Evaluation and treatment of the acutely injured spine
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Evaluation and Treatment of the Acutely Injured Spine. Tara J Manal PT, DPT, OCS, SCS Greg Hicks PT, PhD. Personal Hygiene Lifting Walking Sitting Standing. Sleeping Social Activity Traveling Sex Life Pain Intensity. Oswestry Questionnaire Self Report of Performance Limitation.

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Evaluation and treatment of the acutely injured spine

Evaluation and Treatment of the Acutely Injured Spine

Tara J Manal PT, DPT, OCS, SCS

Greg Hicks PT, PhD


Oswestry questionnaire self report of performance limitation

Personal Hygiene

Lifting

Walking

Sitting

Standing

Sleeping

Social Activity

Traveling

Sex Life

Pain Intensity

Oswestry QuestionnaireSelf Report of Performance Limitation

Scale: 0 - 5 Maximum Score = 50

No Max Double Score/100

Limitations Limitations %Disability


Oswestry questionnaire
Oswestry Questionnaire

  • 5 Minutes to Score

  • Initial Classification

  • Documentation of Outcome


Patient staging
Patient Staging

  • Stage I Inability to Perform Stand, Walk, Sit

    • Reduce Oswestry <40%-60%

    • Enable to Sit > 30 min

    • Enable to Stand >15 min

    • Enable to Walk > 1/4 mile


Patient staging1
Patient Staging

  • Stage II Decreased Activities of Daily Living

    • Reduce Oswestry to <20% - 40%

    • Enable to perform ADL’s


Patient staging2
Patient Staging

  • Stage III Return to High Demand Activity

    • Reduce Oswestry to 20% or less

    • Enable to Return to Work


Neurological examination
Neurological Examination

  • Indication - Symptoms Below the Knee

    • LE Sensory Testing

    • Muscle Strength Assessment

    • Reflex Testing

    • Nerve Root Testing

    • Babinski testing

    • Clonus


Pelvic assessment i
Pelvic Assessment I

  • PSIS Symmetry in Sitting

    • Unequal heights

    • Positive Test


Pelvic assessment ii
Pelvic Assessment II

  • Standing Flexion Test

    • Start Position

  • Palpate PSIS

    • Relative position


Pelvic assessment ii1
Pelvic Assessment II

  • Standing Flexion Test

    • End Position

    • Full Flexion

  • Palpate PSIS

    • Relative position compared to standing

  • Positive Test

    • Change in relationship

    • Start to Finish



Supine to sit
Supine to Sit

  • Posterior rotation - leg lengthens (A)

  • Anterior rotation - leg shortens (C)

  • Supine to Sit Test

    • Start Position

  • Palpate inferior medial malleoli

  • Positive test

    • Change in relative leg length

    • Start to Finish


Pelvic assessment iv
Pelvic Assessment IV

  • Start position

    • Prone

    • Palpate inferior to lateral malleoli or plantar aspect of calcaneus

    • Observe leg length


Prone knee flexion
Prone Knee Flexion

  • End position

    • Knee flexed to 90°

    • Positive: change in position from start to finish


Pelvic assessment results
Pelvic Assessment Results

  • 3 of 4 Tests Composite

    • Reliability k=.88

  • If (-) Palpate Iliac Crest Heights

    • Correct difference with heel lift

  • If (+) SIJ Manipulation Indicated

    • Manual Techniques

    • Manipulation


Specific manipulation for sij
Specific Manipulation for SIJ

Re-test composite after manipulation



Osteology
Osteology

  • Innominate

  • Sacrum

    • Base

    • ILA


Mobility of the si joint

Ilial

Rotation

Slip

Flare

Sacral

Nutation (Flexion)

Counternutation (Extension)

Rotation

Torsion

Mobility of the SI Joint


Stability of the si joint
Stability of the SI Joint

  • Ligamentous

  • Bony (“Form Closure”)

  • Muscular (“Force Closure”)





Rotations1
Rotations

  • IfAnterior Rotation

    • mob posteriorly

  • If Posterior rotation

    • mob anteriorly




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