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The Spine: Management Guidelines

The Spine: Management Guidelines. Chapter 15. Spinal Pathologies and impaired spinal function. Injury and Degeneration of the Disk. Definitions Herniation Protrusion Prolapse Extrusion Free sequestration. Injury and Degeneration of the Disk (cont'd).

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The Spine: Management Guidelines

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  1. The Spine: Management Guidelines Chapter 15

  2. Spinal Pathologies and impaired spinal function

  3. Injury and Degeneration of the Disk • Definitions • Herniation • Protrusion • Prolapse • Extrusion • Free sequestration

  4. Injury and Degeneration of the Disk (cont'd) • Fatigue Breakdown and Traumatic Rupture • Axial Overload • Age • Degenerative Changes • Effect on Spinal Mechanics

  5. Disc Pathologies and Related Conditions • Tissue Fluid Stasis • Symptoms may be similar to those of disc lesions

  6. Signs and Symptoms of Disk Lesions and Fluid Stasis • Etiology of Symptoms • Pain • Neurological signs and symptoms • Variability of symptoms • Shifting symptoms • Inflammation

  7. Signs and Symptoms of Disk Lesions and Fluid Stasis (cont'd) • Onset and Behavior of Symptoms from Disk Lesions • Objective Clinical Findings in the Lumbar Spine • Objective Clinical Findings in the Cervical Spine

  8. Pathomechanical Relationships of the Intervertebral Disk and Facet Joints • Disc Degeneration • Initial changes • Altered muscle control • Progressive bony changes • Related Pathologies • Segmental (clinical) instability • Stenosis • Neurological symptoms: radiculopathy • Dysfunction

  9. Pathology of the Zygapophyseal (Facet) Joints • 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)

  10. Pathology of the Vertebrae • Compression Fracture Secondary to Osteoporosis • Scheuermann’s Disease

  11. Pathology of Muscle and Soft Tissue Injuries: Strains, Tears, and Contusions • General Symptoms From Trauma • Common Sites of Lumbar Strain • Common Sites of Cervical Strain • Postural Strain • Emotional Stress • Functional Activity Limitations and Participation Restrictions

  12. Pathomechanics of Spinal Instability • Neutral Zone • Neutral spine • Instability

  13. Management guidelines based on stages of recovery and diagnostic categories

  14. Principles of Management of the Spine • 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

  15. General Guidelines for Managing Acute Spinal Impairments: Protection Phase • 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

  16. General Guidelines for Managing Acute Spinal Impairments: Protection Phase (cont'd) • 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

  17. General Guidelines for Managing Subacute Spinal Impairments: Controlled Motion Phase • Pain Modulation • Kinesthetic Training • Stretching/Manipulation • Muscle Performance • Cardiopulmonary Conditioning • Postural Stress Management and Relaxation Exercises • Functional Activities

  18. General Guidelines for Managing Chronic Spinal Impairments: Return to Function Phase • 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

  19. Management Guidelines: Non-Weight-Bearing Bias • Management of Acute Symptoms • Traction • Harness • Pool • Progression

  20. Management Guidelines: Extension Bias • 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

  21. Techniques Using an Extension Approach in the Lumbar Spine • Management of Acute Symptoms • Extension • Lateral shift correction • Patient education • Lumbar traction • Joint manipulation • Kinesthetic training, stabilization, and basic functional activities

  22. Techniques Using an Extension Approach in the Lumbar Spine (cont'd) • Management When Acute Symptoms Have Stabilized • Signs of improvement • Intervention

  23. Interventions to Manage a Disk Lesion in the Cervical Spine • Acute Phase • Passive axial extension (cervical retraction) • Patient education • Traction • Kinesthetic training for posture correction • Progression as Symptoms Stabilize

  24. Disc Lesions: Surgery • Indications for Surgery • Common Surgeries • Laminectomy • Fusions • Procedures

  25. Disc Lesions: Postoperative Management • Maximum Protection Phase • Patient education • Wound management and pain control • Bed mobility • Bracing • Exercise • Contraindications

  26. Disc Lesions: Postoperative Management (cont'd) • Moderate and Minimum Protection Phase • Scar tissue mobilization • Progressive stretching and joint mobilization/manipulation of restricted tissue • Muscle performance • Gait training • Contraindications

  27. Management Guidelines: Flexion Bias • 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

  28. Techniques Utilizing a Flexion Approach • 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

  29. Management Guidelines: Stabilization • Identification of Clinical Instability • Principles of Management • Passive support • Deep segmental muscle activation • Lumbar region • Cervical region • Progression of stabilization exercises

  30. Management Guidelines: Mobilization/Manipulation • Management: Lumbar Spine • Management: Cervical Spine

  31. Management Guidelines: Soft Tissue Injuries • Management During the Acute Stage: Protection Phase • Pain and inflammation control • Cervical region • Lumbar region • Muscle function • Cervical region • Reverse muscle action • Lumbar region

  32. Management Guidelines: Soft Tissue Injuries (cont'd) • 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

  33. Management of regional diagnoses

  34. Lower Thoracic and Lumbo-Pelvic Region • Compression Fracture Secondary to Osteoporosis • Spondylolisthesis • Ankylosing Spondylitis • Scheuermann’s Disease • Rib Subluxation

  35. Lower Thoracic and Lumbo-Pelvic Region (cont'd) • 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

  36. Cervical and Upper Thoracic Region • Tension Headache/Cervical Headache • Etiology • Presenting signs and symptoms • General management guidelines • Cervical Myelopathy • Neck Pain

  37. Temporomandibular Joint Dysfunction • 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

  38. Temporomandibular Joint Dysfunction (cont'd) • 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

  39. Independent Learning Activities • Critical Thinking and Discussion • Laboratory Practice • Case Studies

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