Download presentation
Presentation is loading. Please wait.
1
chapter 18 Spine and Sacroiliac
2
Vertebral Column 33 vertebrae –7 C/S (cervical spine) –12 T/S (thoracic spine) –5 L/S (lumbar spine) –5 sacral –4 coccygeal
3
Spinal Curves Primary curve –Kyphosis: “C” curve –Convex posteriorly –Thoracic and sacral regions Secondary curve –Lordosis –Convex anteriorly –Cervical and lumbar regions
4
Curve Functions Dynamically Extension: lordosis / kyphosis Flexion: lordosis / kyphosis
5
Good News: Provide strength and resilience to column –Compressive forces are shared between convex curves and supporting soft tissue –Absorb, distribute, and dissipate loads through axis Bad News: Consequence = Shear forces at transition zones potential breakdown sites Good News-Bad News of Spine Curves
6
Curvature Line of gravity in anatomical position –Mastoid process –Anterior to L/S junction and sacroiliac (SI) joint –Anterior to 2nd sacral vertebra –Posterior to hip joint –Anterior to knee joint –Anterior to ankle (continued)
7
Curvature (continued) Structures contributing to curves: –Intervertebral discs: broader anteriorly in cervical and lumbar regions –Orientation of articular processes/facets –Attachment/alignment of ligaments and muscles
8
Curvature Variability Changes in one curve compensation in joints above and below Exaggerated curves stress to muscles, ligaments, joints, discs, sometimes nerves Exaggerated curves change volume within body cavities
9
Treatment Program Considerations Examination –Healing process –SINS –Response to previous treatment Modalities: pain, edema, healing Need to maintain level of conditioning Goals and progression
10
Williams’ Flexion Exercises Paul C. Williams, orthopedic surgeon Lordosis the cause of back pain Six exercises for chronic low-back pain (LBP) Emphasis on flexion Strengthening of abdominal and gluteal muscles Stretching of hip flexors and erector spinae
11
Figure 18.1a
12
Figure 18.1b
13
Figure 18.1c
14
Figure 18.1d
15
Figure 18.1e
16
Figure 18.1f
17
Figure 18.1g
18
McKenzie Extension Program Robin McKenzie: New Zealand physiotherapist Disc the primary cause of back pain Predisposing factors in back pain: –Prolonged sitting in flexion –Frequency of flexion –Lack of extension Emphasis on extension to relieve disc pressure
19
McKenzie Mechanical Syndrome Classifications Postural syndromes Dysfunctions Derangements
20
Postural Syndromes Pain in LB (L/S), in neck (C/T), or interscapular (T/L) No N/T Intermittent Non-severe Age: teens, early 20s Aggravating factor: prolonged postures History: gradual onset, insidious; often comes on with change in activity, lifestyle Exam: essentially negative Can progress to dysfunction
21
Dysfunctions Loss of accessory movement, adaptive shortening pain Pain: constant or intermittent, changes with postural stresses Aggravating factor: prolonged posture Easing factor: movement Exam: range of motion (ROM), rep ROM pain, Ø neural signs and symptoms (S/S), Ø tension S/S, palpation = stiffness, sacrotuberous (ST) mobility Rx: posture, correct deficiencies, moderate
22
Derangements Movements of the spine influence disc hydrostatic mechanisms. Normal position of vertebrae is altered, causing alteration in disc nucleus. Disc is source of pain, not inflammation. If derangement is medial to nerve root, shift is to the side of pain. If derangement is lateral to nerve root, shift is away from pain.
23
McKenzie Derangements: #1 Mild disc bulge Central/symmetrical pain Rarely referred pain Pain = secondary to irritation of posterior annulus and posterior longitudinal Ligament (PLL) Pain subsides in a few days Rx: education for posture and mechanics, exercises
24
McKenzie Derangements: #2 Moderate disc bulge Central/symmetrical pain May or may not have buttock/thigh pain Flat lumbar spine Difficulty with position changes or sustained sitting Rx: position prone; add treatment for #1 \QQ AU: XQQ\
![McKenzie Derangements: #2 Moderate disc bulge Central/symmetrical pain May or may not have buttock/thigh pain Flat lumbar spine Difficulty with position changes or sustained sitting Rx: position prone; add treatment for #1 \QQ AU: XQQ\](http://images.slideplayer.com./35/10431305/slides/slide_24.jpg "McKenzie Derangements: #2 Moderate disc bulge Central/symmetrical pain May or may not have buttock/thigh pain Flat lumbar spine Difficulty with position changes or sustained sitting Rx: position prone; add treatment for #1 \QQ AU: XQQ\")
25
McKenzie Derangements: #3 More posterolateral bulge Unilateral/asymmetrical pain Buttock/thigh pain No deformity Goal: centralize pain Rx: Repeated extension in lying (REIL); add treatment for #1
26
McKenzie Derangements: #4 Unilateral or asymmetrical pain Buttock/thigh pain Lateral shift (lumbar scoliosis) Rx: correct shift; centralize pain; treatment as for #1
27
Figure 18.2a
28
Figure 18.2b
29
McKenzie Derangements: #5 Unilateral/asymmetrical pain Buttock/thigh pain with pain below knee No deformity Bulge causing annular, nerve root, dural irritation Rx: REIL; cautious progression to centralization to elimination; treatment as for #1
30
McKenzie Derangements: #6 Unilateral/asymmetrical pain Buttock/thigh pain with pain below knee Complaints of paresthesia, weakness, numbness Lateral shift Disc herniation Rx: carefully reduce shift; centralize pain; treatment as for Derangements 1-4; avoid flexion 8-12 weeks
31
McKenzie Derangements: #7 Unilateral/asymmetrical pain Buttock/thigh pain Fixed lumbar lordosis Anterior or anterolateral bulge irritation to annulus, anterior longitudinal ligament (ALL) Rx: Repeated flexion in lying (RFIL), repeated flexion in standing (RFIS) with progressive knee flexion
32
Figure 18.3a
33
Figure 18.3b
34
Figure 18.3c
35
Figure 18.3d
36
Figure 18.3e
37
Figure 18.3f
38
Figure 18.3g
39
Figure 18.3h
40
Elements of Complete Spine Program Modalities Joint and soft-tissue mobilization Posture correction and stabilization Exercises –Cardiovascular –Flexibility –Strength and endurance: Abdominal muscles: stabilizers and movers Spinal: stabilizers and movers Hips
41
Soft-Tissue Referral Patterns Cervical can refer to shoulder Thoracic can refer to cervical or lumbar Lumbar can receive referrals from T/S and SI
42
Figure 18.4a
43
Figure 18.4b
44
Figure 18.4c
45
Figure 18.5a
46
Figure 18.5b
47
Figure 18.5c
48
Figure 18.6a
49
Figure 18.6b
50
Figure 18.6c
51
Figure 18.6d
52
Figure 18.6e
53
Figure 18.7ab
54
Figure 18.7c
55
Figure 18.7d
56
Figure 18.8a
57
Figure 18.9a
58
Figure 18.9b
59
Figure 18.9c
60
Figure 18.9d
61
Figure 18.9e
62
Figure 18.9f
63
Figure 18.9g
64
Figure 18.9h
65
Figure 18.11a
66
Figure 18.11b
67
Figure 18.11c
68
Figure 18.12a
69
Figure 18.12b
70
Figure 18.12c
71
Figure 18.13
72
Joint Mobilization Place patient so joints are in resting position. Correct body mechanics and force application. Know your goals: What grade to use? No exacerbation of symptoms. If one segment is hypomobile, adjacent segment may be hypermobile. How segments can refer: –C/S T4 –SI L/S Assess before, during, and after treatment.
73
Recording Joint Mobilization Central posterior-anterior (PA) Symbol for central PA: Unilateral posterior-anterior Symbol for unilateral PA: R = Symbol for rib PA: R = Record grade, direction, reps or time and bouts: L/S 4-5: grade III x 1 min, grade IV x 1 min, grade IV x 1 min, grade III x 1 min
74
Vertebral Artery Tests for Arterial Compromise Test before joint mobilization application to C/S Positive symptoms =dizziness, light- headedness, nausea, blurry vision, tinnitus, headaches (HA), facial sensation Five static tests, two active tests
75
Vertebral Artery Tests Supine and sitting/standing Position held 10 s at very end of ROM Positive signs = nystagmus, change in pupil size; ask about any symptoms Test 1: rotation to right Test 2: rotation to left (active in sitting) Test 3: hyperextension (active in sitting) Test 4: rotation and extension to left Test 5: rotation and extension to right
76
Active Vertebral Artery Tests Patient sitting (or standing) Clinician behind patient Test 1: Clinician stabilizes shoulders while patient turns head to right for 10 s and then to left for 10 s Test 2: Clinician stabilizes head while patient turns body to left and right for 10 s + in first test and not second = vestibular + second test: possible vertebral artery compromise
77
Passive Vertebral Artery Tests Patient supine Hyperextension of C/S Rotation to L, then extension of C/S Rotation to R, then extension of C/S
78
Positive Vertebral Artery Results Send to physician. Avoid neck rotation and joint mobilization until patient seen by physician.
79
Figure 18.14
80
Figure 18.16
81
Figure 18.17a
82
Figure 18.17b
83
Figure 18.17c
84
Figure 18.18
85
Figure 18.19
86
Figure 18.20
87
Figure 18.21
88
Figure 18.22a
89
Figure 18.22b
90
Figure 18.22c
91
Flexibility Exercises Research is lacking on flexibility duration and repetitions for scar tissue. Stretch recommendation: hold for 15-20 s. Stretch is repeated three or four times. Develop, justify your own system. Watch for substitutions!
92
Figure 18.24a
93
Figure 18.24b
94
Figure 18.25a
95
Figure 18.25b
96
Figure 18.97
Similar presentations
