Treatment of the Thoracic Spine

Question 1

Dá um exemplo de quando poderá ser útil a utilização do Extension Based Thrust.

Answer 1

Por exemplo, quando o paciente tem dor na extensão da coluna torácica

Question 2

Que técnica poderá ser útil em caso de dor com a flexão da coluna torácica ou inclinação lateral?

Answer 2

Flexion based thrust (pistol technique)

Question 3

Como se aplica a Supine Thoracic Distraction?

Answer 3

The belt is fastened around the back of the clinician and is looped under the thoracic region of the patient. The clinician pulls backward on the belt which applies a strong traction force through the thoracic region.

Também é possível realizar tração na posição de sentado.

Question 4

Como se realiza uma Unilateral Posterior Anterior Mobilization to the costotransverse joint? E a mobilização da faceta?

Answer 4

A unilateral posterior anterior force is applied to the costotransverse joint of the patient. The costotransverse joint is palpated approximately two fingers width lateral to the spinous processes.

The facet joint is located just lateral to the spinous process region at different levels than the spinous process.

Question 5

Como aplicar uma Extension based thoracic thrust manipulation (screw manipulation)?

Answer 5

This thrust manipulation can be performed by applying contralateral force on either the same level or one level above and one level below. The pisiforms of the clinician are used as the contact points to the facets or costotransverse joints of the patient.

Question 6

Como realizar Flexion based thoracic manipulation (the pistol)?

Answer 6

The patient is held in a flexed position and the clinician provides a blocking force below the region of the targeted manipulation. The flexed position is held throughout the procedure.

Question 7

O que acontece no Coronal Plane manual stretching for scoliosis?

Answer 7

In all manual stretching procedures the tightened tissue is lengthened by providing a horizontal force across the muscle fibers.

Question 8

Qual o princípio dos Scoliosis stabilization exercises?

Answer 8

In all stabilization exercises conscience motor control effort is made to contract lengthened tissue and to normalize the posture.

Question 9

Como providenciar Sitting Thoracic Extension stretching?

Answer 9

Using their hand the clinician applies an anterior mobilization force to the back of the patient. By placing the knee and adding force through their own elbow the clinician can provide a much stronger mobilization force.

Question 10

Como providenciar ProneThoracic Extension stretching?

Answer 10

Using a belt the patient is strapped snuggly to the table just below the restricted region. The patient then clasps their fingers together and places each on their forehead. The clinician then provides an extension force to the patient letting the belt assist in the stretch.

Question 11

Como aplicar manualmente Chin retraction and lower cervical extension?

Answer 11

The clinician maintains chin retraction and performs a posterior mobilization force moving the patient into lower cervical extension.

Question 12

O que nos pode ajudar a corrigir a anteriorização da cabeça em casos com escoliose?

Answer 12

Forward head correction leads to a significant and permanent improvement in functional status.
• Anterior neck flexor and posterior neck extensor strengthening;
• Pec minor and major stretching (uni and bilateral);
• Scapular Retractor Strengthening exercises (prone with weights).

Question 13

Deve-se usar bracing em problemas posturais?

Answer 13

Bracing of the spine in patients with Scheuermann’s kyphosis results in permanent correction of vertebral deformity, unlike bracing in patients with idiopathic scoliosis.
There is very low quality evidence in favor of using braces for scoliosis, making generalization very difficult.

Question 14

Qual a ordem proposta para tratamento de hipercifose?

Answer 14

1) Prone trunk lifts to midline; 2) Prone trunk lifts with weighted backpack; 3) Quadruped alternative arm/left lift; 4) Chest stretching; 5) Prone hip extension/knee flexion; 6) Alternating shoulder flexion with diaphragmatic breathing on foam roller; 7) Conscience postural correction; 8) Neutral sit to stand.

Question 15

Qual a possível sequência para o tratamento fraturas por compressão associadas à baixa densidade óssea?

Answer 15

1) Reduction of Pain; 2) Reduction of Deformity; 3) Improve ADL’s (por exemplo, através da educação, atividades que devem ser evitadas); 4) Increase Bone Mass; 5) Reduction or Abolishment of Falls.

Question 16

Qual o plano de movimento em que os exercícios parecem ajudar mais na prevenção de fraturas de compressão em pessoas com osteoporose?

Answer 16

Extension based exercises (paraspinalis, etc.). The target is aquiring bone mass, once low bone mass is the stronghest factor to compression fractures.

Question 17

Quais as considerações acerca do exercício, no que diz respeito à densidade óssea?

Answer 17

• Bones must be overloaded for exercise to be
effective;
• Non-Weight Bearing exercises may not be effective;
• Low Load, high repetition exercises may lead to
low bone mass;
• High loads and low repetitions lead to increased
bone mass.

Question 18

Quais os príncipios no tratamento do thoracic outlet syndrome?

Answer 18

Treatment should initially address comfort, control, and relief and then progress to the neurovascular component. Finally, strengthening and conditioning, if tolerated, are implemented.
Properly educating the patient to achieve behavior modification, exercise compliance, symptom control, and postural correction is requisite to optimal results.

Question 19

Que tipo de exercícios adjuntivos podem ajudar na correção de hipercifose?

Answer 19

Prone hip extension/knee flexion exercises (There is a relationship between strengthening these areas and improving the kyphotic deformity).

Question 20

Existe alguma associação entre a escoliose e a atividade física?

Answer 20

Results demonstrate that systematic exercising is probably not associated with the development of Adolescent Idiopathic Scoliosis (it won’t make it worse). Actively participating in sports activities doesn’t seem to affect the degree of the main scoliotic curve either.

Question 21

Qual a associação entre a cifose torácica e a função?

Answer 21

Kyphosis, by both clinical and quantitative assessment, is associated with diminished function, especially performance of mobility tasks.
If predictive, the impact of kyphosis on physical function should be considered in osteoporosis prevention and treatment counseling.

Question 22

O pilates é eficaz na melhoria da postura torácica?

Answer 22

Individually designed Pilates-based exercise program was feasible for healthy older adults, and the high attendance rate supports the suitability of the exercise program over a long period.
Small improvement was only observed in the thoracic kyphosis during standing. The longterm effect of Pilates exercise requires further investigation.

Question 23

Em que tipo movimento podem ser baseados de exercícios para melhorar a hipercifose torácica?

Answer 23

Extension based exercises.
Back extensor strength had a significant negative correlation with thoracic kyphosis (r = -0.30, P = 0.019) and a positive correlation with lumbar lordosis (r = 0.26, P = 0.048) and sacral inclination (r = 0.34, P = 0.009).
However, bone mineral density and physical activity score did not show any significant correlations with the radiographic factors.

Question 24

Qual a melhor posição para realizar exercícios gerais para reduzir risco de fratura vertebral e a osteoporose?

Answer 24

Back exercises performed in a prone position, rather than a vertical position, may have a greater effect on decreasing the risk for vertebral fractures without resulting in compression fracture.

Question 25

Refere alguns benefícios da prática regular de exercício físico geral nos idosos.

Answer 25

In older adults, regular exercise provides numerous health benefits that include improvements in blood pressure, coronary artery disease, diabetes, lipid profile, osteoarthritis, osteoporosis, mood, neurocognitive function, and overall morbidity and mortality.

Question 26

Existe benefício ao adicionar exercício terapêutico ao tratamento conservador em Thoracic Outlet Syndrome?

Answer 26

After 6 months of conservative treatment (with postural and strenghtening based exercises) 34% of patients showed full recovery, 28% had marked improvement, 32% had partial improvement while 6% patients reported with persistent severe symptoms.