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Vertebrae differ by
Longer spinous processs
How many degrees of flexion and extension
What happens to mobility in the lower thoracic
More mobility due to lack of rib articulation
- Pump handle
- Anterior lung expansion
- Bucket handle
- -Lateral expansion
- - transverse, rotates ribs outward
Spine segments most to least mobile
What prevents rotation
What prevents flexion
- Facet orientation in frontal plane
Amount of lateral side bend
Amount of rotation
Per segment thoracic has more or less mobility than lumbar?
As a whole lumber and thoracic have more, less, or equal mobility
Which test is more effective for thoracic? MMT or functional?
Most common hypomobility?
Uniside bend or limited extension
What motion in thoracic tends to occur with side bend?
Rotation to other side
T/F can have hypo and hyper mobility combination.
- Ie functional scoliosis: L side could be hypomobile while right hyper
If both hyper and hypo mobile what would you do to fix?
- Stabilize hypermobile motion
- Mobilize the hypomobile motion
If a joint is hypo or hyper mobile what you might see else where?
If joint is hypo you'd find a hyper mobile joint that accommodates it and vice versa
Easiest to hardest planes for trunk exercises
An elongated muscle is best trained in what position?
Exaggerated kyphosis can lead to the rib cage to rest on what?
Anterior iliac crest.
Severe kyphosis can shorten or lengthen the appendicular skeleton?
What is the only type of stretching an osteoporosis patient should receive?
Idiopathic vs acquired scoliosis
Structural vs functional
Swayback is due to..
Common population for osteoporosis
- Post menopausal women
- Elderly men
- Decreased calcium or vitamin D
What progresses osteoporosis?
- Decreased mobility
- Sedentary lifestyle
Osteopor clinical findings
- Pain in bones, back, and muscle spasm
- Height reduction
- Kyphosis and scoliosos
- Usually unable to restore to normal, just prevention of progression
- Hi Ca++ diet, vitamin D, protein
- Fluoride supplements
- Foasmax to inhibit osteoclast activity
- Weight bearing exercises
- Greater than 45-50 degrees
- Excessive thoracic associated with anterior wedging of thoracic vert
- Juvenile- Occuring in kids
- Younger children with mild deform
- -Spinal extensor strengthening
- -Stretching hams, pec major, superior abs
- Bracing in adolescents until maturity
- Spinal fusion surgery in curves greater than 70
- Freezing of the joints of the spine with inflammation
- Chronic progressive
- Affects SI, intervert and costovert spaces
- 20-30 y/os
- Remissions and exacerbations
- Possible autoimmune disorder, genetic basis
Ankylosing Spondylitis Pathology
- Starts as inflam of the vertebral joints
- Fibrosis then calcification (loss of ROM)
- Initially LB and SI
- Kyphosis develops from lack of ROM
- Osteoporosis with possible patho fractures
- Limited lung expansion due to calficiation of costovertebral joints
Ankylosing Spondylitis SnS
- Early: LBP and morning stiffness
- Discomfort relieved by walking and mild EX
- Spine rigid
- May develop radicular pain
- 1/3rd develop system signs
- -fatigue, fever, iritis, weight loss
Ankylosing Spondylitis Tx
- Maintain joint mob
- Breathing EX
- Decrease synovitis: NSAIDs
- Possible joint replacement
Which side has a visible posterior rib hump in a structural scoliosis?
Which side can you see anterior rib flare
Excessively large thoracic kyphosis
How does LLD relate to scoliosis (does it always occur?)
- Could be a compensation for scoliosis
- Not always a result of scolosis
T/F Positive Adam's test shows functional scoliosis
- Positive Adam's test shows structural. If scoliosis disappears during Adam's test it means its a functional Scoliosis.
Functional scoliosis is usually secondary to..
- Spasm/pain in LW or midback musculature.
- ie always standing on one leg
Severe scoliosis curves may effect
cardio pulmonary due to limited lung expansions
- Mild: <20 degrees
- Mod: 20-50 degrees
- Severe: >50 degrees
Etiology of structural scoliosis
- Idiopathic 75-85%
- Usually adolescent
- F>M 10-15 y/o
- Muscle imbalance, postural control, or bone malformation
Neuromuscular Structural Scoliosis
Osteopathic structural scoliosis
- Bone malformation
Non-structural scoliosis types
- LLD (functional)
- SI disorders
- Dislocated hip (possible LLD)
- LB spasms and/or disc protrusions
- -Gives a posture to avoid pain; results in functional scoliosis
- Habitual posture changes
- -Standing on one hip
Clinical findings Scoliosis
- Scap winging (on convexity of curve)
- Pelvic obliquity (crest not level)
- Waist angle changes
- Curve increases or stays with forward bending
- Exercise with cast/brace
- -Stretch and strengthen
- -Usually pre-op
- Spinal bracing (boston, milwaukee)
- -On convex side to strengthen and realign spine upright
- -Spinal fusion with Harrington rod >40degrees
What side do you strengthen, which do you stretch
- Strengthen convex
- Stretch concave