstable
- The AD is more than 6mm
- Lumbar convexity is to the short leg side
- Lumbar body rotation is to the short leg side
- Patient is fully formed and under the age of 45
Medical treatment for idiopathic scoliosis
General guidelines include re-evaluation every 4-6 months (including a PA erect T-L spine) for patients who are skeletally immature and have curves less than 25°.
Brace (orthotic) management of adolescent idiopathic scoliosis is used in children with spinal deformity and curve magnitudes of 25-40° who are skeletally immature and with significant growth remaining. The primary goal of brace management is to stop curve progression. Any amount of curve correction at the end of brace treatment must be considered a “bonus.” Brace removal for participation in sports is strongly encouraged.
Surgery for idiopathic scoliosis is suggested when curve magnitude is 50° or more in either the previously untreated patient or in one who fails brace treatment. Surgery is undertaken with two goals in mind. The primary one is to prevent spine deformity progression and the secondary one is to diminish spinal deformity.
The natural history of idiopathic scoliosis during adulthood is one of continued progression if the curves tend to be more than 50° at the end of growth.
When adjusting a facet syndrome
At L5
How do we thrust?
At L5- The Thrust is
- P-A and I-S according to the facet joint angle. Then…
- P-A and S-I to reduce the posterior translation.
What is the case management for L5 facet syndrome?
Case Management:
Facet joint motion will end the pain presentation. (3-5 visits)
This subluxation should take about 8-12 visits.
Patient must be put on exercises to reduce extension loading.
Disc healing times
Disc healing time Lateral—2 weeks Medial—4 weeks Subrhizal---4-6 weeks Central—6 weeks
Protocol for acute low back
Protocol 2 times a day ( 6hrs apart) no sitting ice 20 mins every hour walk 5 mins each hour 14x36 full spine
Indications for Knee chest
Indications:
- Pregnancy
- Elderly (rigid)
- Osteoporosis
- Patient is larger, especially if larger than doctor
- Children
- Straightened lumbar spine
Contraindications for knee chest
Contraindications:
- Pain on extension ( acute low back, facet syndrome)
- Very Flexible patient
- Knee/Hip Problems
- Spondylolysthesis
- Knife Clasp
- Scoliosis
- Emotionally unable to handle the table
Relative contraindications with spondylo
Relative Contraindications:
Relative contraindications with spondylo Relative Contraindications: 1. Asymptomatic 2. Pregnancy 3. Abdominal Aneurysm 4. Greater than a Grade 2 In the Gonstead System, the ONLY Contraindication is: ASYMPTOMATIC
