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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. 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

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  1. Evaluation and Treatment of the Acutely Injured Spine Tara J Manal PT, DPT, OCS, SCS Greg Hicks PT, PhD

  2. 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

  3. Oswestry Questionnaire • 5 Minutes to Score • Initial Classification • Documentation of Outcome

  4. 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

  5. Patient Staging • Stage II Decreased Activities of Daily Living • Reduce Oswestry to <20% - 40% • Enable to perform ADL’s

  6. Patient Staging • Stage III Return to High Demand Activity • Reduce Oswestry to 20% or less • Enable to Return to Work

  7. Neurological Examination • Indication - Symptoms Below the Knee • LE Sensory Testing • Muscle Strength Assessment • Reflex Testing • Nerve Root Testing • Babinski testing • Clonus

  8. Pelvic Assessment I • PSIS Symmetry in Sitting • Unequal heights • Positive Test

  9. Pelvic Assessment II • Standing Flexion Test • Start Position • Palpate PSIS • Relative position

  10. 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

  11. Pelvic Assessment III

  12. 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

  13. Pelvic Assessment IV • Start position • Prone • Palpate inferior to lateral malleoli or plantar aspect of calcaneus • Observe leg length

  14. Prone Knee Flexion • End position • Knee flexed to 90° • Positive: change in position from start to finish

  15. 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

  16. Specific Manipulation for SIJ Re-test composite after manipulation

  17. Pubic Manipulation

  18. Osteology • Innominate • Sacrum • Base • ILA

  19. Ilial Rotation Slip Flare Sacral Nutation (Flexion) Counternutation (Extension) Rotation Torsion Mobility of the SI Joint

  20. Stability of the SI Joint • Ligamentous • Bony (“Form Closure”) • Muscular (“Force Closure”)

  21. Form Closure

  22. Force Closure

  23. Rotations

  24. Rotations • IfAnterior Rotation • mob posteriorly • If Posterior rotation • mob anteriorly

  25. Sacral

  26. Bracing

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