1. MSK Rev SK, PT
Anatomy & Biomechanics: unique characteristics of the spine
Cervical spine: MT, exercise
Thoracic Spine: OP, MT, exercise and regional interdependence
Lumbar Spine: common diagnosis, further testing, numerous exercise options, MT
SIJ: Pittsburgh Rules
Small group / Clinical Reasoning Vignettes: Whiplash, CLBP, Upper Quadrant complaints

2. Anatomy & biomechanics in 3 slides
Cervical:
No C1 SP
Vertebral artery twists from c1 to c2
AO & AA: flex & Rot opp
C-sp: flex & rot same

3. Anat… Thoracic Easy to palpate Rotation!
Related to neck, shoulder, lumbar
“any” rotational entities
List:

4. Anat…
Lumbar
Not designed well for flexion…but you don’t need to avoid it in a healthy spine
Pll
Pl disc
Lack of compression from multifidi
HIp

5. Cervical Quebec c-sp rules Vertebral artery instability
> 65 yo, extremity paresthesia, dangerous mechanism
Amb?, immediate pain?, midline tender?, complex Mva?
AROM rotation bilateral = or > 45 degrees
Vertebral artery
Cardiac precautions present?
Cranial nn signs?
instability

6. Cervical mt soft tissue: if it aint tight, don’t stretch it
Upper trap, Levator, scalenes (C2 – 7 TP’s to Rib 1,2) / SCM
Mob’s: as always follow up with edu & Te
Open, close, OA flex or SOR

7. Cervical TE Acute neck pain: very little evidence Chronic neck pain:
cervico-scapulothoracic and upper extremity strength training
scapulothoracic and upper extremity endurance training for slight beneficial effect on pain
combined cervical, shoulder and scapulothoracic strengthening and stretching exercises varied
Low evidence: mindfulness, general fitness, stretching only, feedback, breathing
C-SP HA & RADICULOPATHY: moderate quality evidence supports specific static-dynamic cervico-scapulothoracic strengthening/endurance exercises including pressure biofeedback
Snags: low evidence
Flexibility: combine with other TE, be specific and target the usual suspects
Exercise for coordination, strength, endurance: strong evidence / target deep neck flexors & usual suspects
Traction: combine intermittent traction with other treatment
Pt education: good to encourage return to normal activity
reassurance that they should get better
avoid giving them a ‘diagnosis’ when FAB’s are high
C-SP Mobilization: strong evidence, combine with other treatments
TH-SP Mobilization: lots of evidence
Centralization: ‘better’ in L-SP

8. Th-sp OP: BMD > 1 SD below ave / T score -1 or > Fx
Contraindications
Address fall prevention

9. MT
Soft tissue: hypertonicity segmental!
Mobs:
Ctj
Supine gap

10. Th-sp TE Must include te for: neck, shoulder, l-sp, hip and
& rotational regions or joints
posture

11. Th-sp Ri So much to say here… Shoulder: impingement, rtc pathology
Neck: everything really
Lumbar
Hips, feet, upper cervical, sports, job, repetitive motion, bike, swimming, etc.

12. L-sp
Stenosis: B pain, LE > LBP, walking & standing, better w flex, > 65 yo
DDD: NORMAL
Instability is now movement impairment
Treat hypo areas, motion, retrain (mutifidii, transvers abs, pelvic floor)
Disc: extend, no flex
MM strain, sprain

13. L-sp te options Just too many to list… In general: Get them moving
Don’t peripheralize
Walk
Strengthen & retrain
educate

14. L-sP TE Centralize, Centralize, and repeat TBC:
Mobilization: MT, exercise: ROM, PREs (get specific), EDU
Traction: refer to Fritz
Stabilization: engage TA, strengthen RA, don’t forget about PF, evidence exists for multifidii
Specific Exercise: ROM (vary WB and NWB), PREs: strength v endurance or both
3 x 10 is lame
consider history
the category is SPECIFIC exercise, not PROTOCOL exercise, or ‘what is the machine I have here at my clinic’ exercise…
Disc: wake up ritual (prone, POE, PPU), lumbar roll, AVOID flexion, APT
OA: move more than usual, but not too much right away
Stenosis: SKTC, seated flex, DKTC, LTR, PPT
MM spasm / strain: ROM, STM, modalities, EDU

15. L-sp MT Lumbar gapping Remember contraindications Sore side up Flex up
Rotate down
Pre manip hold
thrust along line of femur on pelvis
Remember contraindications

16. Pittsburgh sij rules Doesn’t exist Massively overtreated in this area
There is simply no credible evidence anywhere that this should be the first region treated, that we can palpate it, or that it moves at all in most people.
If you are told you need to treat the pelvis first before doing anything else, please let me know.
Even if someone has pain in the sij is likely not si pain (please help)

20. One INJURY YOU CAN’T Treat
HE was really in charge of the worlds 5th largest economy
Cal-E-Forn-E-Ah