Recent Changes

Tuesday, August 12

  1. 2:13 pm

Monday, December 13

  1. page home edited ... {http://t3.gstatic.com/images?q=tbn:ANd9GcTaWM2tJP-HCsUgGfiTKhweHE91P9_SDMjPG9Uo5ko1Ppcm6s4FXQ…
    ...
    {http://t3.gstatic.com/images?q=tbn:ANd9GcTaWM2tJP-HCsUgGfiTKhweHE91P9_SDMjPG9Uo5ko1Ppcm6s4FXQ} {http://t1.gstatic.com/images?q=tbn:ANd9GcSWDha6ICECv0ACdMwloG_xLEy2F8WYBGE02Doi6cbXqLk-7KIJ}
    Examination Findings:
    ...
    As there areis no UMNsUMN’s in the
    ...
    UMN findings (hyperactive reflexes) shouldmay not be
    Diagnostic testing:
    Imaging can reveal the degenerative process long before clinical symptoms bring a patient to therapy. In the case of claudication, radicular symptoms are produced in positions of extension and reduced in positions of flexion. A common test is a treadmill test where a patient walks until symptoms are produced and then sits in flexion and symptoms abolish. When treadmill walking is performed with an incline (produces spinal flexion) symptoms are less irritable or not present. Pedaling a stationery bike in a slouched position is asymptomatic. The individual should not have symptoms when exercising in a flexed position (such as when using a recumbent bike) because this position reduces the stress on the nerves involved. However, if the individual continues to experience symptoms in his/her lower extremities during the exercise, it is most likely caused by intermittent vascular claudication. In this condition, the blocked artery reduces the blood flow and oxygen supply to the muscles involved in the aerobic activity. Therefore, these tests (stationary bike and inclined treadmill walking) can be helpful in differentiating between a vascular condition and neurogenic claudicaiton.
    Non-PT Interventions: Anti-inflammatory medications are helpful in reducing neural inflammation. In severe cases foraminotomy procedures can be performed to restore the canal space but are often of minimal long term benefit. In severe cases, surgical removal of portions of the involved facets will be performed to fully decompress the neural tissue. In these severe cases, surgical fusion of the vertebra involved is common to decrease the possibility of spondylolisthesis after decompression. According to spineuniverse.com, 80-90 % postoperative patients have relief of their pain after surgical decompression is performed. An epidural can also be performed as a means of local anesthetic for pain or a direct anti-inflammatory to the area of pain.
    The laminectomy and foraminotomy procedures are typically performed in the cervical spine.
    ...
    acupuncture, massage, etc.etc
    PT Interventions:
    Patient education in posture and body-mechanics can slow the degenerative process. In late stage cases exercises to bias toward flexed postures can help control neurologic symptoms because flexion will increase the spinal canal space, relieving the compressed neural tissue. This can include pelvic tilting, abdominal strengthening, core training and stability exercises.
    ...
    http://www.youtube.com/watch?v=zN1XS_vlUqY&feature=related
    Prognosis:
    ...
    minimize pain. Decompression surgeries tend to have poor outcomes due to the fact that not all levels/areas are decompressed or the problems return.
    Applicable Case Studies
    Mary-Lou Whittaker is a 70 y/o woman who arrives in the clinic with complaints of back pain. She states "My back hasn't ever really felt great but now its really becoming a problem." She further illustrates this point stating that she gets more pain and a strange tingle in her legs every time she reaches into her overhead cabinets. She loves cooking for her husband, Hank every day, but states it is really becoming a bother. Afterwords she insists on knitting in her favorite recliner until she falls asleep. When you ask the Mary-Lou to have a seat so you can observe her posture she tries to sit up straight but complains of pain throughout her lower back that spread into her right upper thigh. Medical history includes osteoporosis, for which the patient states she is taking nutritional supplements. Patient states she has been beginning to have pain in her neck when she is knitting and fears that the problem is spreading throughout her body.
    ...
    Anti-steroidal drugs to reduce swelling and pain.
    Corticosteroid injections help reduce swelling and treat pain that radiates to hips/leg. The pain relief may only be temporary. Patients shouldn't get more than 3 injections in a 6 month period.
    ...
    discectomy, corpectomy, laminoplasty, decompression.laminoplasty.
    Complementary and Alternative Medicine (CAM): acupuncture, massage, etc
    PT Interventions:
    ...
    the spine. Also patient education and identifying directional exercises that help decrease their pain.
    Deep tissue massage, TENS, hot and cold therapies, US to help with pain
    Home adaptations to allow pt. to perform ADLs with increased ease.
    ...
    Relevant History/Onset of symptoms:
    When one vertebra slips forward over the one beneath it. Most common in low back because of amount of weight bearing and directional forces. Can result from repeated stresses or strains.
    ...
    at L5 on S1 (most common
    Common in divers, football players, weight lifters, gymnasts (teenage athletes)
    The most common symptom of spondylolisthesis is low back pain. This is often worse after exercises especially with extension of the lumbar spine. Other symptoms include tightness of the hamstrings and decreased range of motion of the lower back into the direction of lumbar flexion. Some patients can develop pain, numbness, tingling or weakness in the legs due to nerve compression
    ...
    Complementary and Alternative Medicine (CAM): acupuncture, massage, etc
    PT Interventions:
    ...
    to avoid activitiesactivites that increase
    If surgical fusion was performed on the patient, allow a period of immobility to enhance the fusion process. Then focus on stabilization, functional mobility and activity. May need to focus on new movement patterns and increasing hip and shoulder flexibility to help compensate.
    ...
    to help strengthenstrenghten body and
    Strengthen mm. supporting spine.
    directional exercises (Flexion)
    ...
    Prognosis:
    In young patients with spondylolisthesis, surgical fusion with or without decompression may be curative, and no further intervention may be required. Individuals who have sustained an acute fracture with minimal slippage may completely recover if the fracture heals. Individuals with progressive degenerative changes may continue to have intermittent symptoms. Surgery can be curative, but some individuals may experience only partial or intermittent relief.
    Spondylolesthesis is very common
    Surgery is usually indicated after patient has not seen progress in ~6 months.
    Ankylosing Spondylitis
    ...
    Relevant History/Onset of symptoms:
    Implies a crush/wedge injury (fall, picking up heavy weight). Result of some form of trauma
    Ranges from mildfrommild to severe.
    A severe compression fracture may involve the SC or n. roots (neurologic injury rare with compression fracture--degree of neurologic injury is usually due to amount of force present at time of injury; can cause weakness, sensory changes and reflex changes). Severe pain results, as well as a kyphosis.
    Risk for spinal compression fractures increases with age. Osteoporosis is a common risk factor d/t the weakening of bones.
    ...
    Postural education
    PT Manipulation
    Prognosis: Varies depending on underlying cause, severity and duration of the compression and promptness and adherence to treatment therapies, but many have complete recovery. Most individuals treated conservatively with activity modification, splinting, and medication will experience a satisfactory long-term outcome.
    Degenerative Disc Disease
    Relevant History/Onset of symptoms:
    ...
    Link for video: http://www.spineandscoliosis.com/subject.php?pn=animate-ddd
    Tissue Involved:
    ...
    as a secondarysecondarfy effect.
    Impact of process on tissue:
    Over time the collagen in the annulus weakens and the water content of the disc decreases causing the disc not to be able to handle mechanical stress.The disc loses it's "sponginess" and becomes thinner, decreasing the space between the vertebra. This change in the height of the disc also affects the facet joints. As a result, the facet joints actually can be HYPERmobile due to cartilage wearing which can lead to a secondary diagnosis of spinal stenosis (through osteophyte production and a narrowing of the intervertebral foramen).
    ...
    Swelling (in acute stage)
    Decreased ROM-usually because one is hesitant to move after injury(disuse) or due to scar tissue adhesions limiting movement
    ...
    movement - fibrousfribrus adhesions if
    Diagnostic testing:
    MRI-can detect ligament damage
    ...
    - Loss of ROM and attempted movement induces pain.
    - No pain at rest.
    ...
    amount of separationseperation should be
    If you suspect a facet downglide or closing restrtiction some special tests you should perform to help you make your diagnosis is to first perform PA pressure to assess what segment/level is restricted, next facet downglide or closing PIVM to assess interspinous space (the amount of approximation should be relatively the same for each level; if a particular level does not approximate when extending the leg this indicates a downglide or closing restriction at that level), and also the facet downglide or closing PIVM to assess transverse process movement (normally transverse process should remain level as both facets downglide; if one transverse process becomes more superficial this indicates a downglide or closing restriction on the opposite side).
    Diagnostic testing:
    ...
    Thoracic spine manipulation link: http://www.youtube.com/watch?v=qbS8kOmJ7_k
    Prognosis:
    Prognosis for facet restrictions are generally good for the healthy individual. Problems arrise when they are due to prolonged posture (months to years), which will cause the patient to need more/longer treatment. If the patient is educated about posture and breaks his/her fear avoidance cycle, a full recovery expected.
    Piriformis Syndrome/Sciatica
    Relevant History/Onset of symptoms: insidious onset, overuse/repetitive motion injury, seen often in runners and most common in women.
    ...
    Sciatica Symptoms:
    Pain that travels from the low back, through the buttocks, downward into the leg, and sometimes into the foot. Numbness and tingling down leg.Leg weakness or numbness.Pain in the buttock or leg that is worse when sitting .A shooting pain that makes it difficult to stand up, and for some makes it difficult to walk
    ...
    piriformis m. May have positive: SLR, Well leg raise test, distraction test, slump test.
    Non-PT Interventions:
    rest to prevent overuse! It is important to determine the cause of the piriformis muscle tightness/adaptive shortening or spasm and address those factors. After resting, restoring normal length and strength is critical.
    ...
    Relevant History/Onset of symptoms:
    Age: 20-50 y.o.
    ...
    pain started. Typically related to posture.
    {http://www.umm.edu/spinecenter/education/images/pinched_nerve.gif} {http://3.bp.blogspot.com/_MTJMv4N6oOM/SvGg9vSNxxI/AAAAAAAAAgc/MKRtPMcExSY/s400/herniated+disc.jpg}
    Tissue Involved:
    ...
    Possible positive SLR, Sitting Slump, and Centralization tests
    Check myotome/dermatome/reflexes at suspected nerve root level
    Diagnostic Discogram identifies contained vs complete annular rupture
    Non-PT Interventions:
    If inc pain: treat with rest and anti-inflammatory meds
    Steroid injections - variable duration relief
    Discectomy - partial or complete
    Epidural with anesthetic or anti-inflammatory
    PT Interventions:
    ...
    Extension Bias
    Relevant History/Onset of symptoms: Indicates that the preferred position of the patient's spine has decreased lordosis in the lower back and neck. Herniated discs and injury to the posterior longitudinal ligament are two conditions with extension bias. May be due to an intervertebral disc lesion, fluid stasis, a flexion injury, or muscle imbalances from a flexed posture.
    ...
    areas and swelling posteriorly.swelling. Thus, extension
    ...
    the fluid anteriorly away from
    Impact of process on tissue: Pt. may have dec. lordosis due to tight hamstrings or abdominals. Hip flexors and back extensors may be long/weak.
    Examination Findings (* the key indicators):
    ...
    Active and/or passive range of motion tests that show centralization of symptoms when patient moves into extension.
    Non-PT Interventions:
    ...
    traction of the spine to relieve pressure on the intervertebral disc.
    {http://jan.ucc.nau.edu/~mtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/press_up.jpg}

    {http://jan.ucc.nau.edu/%7Emtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/press_up.jpg}

    Prognosis:
    Depends on severity of impairment.
    ...
    Non-PT Interventions:
    PT Interventions: Patients with flexion biased low back pain often benefit from core strengthening, postural training, and ergonomic assessment. It seems that flexion bias would be easier to treat if the physical therapist knew the cause. Exercises include single knee to chest, double knee to chest, and posterior pelvic tilts.
    {http://jan.ucc.nau.edu/~mtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/SKTC.jpg}{http://jan.ucc.nau.edu/%7Emtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/SKTC.jpg} SKTC
    {http://jan.ucc.nau.edu/~mtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/DKTC.jpg}

    {http://jan.ucc.nau.edu/%7Emtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/DKTC.jpg}
    DKTC
    Prognosis:
    Depends on severity of impairment
    ...
    Surgery to repair passive structures
    PT Interventions:Lumbar stabilization exercise program includes a range of exercises that typically progress from beginning to more advanced for example, static to dynamic or gravity minimized positions to against gravity positions. During all exercises a neutral spine position is maintained. Some examples of exercises are:
    ...
    biofeedback mechanisms. Cue: Draw belly button in and up towards rib cage.
    Hamstring Stretches:
    ...
    exercise. Lay supine on the
    ...
    the leg muscles {file:///C:/DOCUME%7E1/sdsmith/LOCALS%7E1/Temp/moz-screenshot.png} {file:///C:/DOCUME%7E1/sdsmith/LOCALS%7E1/Temp/moz-screenshot-1.png}
    Pelvic
    muscle.
    {http://www.topendsports.com/medicine/images/hamstring-supine.gif} http://www.topendsports.com/medicine/images/hamstring-supine.gif
    Pelvic
    Tilt exercises:
    ...
    spine. Lay supine on the
    ...
    on the floor.Holdfloor. For anterior pelvic tilt, cue patient to arch back. For posterior pelvic tilt, cue patient to round out back by pushing into the table. Hold for 10
    ...
    on opposite sideside.
    {http://img.wonderhowto.com/screengrabs/633501061806250000.jpg} http://img.wonderhowto.com/screengrabs/633501061806250000.jpg

    Exercise Ball
    ...
    ball). Lay supine on floor
    ...
    2-3 inches.
    {http://www.istockphoto.com/file_thumbview_approve/3523364/2/istockphoto_3523364-bridge-with-extended-legs-on-exercise-ball.jpg} http://www.istockphoto.com/file_thumbview_approve/3523364/2/istockphoto_3523364-bridge-with-extended-legs-on-exercise-ball.jpg

    http://www.spine-health.com/wellness/exercise/lumbar-stabilization-exercises-lower-back-pain
    Additional core stabilization exercises that have shown to be effective are:
    ...
    - Static Traction (sustained force for up to 15-20 minutes): This is an effective treatment for a patient presenting with a herniated disc
    - Intermittent Traction: This is an effective treatment for joint stiffness and muscle spasms.
    Predictiors for Identifying Patient with LBP who will improve with spinal manipulation:
    Symptoms present for less than 16 days
    No symptoms below the knee
    FABQ <19
    Lumbar Hypomobility
    Hip IR >35 degrees.
    If four or more factors are present, there is a 95% likelihood of dramatic outcome
    Predictors for Identifying Patient with cervical pain who will improve with thoracic spine thrust manipulation:
    Symptoms present for less than 30 days
    FABQ > 11
    No symptoms distal to the shoulder
    Looking up does not aggravate symptoms
    Cervical Extension < 30 degrees
    Flat T3-T5
    If three or more factors are present, there is a 86% likelihood of dramatic outcome

    The effects of spinal traction are: separation of vertebral bodies, gliding of facet joints, tensing of ligamentous structures, opening of the intervertebral foramen, and stretching/straightening of the spinal musculature.
    {neckr.jpg}
    {services_clip_image008_0000.jpg}
    Contraindications to Traction: Osteoporosis, infection, tumor, RA, vertebral fractures, hypermobility, ruptured disc, acute sprain/strain
    Prognosis:
    Good. May need to be combined with other interventions. Use as part of an intervention program
    (view changes)
    5:38 am

Sunday, December 12

  1. page home edited ... Non-PT Interventions: Anti-inflammatory medications are helpful in reducing neural inflammatio…
    ...
    Non-PT Interventions: Anti-inflammatory medications are helpful in reducing neural inflammation. In severe cases foraminotomy procedures can be performed to restore the canal space but are often of minimal long term benefit. In severe cases, surgical removal of portions of the involved facets will be performed to fully decompress the neural tissue. In these severe cases, surgical fusion of the vertebra involved is common to decrease the possibility of spondylolisthesis after decompression. According to spineuniverse.com, 80-90 % postoperative patients have relief of their pain after surgical decompression is performed. An epidural can also be performed as a means of local anesthetic for pain or a direct anti-inflammatory to the area of pain.
    The laminectomy and foraminotomy procedures are typically performed in the cervical spine.
    ...
    acupuncture, massage, etcetc.
    PT Interventions:
    Patient education in posture and body-mechanics can slow the degenerative process. In late stage cases exercises to bias toward flexed postures can help control neurologic symptoms because flexion will increase the spinal canal space, relieving the compressed neural tissue. This can include pelvic tilting, abdominal strengthening, core training and stability exercises.
    ...
    Thoracic spine manipulation link: http://www.youtube.com/watch?v=qbS8kOmJ7_k
    Prognosis:
    Prognosis for facet restrictions are generally good for the healthy individual. Problems arrise when they are due to prolonged posture (months to years), which will cause the patient to need more/longer treatment. If the patient is educated about posture and breaks his/her fear avoidance cycle, a full recovery expected.
    Piriformis Syndrome/Sciatica
    Relevant History/Onset of symptoms: insidious onset, overuse/repetitive motion injury, seen often in runners and most common in women.
    ...
    Non-PT Interventions:
    PT Interventions: Patients benefit from early interventions that emphasize extension(such as prone press-ups), postural education, pelvic tilt exercises, and traction of the spine to relieve pressure on the intervertebral disc.
    {http://jan.ucc.nau.edu/%7Emtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/press_up.jpg}{http://jan.ucc.nau.edu/~mtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/press_up.jpg}
    Prognosis:
    Depends on severity of impairment.
    ...
    Non-PT Interventions:
    PT Interventions: Patients with flexion biased low back pain often benefit from core strengthening, postural training, and ergonomic assessment. It seems that flexion bias would be easier to treat if the physical therapist knew the cause. Exercises include single knee to chest, double knee to chest, and posterior pelvic tilts.
    {http://jan.ucc.nau.edu/%7Emtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/SKTC.jpg}{http://jan.ucc.nau.edu/~mtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/SKTC.jpg} SKTC
    {http://jan.ucc.nau.edu/%7Emtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/DKTC.jpg}

    {http://jan.ucc.nau.edu/~mtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/DKTC.jpg}
    DKTC
    Prognosis:
    Depends on severity of impairment
    (view changes)
    8:38 pm
  2. page home edited ... http://www.youtube.com/watch?v=zN1XS_vlUqY&feature=related Prognosis: ... minimize pai…
    ...
    http://www.youtube.com/watch?v=zN1XS_vlUqY&feature=related
    Prognosis:
    ...
    minimize pain. Decompression surgeries tend to have poor outcomes due to the fact that not all levels/areas are decompressed or the problems return.
    Applicable Case Studies
    Mary-Lou Whittaker is a 70 y/o woman who arrives in the clinic with complaints of back pain. She states "My back hasn't ever really felt great but now its really becoming a problem." She further illustrates this point stating that she gets more pain and a strange tingle in her legs every time she reaches into her overhead cabinets. She loves cooking for her husband, Hank every day, but states it is really becoming a bother. Afterwords she insists on knitting in her favorite recliner until she falls asleep. When you ask the Mary-Lou to have a seat so you can observe her posture she tries to sit up straight but complains of pain throughout her lower back that spread into her right upper thigh. Medical history includes osteoporosis, for which the patient states she is taking nutritional supplements. Patient states she has been beginning to have pain in her neck when she is knitting and fears that the problem is spreading throughout her body.
    ...
    Anti-steroidal drugs to reduce swelling and pain.
    Corticosteroid injections help reduce swelling and treat pain that radiates to hips/leg. The pain relief may only be temporary. Patients shouldn't get more than 3 injections in a 6 month period.
    ...
    discectomy, corpectomy, laminoplasty.laminoplasty, decompression.
    Complementary and Alternative Medicine (CAM): acupuncture, massage, etc
    PT Interventions:
    ...
    the spine. Also patient education and identifying directional exercises that help decrease their pain.
    Deep tissue massage, TENS, hot and cold therapies, US to help with pain
    Home adaptations to allow pt. to perform ADLs with increased ease.
    ...
    Relevant History/Onset of symptoms:
    When one vertebra slips forward over the one beneath it. Most common in low back because of amount of weight bearing and directional forces. Can result from repeated stresses or strains.
    ...
    at L5 on S1 (most common
    Common in divers, football players, weight lifters, gymnasts (teenage athletes)
    The most common symptom of spondylolisthesis is low back pain. This is often worse after exercises especially with extension of the lumbar spine. Other symptoms include tightness of the hamstrings and decreased range of motion of the lower back into the direction of lumbar flexion. Some patients can develop pain, numbness, tingling or weakness in the legs due to nerve compression
    ...
    Complementary and Alternative Medicine (CAM): acupuncture, massage, etc
    PT Interventions:
    ...
    to avoid activitesactivities that increase
    If surgical fusion was performed on the patient, allow a period of immobility to enhance the fusion process. Then focus on stabilization, functional mobility and activity. May need to focus on new movement patterns and increasing hip and shoulder flexibility to help compensate.
    ...
    to help strenghtenstrengthen body and
    Strengthen mm. supporting spine.
    directional exercises (Flexion)
    ...
    Prognosis:
    In young patients with spondylolisthesis, surgical fusion with or without decompression may be curative, and no further intervention may be required. Individuals who have sustained an acute fracture with minimal slippage may completely recover if the fracture heals. Individuals with progressive degenerative changes may continue to have intermittent symptoms. Surgery can be curative, but some individuals may experience only partial or intermittent relief.
    Spondylolesthesis is very common
    Surgery is usually indicated after patient has not seen progress in ~6 months.
    Ankylosing Spondylitis
    ...
    Relevant History/Onset of symptoms:
    Implies a crush/wedge injury (fall, picking up heavy weight). Result of some form of trauma
    Ranges frommildfrom mild to severe.
    A severe compression fracture may involve the SC or n. roots (neurologic injury rare with compression fracture--degree of neurologic injury is usually due to amount of force present at time of injury; can cause weakness, sensory changes and reflex changes). Severe pain results, as well as a kyphosis.
    Risk for spinal compression fractures increases with age. Osteoporosis is a common risk factor d/t the weakening of bones.
    ...
    Postural education
    PT Manipulation
    Prognosis: Varies depending on underlying cause, severity and duration of the compression and promptness and adherence to treatment therapies, but many have complete recovery. Most individuals treated conservatively with activity modification, splinting, and medication will experience a satisfactory long-term outcome.
    Degenerative Disc Disease
    Relevant History/Onset of symptoms:
    ...
    Link for video: http://www.spineandscoliosis.com/subject.php?pn=animate-ddd
    Tissue Involved:
    ...
    as a secondarfysecondary effect.
    Impact of process on tissue:
    Over time the collagen in the annulus weakens and the water content of the disc decreases causing the disc not to be able to handle mechanical stress.The disc loses it's "sponginess" and becomes thinner, decreasing the space between the vertebra. This change in the height of the disc also affects the facet joints. As a result, the facet joints actually can be HYPERmobile due to cartilage wearing which can lead to a secondary diagnosis of spinal stenosis (through osteophyte production and a narrowing of the intervertebral foramen).
    ...
    Non-PT Interventions:
    -Spinal fusion
    *NOTE that with spinal fusion surgeries stress is shifted from the affected segment to segments above and below the surgical site. This can cause introduction of similar problems at different vertebral levels as well as new movement patterns.
    -New treatment of artificial disc replacement, interbody fusion with/without hardware. Including fusion with fusion cage or bone graft.
    Complementary and Alternative Medicine (CAM): acupuncture, massage, etc
    ...
    Swelling (in acute stage)
    Decreased ROM-usually because one is hesitant to move after injury(disuse) or due to scar tissue adhesions limiting movement
    ...
    movement - fribrusfibrous adhesions if
    Diagnostic testing:
    MRI-can detect ligament damage
    ...
    - Loss of ROM and attempted movement induces pain.
    - No pain at rest.
    ...
    amount of seperationseparation should be
    If you suspect a facet downglide or closing restrtiction some special tests you should perform to help you make your diagnosis is to first perform PA pressure to assess what segment/level is restricted, next facet downglide or closing PIVM to assess interspinous space (the amount of approximation should be relatively the same for each level; if a particular level does not approximate when extending the leg this indicates a downglide or closing restriction at that level), and also the facet downglide or closing PIVM to assess transverse process movement (normally transverse process should remain level as both facets downglide; if one transverse process becomes more superficial this indicates a downglide or closing restriction on the opposite side).
    Diagnostic testing:
    ...
    Sciatica Symptoms:
    Pain that travels from the low back, through the buttocks, downward into the leg, and sometimes into the foot. Numbness and tingling down leg.Leg weakness or numbness.Pain in the buttock or leg that is worse when sitting .A shooting pain that makes it difficult to stand up, and for some makes it difficult to walk
    ...
    piriformis m. May have positive: SLR, Well leg raise test, distraction test, slump test.
    Non-PT Interventions:
    rest to prevent overuse! It is important to determine the cause of the piriformis muscle tightness/adaptive shortening or spasm and address those factors. After resting, restoring normal length and strength is critical.
    ...
    Extension Bias
    Relevant History/Onset of symptoms: Indicates that the preferred position of the patient's spine has decreased lordosis in the lower back and neck. Herniated discs and injury to the posterior longitudinal ligament are two conditions with extension bias. May be due to an intervertebral disc lesion, fluid stasis, a flexion injury, or muscle imbalances from a flexed posture.
    ...
    areas and swelling.swelling posteriorly. Thus, extension
    ...
    the fluid anteriorly away from
    Impact of process on tissue: Pt. may have dec. lordosis due to tight hamstrings or abdominals. Hip flexors and back extensors may be long/weak.
    Examination Findings (* the key indicators):
    ...
    Non-PT Interventions:
    PT Interventions: Patients benefit from early interventions that emphasize extension(such as prone press-ups), postural education, pelvic tilt exercises, and traction of the spine to relieve pressure on the intervertebral disc.
    {http://jan.ucc.nau.edu/~mtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/press_up.jpg}{http://jan.ucc.nau.edu/%7Emtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/press_up.jpg}
    Prognosis:
    Depends on severity of impairment.
    ...
    Non-PT Interventions:
    PT Interventions: Patients with flexion biased low back pain often benefit from core strengthening, postural training, and ergonomic assessment. It seems that flexion bias would be easier to treat if the physical therapist knew the cause. Exercises include single knee to chest, double knee to chest, and posterior pelvic tilts.
    {http://jan.ucc.nau.edu/~mtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/SKTC.jpg}{http://jan.ucc.nau.edu/%7Emtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/SKTC.jpg} SKTC
    {http://jan.ucc.nau.edu/~mtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/DKTC.jpg}

    {http://jan.ucc.nau.edu/%7Emtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/DKTC.jpg}
    DKTC
    Prognosis:
    Depends on severity of impairment
    (view changes)
    8:29 pm
  3. page home edited ... http://www.youtube.com/watch?v=zN1XS_vlUqY&feature=related Prognosis: ... minimize pai…
    ...
    http://www.youtube.com/watch?v=zN1XS_vlUqY&feature=related
    Prognosis:
    ...
    minimize pain. Decompression surgeries tend to have poor outcomes due to the fact that not all levels/areas are decompressed or the problems return.
    Applicable Case Studies
    Mary-Lou Whittaker is a 70 y/o woman who arrives in the clinic with complaints of back pain. She states "My back hasn't ever really felt great but now its really becoming a problem." She further illustrates this point stating that she gets more pain and a strange tingle in her legs every time she reaches into her overhead cabinets. She loves cooking for her husband, Hank every day, but states it is really becoming a bother. Afterwords she insists on knitting in her favorite recliner until she falls asleep. When you ask the Mary-Lou to have a seat so you can observe her posture she tries to sit up straight but complains of pain throughout her lower back that spread into her right upper thigh. Medical history includes osteoporosis, for which the patient states she is taking nutritional supplements. Patient states she has been beginning to have pain in her neck when she is knitting and fears that the problem is spreading throughout her body.
    ...
    Non-PT Interventions:
    -Spinal fusion
    *NOTE that with spinal fusion surgeries stress is shifted from the affected segment to segments above and below the surgical site. This can cause introduction of similar problems at different vertebral levels as well as new movement patterns.
    -New treatment of artificial disc replacement, interbody fusion with/without hardware. Including fusion with fusion cage or bone graft.
    Complementary and Alternative Medicine (CAM): acupuncture, massage, etc
    ...
    Non-PT Interventions:
    PT Interventions: Patients benefit from early interventions that emphasize extension(such as prone press-ups), postural education, pelvic tilt exercises, and traction of the spine to relieve pressure on the intervertebral disc.
    {http://jan.ucc.nau.edu/%7Emtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/press_up.jpg}{http://jan.ucc.nau.edu/~mtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/press_up.jpg}
    Prognosis:
    Depends on severity of impairment.
    ...
    Non-PT Interventions:
    PT Interventions: Patients with flexion biased low back pain often benefit from core strengthening, postural training, and ergonomic assessment. It seems that flexion bias would be easier to treat if the physical therapist knew the cause. Exercises include single knee to chest, double knee to chest, and posterior pelvic tilts.
    {http://jan.ucc.nau.edu/%7Emtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/SKTC.jpg}{http://jan.ucc.nau.edu/~mtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/SKTC.jpg} SKTC
    {http://jan.ucc.nau.edu/%7Emtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/DKTC.jpg}

    {http://jan.ucc.nau.edu/~mtl8/images/ther_ex_pics/Exercise_Pics/Pics_for_Basic_skills/Spine/DKTC.jpg}
    DKTC
    Prognosis:
    Depends on severity of impairment
    (view changes)
    7:52 pm
  4. page home edited ... http://www.youtube.com/watch?v=zN1XS_vlUqY&feature=related Prognosis: ... minimize pai…
    ...
    http://www.youtube.com/watch?v=zN1XS_vlUqY&feature=related
    Prognosis:
    ...
    minimize pain. Decompression surgeries tend to have poor outcomes due to the fact that not all levels/areas are decompressed or the problems return.
    Applicable Case Studies
    Mary-Lou Whittaker is a 70 y/o woman who arrives in the clinic with complaints of back pain. She states "My back hasn't ever really felt great but now its really becoming a problem." She further illustrates this point stating that she gets more pain and a strange tingle in her legs every time she reaches into her overhead cabinets. She loves cooking for her husband, Hank every day, but states it is really becoming a bother. Afterwords she insists on knitting in her favorite recliner until she falls asleep. When you ask the Mary-Lou to have a seat so you can observe her posture she tries to sit up straight but complains of pain throughout her lower back that spread into her right upper thigh. Medical history includes osteoporosis, for which the patient states she is taking nutritional supplements. Patient states she has been beginning to have pain in her neck when she is knitting and fears that the problem is spreading throughout her body.
    (view changes)
    7:40 pm
  5. page home edited ... {http://t3.gstatic.com/images?q=tbn:ANd9GcTaWM2tJP-HCsUgGfiTKhweHE91P9_SDMjPG9Uo5ko1Ppcm6s4FXQ…
    ...
    {http://t3.gstatic.com/images?q=tbn:ANd9GcTaWM2tJP-HCsUgGfiTKhweHE91P9_SDMjPG9Uo5ko1Ppcm6s4FXQ} {http://t1.gstatic.com/images?q=tbn:ANd9GcSWDha6ICECv0ACdMwloG_xLEy2F8WYBGE02Doi6cbXqLk-7KIJ}
    Examination Findings:
    ...
    As there isare no UMN’sUMNs in the
    ...
    UMN findings may(hyperactive reflexes) should not be
    Diagnostic testing:
    Imaging can reveal the degenerative process long before clinical symptoms bring a patient to therapy. In the case of claudication, radicular symptoms are produced in positions of extension and reduced in positions of flexion. A common test is a treadmill test where a patient walks until symptoms are produced and then sits in flexion and symptoms abolish. When treadmill walking is performed with an incline (produces spinal flexion) symptoms are less irritable or not present. Pedaling a stationery bike in a slouched position is asymptomatic. The individual should not have symptoms when exercising in a flexed position (such as when using a recumbent bike) because this position reduces the stress on the nerves involved. However, if the individual continues to experience symptoms in his/her lower extremities during the exercise, it is most likely caused by intermittent vascular claudication. In this condition, the blocked artery reduces the blood flow and oxygen supply to the muscles involved in the aerobic activity. Therefore, these tests (stationary bike and inclined treadmill walking) can be helpful in differentiating between a vascular condition and neurogenic claudicaiton.
    ...
    Impact of process on tissue:
    {http://www.floridabackinstitute.com/images/compression.jpg}
    Information on wedge fractures: here
    Examination Findings (* the key indicators):
    Tenderness and sensitivity over specific vertebrate near the area of pain.
    (view changes)
    7:34 pm
  6. page home edited ... Home adaptations to allow pt. to perform ADLs with increased ease. Prognosis: It is a progres…
    ...
    Home adaptations to allow pt. to perform ADLs with increased ease.
    Prognosis: It is a progressive degenerative process. Presentation will worsen and control symptomatically.
    {webkit-fake-url://228BAB33-8596-4A10-881A-789136929CFF/clip_image002.jpg} clip_image002.jpg
    Spondylolysis/Spondylolisthesis
    Relevant History/Onset of symptoms:
    ...
    Impact of process on tissue:
    {http://www.floridabackinstitute.com/images/compression.jpg}
    Information on wedge fractures: here
    Examination Findings (* the key indicators):
    Tenderness and sensitivity over specific vertebrate near the area of pain.
    ...
    Branching to the anterior interosseous nerve- Patients present with pain in the proximal forearm which increases with activity and weakness of the; FPL, FDP, PQ and lumbricals.
    Transverse Carpal Ligament or the Carpal Tunnel- Patients present with insidious onset of pain, including nocturnal radiating pain. Patients with CTS will complain of a comparable sign with prolonged pressure on the carpal tunnel through end range wrist flexion.
    {webkit-fake-url://6FB800F1-1128-481D-8337-538E6F5B6459/hand_carpal_tunnel_intro01.jpg} hand_carpal_tunnel_intro01.jpg
    Radial Nerve
    Anterior to the head of the radius at the elbow
    ...
    Chiropractic manipulation
    Surgical: Removal of structure causing the entrapment, example: soft tissue.
    {webkit-fake-url://1C76CFC0-BF9C-4F18-A263-124F197EC8A0/19250.jpg} 19250.jpg
    PT Interventions:
    Provide patient with exercises to do on their own that will mobilize and stretch the affected n. such as nerve gliding/nerve flossing
    ...
    Relevant History/Onset of symptoms:
    Degenerative Disc Disease is a progressive disease most commonly with an insidious onset. The intervertebral disc is prone to the degenerative changes due to wear and tear, and aging; the disc becomes thinner and stiffer. It is most common in the lumbar and cervical spine. Smoking increases the risk of developing DDD as it decreases the amount of water in the disc. Additionally, a history of heavy lifting is common in patients with DDD.
    {degenerative-spine.gif} {webkit-fake-url://580EBFFA-D278-47EC-883C-57B39E3F9D58/degenerative-disc-disease_clip_image001.jpg} degenerative-disc-disease_clip_image001.jpg
    Link for video: http://www.spineandscoliosis.com/subject.php?pn=animate-ddd
    Tissue Involved:
    ...
    Sciatica Symptoms:
    Pain that travels from the low back, through the buttocks, downward into the leg, and sometimes into the foot. Numbness and tingling down leg.Leg weakness or numbness.Pain in the buttock or leg that is worse when sitting .A shooting pain that makes it difficult to stand up, and for some makes it difficult to walk
    {webkit-fake-url://4F54F7F4-261E-4F40-9F17-D48B8533051A/borland7.jpg} borland7.jpg
    Diagnostic testing: Limited hip external rotation strength due to symptoms produced with contraction, limited internal rotation at the hip due to symptoms produced at end range and tenderness at the piriformis m.
    Non-PT Interventions:
    ...
    avoid repetitive motions
    Pt education on positions to avoid, especially in sleeping (won't want to sleep in sidelying fetal position as will put muscle on a tensed position all night)
    {webkit-fake-url://60CE3D18-BD99-41E2-9663-C19DC48A17AA/xpirifor.gif} xpirifor.gif
    Prognosis: Pts heal following rest and treatment well and can return to activity
    Thoracic Outlet Syndrome
    ...
    Progressing from outer annulus and encroaching on dura to evolve and compress nerve root
    Disc may be categorized as an intradiscal displacement and protrusion (if no neurlogical/referred symptoms).
    {webkit-fake-url://A82DB5B7-EFD6-4BFC-B2C9-B1A9BBCA270D/Cervical_Disc_Herniation2.gif} Cervical_Disc_Herniation2.gif
    Impact of process on tissue:
    Progresses to include the nerve root in damage. With highly innervated annulus, the pain is referred distally to UE/LE, causing the "nerve root symptoms".
    ...
    Tissue Involved:
    -Nucleus Pulposus and Annulus Fibrosis. Nerve Root and dural sleeve.
    {webkit-fake-url://221FECDE-3FE5-498E-A6E2-9BF39B31B1E6/Cervical_Disc_Herniation2.gif} Cervical_Disc_Herniation2.gif
    Impact of process on tissue:
    -The nucleus pulposus is displaced either within the annulus (intradiscal displacement or protrusion) or is pushed all the way through the annulus (extrusion or sequestration). The annulus undergoes microtears and fissures in which the cartilaginous rings of the annulus also separate. This separation between the rings makes it more difficult to relocate the nucleus. The nerve root is compressed/agitated by the displaced nucleus. This compression leads to nerve root findings in a neurological screening.
    (view changes)
    7:33 pm
  7. page home edited ... Home adaptations to allow pt. to perform ADLs with increased ease. Prognosis: It is a progres…
    ...
    Home adaptations to allow pt. to perform ADLs with increased ease.
    Prognosis: It is a progressive degenerative process. Presentation will worsen and control symptomatically.
    {webkit-fake-url://228BAB33-8596-4A10-881A-789136929CFF/clip_image002.jpg} clip_image002.jpg
    Spondylolysis/Spondylolisthesis
    Relevant History/Onset of symptoms:
    ...
    Branching to the anterior interosseous nerve- Patients present with pain in the proximal forearm which increases with activity and weakness of the; FPL, FDP, PQ and lumbricals.
    Transverse Carpal Ligament or the Carpal Tunnel- Patients present with insidious onset of pain, including nocturnal radiating pain. Patients with CTS will complain of a comparable sign with prolonged pressure on the carpal tunnel through end range wrist flexion.
    {webkit-fake-url://6FB800F1-1128-481D-8337-538E6F5B6459/hand_carpal_tunnel_intro01.jpg} hand_carpal_tunnel_intro01.jpg
    Radial Nerve
    Anterior to the head of the radius at the elbow
    ...
    Chiropractic manipulation
    Surgical: Removal of structure causing the entrapment, example: soft tissue.
    {webkit-fake-url://1C76CFC0-BF9C-4F18-A263-124F197EC8A0/19250.jpg} 19250.jpg
    PT Interventions:
    Provide patient with exercises to do on their own that will mobilize and stretch the affected n. such as nerve gliding/nerve flossing
    ...
    Relevant History/Onset of symptoms:
    Degenerative Disc Disease is a progressive disease most commonly with an insidious onset. The intervertebral disc is prone to the degenerative changes due to wear and tear, and aging; the disc becomes thinner and stiffer. It is most common in the lumbar and cervical spine. Smoking increases the risk of developing DDD as it decreases the amount of water in the disc. Additionally, a history of heavy lifting is common in patients with DDD.
    {degenerative-spine.gif} {webkit-fake-url://580EBFFA-D278-47EC-883C-57B39E3F9D58/degenerative-disc-disease_clip_image001.jpg} degenerative-disc-disease_clip_image001.jpg
    Link for video: http://www.spineandscoliosis.com/subject.php?pn=animate-ddd
    Tissue Involved:
    ...
    Sciatica Symptoms:
    Pain that travels from the low back, through the buttocks, downward into the leg, and sometimes into the foot. Numbness and tingling down leg.Leg weakness or numbness.Pain in the buttock or leg that is worse when sitting .A shooting pain that makes it difficult to stand up, and for some makes it difficult to walk
    {webkit-fake-url://4F54F7F4-261E-4F40-9F17-D48B8533051A/borland7.jpg} borland7.jpg
    Diagnostic testing: Limited hip external rotation strength due to symptoms produced with contraction, limited internal rotation at the hip due to symptoms produced at end range and tenderness at the piriformis m.
    Non-PT Interventions:
    ...
    avoid repetitive motions
    Pt education on positions to avoid, especially in sleeping (won't want to sleep in sidelying fetal position as will put muscle on a tensed position all night)
    {webkit-fake-url://60CE3D18-BD99-41E2-9663-C19DC48A17AA/xpirifor.gif} xpirifor.gif
    Prognosis: Pts heal following rest and treatment well and can return to activity
    Thoracic Outlet Syndrome
    ...
    Progressing from outer annulus and encroaching on dura to evolve and compress nerve root
    Disc may be categorized as an intradiscal displacement and protrusion (if no neurlogical/referred symptoms).
    {webkit-fake-url://A82DB5B7-EFD6-4BFC-B2C9-B1A9BBCA270D/Cervical_Disc_Herniation2.gif} Cervical_Disc_Herniation2.gif
    Impact of process on tissue:
    Progresses to include the nerve root in damage. With highly innervated annulus, the pain is referred distally to UE/LE, causing the "nerve root symptoms".
    ...
    Tissue Involved:
    -Nucleus Pulposus and Annulus Fibrosis. Nerve Root and dural sleeve.
    {webkit-fake-url://221FECDE-3FE5-498E-A6E2-9BF39B31B1E6/Cervical_Disc_Herniation2.gif} Cervical_Disc_Herniation2.gif
    Impact of process on tissue:
    -The nucleus pulposus is displaced either within the annulus (intradiscal displacement or protrusion) or is pushed all the way through the annulus (extrusion or sequestration). The annulus undergoes microtears and fissures in which the cartilaginous rings of the annulus also separate. This separation between the rings makes it more difficult to relocate the nucleus. The nerve root is compressed/agitated by the displaced nucleus. This compression leads to nerve root findings in a neurological screening.
    (view changes)
    7:32 pm
  8. 6:46 pm

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