NPTE FF Spine conditions / Tx

Spondylosis

• Degenerative changes to IVD’s

• > 50 y/o

• Back: unilateral

• Aggravating factors: extension, standing

• Relieving factors: sitting, bending

• SLR: Negative

• Diagnostic imaging: x-ray positive for arthritic change

spondylosis

• Defect in the pars interarticularis or posterior arch of the vertebra (Fx)

• > 15-20 y/o

• Back

• Aggravating factors: extension, standing, and bending to lift objects

• Relieving factors: sitting

• SLR: Negative

• Diagnostic imaging: x-ray oblique view shows fracture of pars interarticularis

Spondylolisthesis

• Anterior displacement of one vertebra over another (bilateral fracture)

• Retrolisthesis: posterior displacement of one vertebra on the vertebra just beneath it

  • avoid flexion

  • Retrolisthesis is rare

• No extension exercises

• 30- 50 y/o

• Back, leg (unilateral)

• Aggravating factors: extension, standing, and bending to lift objects

• Relieving factors: sitting

• SLR: Negative

• Diagnostic imaging: x-ray positive for slippage of vertebrae

Disc herniation

• 30-50 years old

• Back, leg unilateral s/s

• Aggravating factors: sitting bending, ascending stairs

• Relieving factors: extension, standing, descending stairs

• SLR: positive

• Diagnostic imaging: MRI, CT indicates bulging disc

Spinal stenosis

• > 60 years old

• Back, leg bilateral s/s

• Aggravating factors: extension, standing

• Relieving factors: sitting, bending

• SLR: positive

• Diagnostic imaging: MRI, CT, x-ray

Scheurmann disease

• thoracic kyphosis

• anterior wedging of > 5 degrees in 3 adjacent vertebrae

  • commonly found in mid- and lower thoracic areas

• often affects young gymnasts

• Schmorl nodes present

• congenital or degenerative weakening of vertebral end plates

• Normally, no radicular s/s b/c berve root is not involved

• do extension exercises

Pott disease

• Tuberculosis (TB) of the spine, lower TS and upper LS are most affected

• Tuberculosis arthritis of intervertebral joints

Spinal stenosis

• Narrowing of spine canal

• Pain with extension; feels better walking uphill or holding onto cart

• Do flexion exercises

Ankylosing spondylitis

• Progressive inflammatory (rheumatic) disease that affects axial skeleton

  • Bamboo spine

• Do extension exercises

• Dx Criteria

  • Night pain

  • Back pain for > 3 months

  • more common in med

  • rigid spine

  • Ages 20-50

  • Human leukocyte antigen B27 (HLA-B27) level and erythrocyte sedimentation rate (ESR) increase

Scoliosis- functional v. structural

• Functional: disappears with forward bending

  • Right thoracic rotation and L side bending leads to right rib hump

• Structural: causes by a structural abnormality; apparent while standing and with forward bending

Scoliosis- concave side

• High pelvis, anterior rib hump, spinous process (SP) rotation, muscle short and tight

• Anterior rib distortion

• decreased lung volume

• narrowing of intercostal spaces

• supination and lengthening

  • stretch the concave side, including quadratus lumborum (QL), latisimus dorsi and external oblique

  • glute med weakness

Scoliosis- convex side

• Named after convex side

• muscles are lengthened and weak, vertebral body rotated, shoulder elevated, scapula prominent

• increased lateral costal expansion (increased lung volume)

• Widening of intercostal spaces

• Apparent short limb and pronation (need a shoe lift)

  • Strengthen the convex side including QL, lat and external oblique

  • Body rotates to the side of scoliosis, and spinous processes rotate to the opposite side

NPTE terminology for opening v. closing

• Opening

  • gaping

  • increased space

  • up glide

  • flexion

• Closing

  • decreased space

  • downglide

  • extension

closing and gaping

• Flexion: opening- increasing gap → mob top vertebrae, keep the bottom stable

• Extension: closing- decreasing gap → move bottom vertebrae, keep top table

  • C rule → make hand into a C

    • to open/ increase space “pop the top” (mob top vertebrae)

    • to close/ decrease space “ bottoms up” (mob bottom vertebrae”

Cervical and Lumbar spine coupled motion

• In the cervical (C2-C7) and thoracic spine, the side bending and rotation are in the same direction

• In the lumbar spine, the side bending and rotation occur in the opposite direction

coupled movements mobilizations

• Cervical/ thoracic

  • To open: flexion, side bend away, and rotate away

  • To close: Extension, sidebend towards, and rotate towards

• Lumbar

  • to open: Flexion, side bend away, and rotate towards

  • to close: Extension, side bend toward and rotate away