Thoracic Disc Lesion Traction: - Not established with the T-Spine, though common practice to address _________ symptoms - ________ or __________ - Pt positioned sitting or lying - Duration recommendation __ min – __ hours - Contraindications: “acute lumbago, instability, respiratory or cardiac insufficiency, respiratory irritation, painful reactions, large [disc] extrusion, medial disc herniation, altered mental state; this includes inability of the patient to relax”

- radicular - continuous or intermittent - 2min-24hrs

T-Spine and Ribs Intervention/ C-Spine Manip Flashcards by Chance Lee Cauble

INTRO

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Scheuermann's Disease Interventions:
-\_\_\_\_\_\_\_ control muscle performance
-\_\_\_\_\_\_\_\_\_ of aggravating activities
-Strengthening and stretching of the ]\_\_\_\_\_\_
     -Seated rotation
     -Extension in lying (prone press up, prone on 
      elbows, etc.)
     -Thoracic extensor strengthening
     -Scapular abductor strengthening
-\_\_\_\_\_\_\_\_

Postural
Modification
trunk
Bracing

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With Ankylosing Spondylitis identify ___________/indicators for ________/interdisciplinary communication.

-risk factors/ indicators for referral

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Ankylosing Spondylitis Interventions:
-______ exercises with _________ focus.
-Spine _________ & peripheral joint exercises
-________ exercises
-_______ lying several times/ day for spine/ hip
extension
-Sleeping on firm mattress & avoidance of ___
position
-Swimming

Active exercises with mobility focus.

extension
breathing
prone
SL

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SCOLIOSIS

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__________ __________ Scoliosis has limited/poor/no compelling evidence regarding “correction” or limiting progression of curvature.

Adolescent Idiopathic

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With Adolescent Idiopathic Scoliosis we can have thoracolumbar bracing, which does what 2 things?

Prevention of curvature progression

- Correction of abnormal curvature

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What are the goals with exercise for conservative management of Adolescent Idiopathic Scoliosis?

Strengthen postural muscles
Address muscle length
Maintain/Improve respiration and chest mobility
Address back pain impairments
Resume functional tasks
Strengthen abdominals

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T4 SYNDROME

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T4 Syndrome is a controversial diagnosis with _____ evidence that supports standardized intervention.

poor

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What interventions should we consider with T4 Syndrome (based on impairments)?

Thoracic manual therapy techniques (mobs, thrust manips) followed by thoracic mobility exercises
Scapulothoracic motor performance
Thoracic extensor strengthening

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THORACIC DISC LESIONS

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What is the main intervention used for Disc Lesions?

Traction

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Thoracic Disc Lesion Traction:

Not established with the T-Spine, though common practice to address _________ symptoms
________ or __________
Pt positioned sitting or lying
Duration recommendation __ min – __ hours
Contraindications: “acute lumbago, instability, respiratory or cardiac insufficiency, respiratory irritation, painful reactions, large [disc] extrusion, medial disc herniation, altered mental state; this includes inability of the patient to relax”

radicular
continuous or intermittent
2min-24hrs

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What are the contraindications for mechanical traction?

acute lumbargo
instability
respiratory or cardiac insufficiency
respiratory irritation
painful reactions
large disc extrusion
medial disc herniation
altered mental state

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What is acute lumbargo?

Low back pain

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Z JOINT AND COSTOVERTEBRAL JOINT DYSFUNCTION

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What are some common impairment with z-joint pain?

muscle guarding
joint hypomobility
acute irritation/dysfunction
pain
ROM: commonly motions that close joint(ext/rot/lat flex)

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What interventions may be used for z-joint pain?

Manual therapy interventions

Mobilizations (oscillations, stretch mobilizations)
Manipulation (neurophysiological effect, biomechanical theories)

Exercise

pain and guarding inhibition
neuro re-education

We want to begin with ________ type exercises.

coordination

What interventions may be done with Rib Dysfunctions?

Manual therapy interventions

Rib mobilizations (oscillations, static stretch mobs)
Rib manipulation
STM

With rib manipulation, be careful not to manipulate ________ ribs.

floater

THORACIC OUTLET SYNDROME

There is ____ evidence that supports standardized intervention for TOS.

poor

What are some interventions that can be done with TOS?

Work/ activity modification Nerve glides Shoulder, upper rib/ thoracic manual therapy techniques Scapulothoracic motor performance Address tissue extensibility anterior trunk musculature

IMPAIRMENT-BASED T-SPINE AND RIB INTERVENTION

Generally, in addition to your working diagnosis, think _________ vs. ________ with MSK health conditions.

Stability vs. Mobility

What are some other important things to address?

- Education - Reduce Pain - Address Impairments - Improve Functional Activity Performance and Participation

What are some ways to reduce pain?

- Manual Therapy Intervention - Exercise - Improve Stability

Thoracic Mobility Exercise examples.

- Quadruped thoracolumbar AROM (flex/ext, rotationreaching diagonally in front of body/overhead) - Lying thoracic extension - Sitting rotation, extension - Assisted extension with towel - Prone on elbow/prone press up

Exercise interventions for Upper Quarter and Thoracic Extensor muscle performance

- wall splats - seated thoracic kyphosis "straightening" - resisted thoracic extension

List some Upper Quarter muscle performance exercises for: - Mid Trap - Lower Trap - Rhomboids and Levator Scap

Mid Trap -Prone row -Prone horizontal abduction with 90 deg shoulder abduction & ER Lower Trap -Prone full can -Prone shoulder ER at 90 deg of shoulder abduction -Prone horizontal abduction with 90 deg shoulder abduction & ER -Bilateral shoulder ER in shoulder neutral Rhomboids & Levator Scap -Prone Extension with shoulder ER -Prone row -Prone horizontal abduction with 90 deg shoulder abduction & ER

What is a second function of the thoracic extensors?

Control flexion ROM eccentrically

Modalities that can be used at the T-Spine.

- Ultrasound (thermal, pain relief) - Cryotherapy (pain relief) - E-stim (muscle activation/neuromuscular re-ed, pain relief (TENS), aid in healing)

T-SPINE AND RIBS MANUAL THERAPY

Studies with thoracic ______ demonstrate better short-term results than mobs for mechanical neck pain.

thrust

``` Prone Thoracic P-A Mobilization: -Rate of Force: ____ velocity -Location in Range of Available Movement: ___-range -Direction of Force: _______ force -Target Force: -Mobilizing: ______ process -Stabilizing: N/A Relative Structural Movement: spine segment on adjacent segments Patient Position: ________ ```

- low - end-range - ventral - spinous - prone

Seated Thoracic Extension Mobilization: - Rate of Force: ___ velocity or _______ hold - Location in Range of Available Movement: ___-range - Direction of Force: _______ force - Target Force: - Mobilizing: posterior aspect of bilateral upper arms for superior thoracic segments into relative ________ - Stabilizing: dorsal surface of _______ ________ (or spinous process) of thoracic segment of choice - Relative Structural Movement: _______ segment on _________ segment - Patient Position: ______, fingers interlocked behind head

- low velocity or static hold - end-range - anterior - extension - articular pillars - inferior segment on superior segment - sitting

Facet Gapping In Supine "Pistol": - Rate of Force: _____ velocity - Location in Range of Available Movement: ___-range - Direction of Force: ________ force - Target Force: - Mobilizing: cranial segment with relative _____ translation - Stabilizing: dorsal surfaces of ______ _______ caudal segment - Relative Structural Movement: _______ segment on _______ segment - Patient Position: ______, arms crossed in “gator position”

- high - end-range - posterior - trunk - articular pillars - cranial segment on caudal segment - supine

Seated Lower Thoracic Traction Thrust: -Rate of Force: _____ velocity Location in Range of Available Movement: ___-range Direction of Force: _______ force Target Force: Mobilizing: __________ elbows Relative Structural Movement: ____-thoracic spine on _____ thoracic spine Patient Position: sitting with “______” position of arms

- high - end-range - traction - posterior - mid thoracic spine on lower thoracic spine - "gator"

Upper Thoracic Distraction Thrust: - Rate of Force: _____ velocity - Location in Range of Available Movement: ___-range - Direction of Force: _________ force - Target Force: - Mobilizing: _______ cervical/ ______ thoracic - Relative Structural Movement: upper thoracic/ lower cervical spine on ____-thoracic spine - Patient Position: ______ with fingers interlocked behind head

- high - end-range - traction - lower cervical/upper thoracic - mid - sitting

Supine 1st Rib: -Rate of Force: ____ velocity for thrust, ____ velocity for oscillation -Location in Range of Available Movement: ___-range for thrust, appropriate range for oscillation -Direction of Force: ______,_____,______ force -Target Force: -Mobilizing: cranial surface 1st rib -Relative Structural Movement: 1st rib on thoracic spine -Patient Position: _______; c-spine ipsilateral sidebending, contralateral rotation, slight extension

- high, low - end-range - caudal, medial, ventral - supine

Costotransverse Mobilization: -Rate of Force: ___ velocity for oscillation -Location in Range of Available Movement: ___-range for thrust, appropriate range for oscillation -Direction of Force: -Costal force: ventral, caudal, ipsilateral lateral -Thoracic force: ventral, contralateral lateral, slight cranial -Target Force: -Mobilizing: -Thoracic: dorsal surface contralateral articular pillar -Rib: dorsal surface -Relative Structural Movement: rib on transverse process of thoracic spine -Patient Position: prone

- low | - end-range

C-SPINE THRUST MANIPULATION

Are we allowed to do c-spine manipulations without a referral?

Yes

C0:C1 Traction: - Rate of Force: ____ velocity - Location in Range of Available Movement: ___-range - Direction of Force: _______ force - Target Force: - Mobilizing: lateral aspect of _________ occipital protuberance - Stabilizing: _______ with chin cradle grip - Relative Structural Movement: ________ on c-spine - Patient Position: _______, ipsilateral sidebend and contralateral rotation upper cervical spine

- high - end-range - cranial - ipsilateral - cranium - cranium - supine