1. Copyright © 2013. F.A. Davis Company Part IV: Exercise Interventions by Body Region Chapter 15 The Spine: Management Guidelines

2. Copyright © 2013. F.A. Davis Company SPINAL PATHOLOGIES AND IMPAIRED SPINAL FUNCTION

3. Copyright © 2013. F.A. Davis Company  Definitions – Herniation – Protrusion – Prolapse – Extrusion – Free sequestration Injury and Degeneration of the Disk

4. Copyright © 2013. F.A. Davis Company  Fatigue Breakdown and Traumatic Rupture  Axial Overload  Age  Degenerative Changes  Effect on Spinal Mechanics Injury and Degeneration of the Disk (cont'd)

5. Copyright © 2013. F.A. Davis Company  Tissue Fluid Stasis – Symptoms may be similar to those of disc lesions Disc Pathologies and Related Conditions

6. Copyright © 2013. F.A. Davis Company  Etiology of Symptoms – Pain – Neurological signs and symptoms – Variability of symptoms – Shifting symptoms – Inflammation Signs and Symptoms of Disk Lesions and Fluid Stasis

7. Copyright © 2013. F.A. Davis Company  Onset and Behavior of Symptoms from Disk Lesions  Objective Clinical Findings in the Lumbar Spine  Objective Clinical Findings in the Cervical Spine Signs and Symptoms of Disk Lesions and Fluid Stasis (cont'd)

8. Copyright © 2013. F.A. Davis Company  Disc Degeneration – Initial changes – Altered muscle control – Progressive bony changes  Related Pathologies – Segmental (clinical) instability – Stenosis – Neurological symptoms: radiculopathy – Dysfunction Pathomechanical Relationships of the Intervertebral Disk and Facet Joints

9. Copyright © 2013. F.A. Davis Company  Common Diagnoses and Impairments from Facet Joint Pathologies – Facet sprain/joint capsule injury – Spondylosis, osteoarthritis, degenerative joint disease – Rheumatoid arthritis – Ankylosing spondylitis – Facet joint impingement (blocking, fixation, extrapment) Pathology of the Zygapophyseal (Facet) Joints

10. Copyright © 2013. F.A. Davis Company  Compression Fracture Secondary to Osteoporosis  Scheuermann’s Disease Pathology of the Vertebrae

11. Copyright © 2013. F.A. Davis Company  General Symptoms From Trauma  Common Sites of Lumbar Strain  Common Sites of Cervical Strain  Postural Strain  Emotional Stress  Functional Activity Limitations and Participation Restrictions Pathology of Muscle and Soft Tissue Injuries: Strains, Tears, and Contusions

12. Copyright © 2013. F.A. Davis Company  Neutral Zone – Neutral spine  Instability Pathomechanics of Spinal Instability

13. Copyright © 2013. F.A. Davis Company MANAGEMENT GUIDELINES BASED ON STAGES OF RECOVERY AND DIAGNOSTIC CATEGORIES

14. Copyright © 2013. F.A. Davis Company  Examination and Evaluation – History, systems review, and testing – Stage of recovery Acute inflammatory stage Acute stage without signs of inflammation Subacute stage Chronic stage – Diagnosis, prognosis, and plan of care Principles of Management of the Spine

15. Copyright © 2013. F.A. Davis Company  Patient Education  Symptom Relief or Comfort – Extension bias: extension syndrome – Flexion bias: flexion syndrome – Non-weight-bearing bias:traction syndrome  Kinesthetic awareness of safe postures and effects of movement General Guidelines for Managing Acute Spinal Impairments: Protection Phase

16. Copyright © 2013. F.A. Davis Company  Muscle Performance: Deep Segmental Muscle Activation and Basic Stabilization – Lumbar region: deep segmental muscle activation – Cervical region: deep segmental muscle activation – Basic stabilization  Basic Functional Movements General Guidelines for Managing Acute Spinal Impairments: Protection Phase (cont'd)

17. Copyright © 2013. F.A. Davis Company  Pain Modulation  Kinesthetic Training  Stretching/Manipulation  Muscle Performance  Cardiopulmonary Conditioning  Postural Stress Management and Relaxation Exercises  Functional Activities General Guidelines for Managing Subacute Spinal Impairments: Controlled Motion Phase

18. Copyright © 2013. F.A. Davis Company  Emphasize spinal control in high-intensity and repetitive activities  Increase mobility in restricted muscles/joints/fascia/nerve  Improve muscle performance; dynamic trunk and extremity strength, coordination, and endurance  Increase cardiopulmonary endurance  Emphasize habitual use of techniques of stress relief/relaxation and posture correction  Teach safe progression to high-level/high-intensity activities  Teach healthy exercise habits for self-maintenance General Guidelines for Managing Chronic Spinal Impairments: Return to Function Phase

19. Copyright © 2013. F.A. Davis Company  Management of Acute Symptoms – Traction – Harness – Pool  Progression Management Guidelines: Non-Weight-Bearing Bias

20. Copyright © 2013. F.A. Davis Company  Principles of Management – Effects of postural changes on intervertebral (IV) disk pressure – Effects of bedrest on the IV disk – Effects of traction on the IV disk – Effects of flexion and extension on the IV disk and fluid stasis – Effects of isometric and dynamic exercise – Effects of muscle guarding  Indications, Precautions, and Contraindications for Interventions-Extension Approach Management Guidelines: Extension Bias

21. Copyright © 2013. F.A. Davis Company  Management of Acute Symptoms – Extension – Lateral shift correction – Patient education – Lumbar traction – Joint manipulation – Kinesthetic training, stabilization, and basic functional activities Techniques Using an Extension Approach in the Lumbar Spine

22. Copyright © 2013. F.A. Davis Company  Management When Acute Symptoms Have Stabilized – Signs of improvement – Intervention Techniques Using an Extension Approach in the Lumbar Spine (cont'd)

23. Copyright © 2013. F.A. Davis Company  Acute Phase – Passive axial extension (cervical retraction) – Patient education – Traction – Kinesthetic training for posture correction  Progression as Symptoms Stabilize Interventions to Manage a Disk Lesion in the Cervical Spine

24. Copyright © 2013. F.A. Davis Company  Indications for Surgery  Common Surgeries – Laminectomy – Fusions  Procedures Disc Lesions: Surgery

25. Copyright © 2013. F.A. Davis Company  Maximum Protection Phase – Patient education – Wound management and pain control – Bed mobility – Bracing – Exercise – Contraindications Disc Lesions: Postoperative Management

26. Copyright © 2013. F.A. Davis Company  Moderate and Minimum Protection Phase – Scar tissue mobilization – Progressive stretching and joint mobilization/manipulation of restricted tissue – Muscle performance – Gait training – Contraindications Disc Lesions: Postoperative Management (cont'd)

27. Copyright © 2013. F.A. Davis Company  Principles of Management – Effect of position – Effect of traction – Effect of trauma and repetitive irritation – Effect of meniscoid tissue  Indications and Contraindications for Intervention: Flexion Approach Management Guidelines: Flexion Bias

28. Copyright © 2013. F.A. Davis Company  Management of Acute Symptoms – Rest and support – Functional position for comfort – Cervical traction – Correction of lateral shift – Correction of meniscoid impingements  Management When Acute Symptoms Have Stabilized Techniques Utilizing a Flexion Approach

29. Copyright © 2013. F.A. Davis Company  Identification of Clinical Instability  Principles of Management – Passive support – Deep segmental muscle activation Lumbar region Cervical region – Progression of stabilization exercises Management Guidelines: Stabilization

30. Copyright © 2013. F.A. Davis Company  Management: Lumbar Spine  Management: Cervical Spine Management Guidelines: Mobilization/Manipulation

31. Copyright © 2013. F.A. Davis Company  Management During the Acute Stage: Protection Phase – Pain and inflammation control Cervical region Lumbar region – Muscle function Cervical region – Reverse muscle action Lumbar region Management Guidelines: Soft Tissue Injuries

32. Copyright © 2013. F.A. Davis Company  Management During the Acute Stage: Protection Phase (cont’d) – Traction – Environmental adaptation  Management in the Subacute and Chronic Stages of Healing: Controlled Motion and Return to Function Phases Management Guidelines: Soft Tissue Injuries (cont'd)

33. Copyright © 2013. F.A. Davis Company MANAGEMENT OF REGIONAL DIAGNOSES

34. Copyright © 2013. F.A. Davis Company  Compression Fracture Secondary to Osteoporosis  Spondylolisthesis  Ankylosing Spondylitis  Scheuermann’s Disease  Rib Subluxation Lower Thoracic and Lumbo-Pelvic Region

35. Copyright © 2013. F.A. Davis Company  Sacraoiliac Joint Dysfunction – Identification of SI impairments – Interventions Shot-gun technique Muscle energy technique to correct an anterior rotated innominate Muscle energy technique to correct a posterior rotated innominate HVT to treat an upslipped innominate Lower Thoracic and Lumbo-Pelvic Region (cont'd)

36. Copyright © 2013. F.A. Davis Company  Tension Headache/Cervical Headache – Etiology – Presenting signs and symptoms – General management guidelines  Cervical Myelopathy  Neck Pain Cervical and Upper Thoracic Region

37. Copyright © 2013. F.A. Davis Company  Structure and Function  Motions of the TMJ  Signs and Symptoms  Etiology of Symptoms – Possible causes of TM joint pain – Relationship to neck pain – Mechanical imbalances Temporomandibular Joint Dysfunction

38. Copyright © 2013. F.A. Davis Company  Principles of Management and Intervention – Reduction of pain and muscle guarding – Facial muscle relaxation and tongue proprioception and control – Control of jaw muscles and joint proprioception – Stretching techniques – Reduction of upper quarter muscle imbalances Temporomandibular Joint Dysfunction (cont'd)

39. Copyright © 2013. F.A. Davis Company  Critical Thinking and Discussion  Laboratory Practice  Case Studies Independent Learning Activities