Thomas M. Dodge, PhD, ATC, CSCS Springfield College Springfield, MA

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Thomas M. Dodge, PhD, ATC, CSCS Springfield College Springfield, MA"

Transcription

1 Thomas M. Dodge, PhD, ATC, CSCS Springfield College Springfield, MA

2 Outline Relevance Functional Anatomy Treatment options Electrotherapies Manual Therapies Therapeutic Exercise Conclusions

3 Relevance Cervical pain affects approximately 15% of the population (Cote et al., 2004) Debilitating nature of cervical pain Cervical pain has a multitude of causes Difficult to treat

4

5 Upper segments 45 superior to the transverse plane Lower segments More vertical position

6 Musculature (Ylinen, 2007) Isometric function Posture Stabilization Dynamic function Position head for better sensory input Proprioception Sight, hearing, olfaction, etc. Relationship to shoulders Elevation Inspiration

7 Common Injuries Myofascial Trigger Points Cervical Strains Joint Restrictions/Facet Joint Pathology Cervical Instabilities Disc Pathologies Radicular Pain Cervicogenic Headaches

8 Postural Issues

9 Treatments

10 Electrotherapy

11 Efficacy of IFC Fuentes et al. (2010) IFC provides modest relief for musculoskeletal pain as part of a multimodal treatment approach Acute or Chronic 3 Month Follow Up No specific neck studies included in metaanalysis

12 Electrotherapy TENS coupled with Ischemic compression leads to greater initial reduction in pain (Hou et al., 2002) TENS intervention lead to improvements in strength, pain, and disability status at both 6 weeks and 6 month follow-up (Chiu et al., 2005)

13 Electrotherapy Bottom Line Cochrane Review (Kroeling et al., 2009) Low level of evidence supporting IFC as a treatment for c-spine pain Bottom Line: Its probably worth trying, but not in isolation

14 Traction/Mobilization Techniques

15 Traction/Mobilization Contraindications Vertebral Fracture Vertebral Dislocation Hypermobility Disease/Infection Vertebral Artery Dysfunction Severe Disc Herniation Arthritis?

16 Traction

17 Cervical Traction Clinical Prediction Rule (Raney et al, 2009) Peripheralization with mobility testing C4-C7 (+) Shoulder Abduction Test Age 55 (+) Upper Limb Tension Test (+) Cervical Distraction Test

18 Mobility Testing

19 Shoulder Abduction Test

20 Cervical Distraction Test

21 Upper Limb Tension Test

22 Cervical Traction Clinical Prediction Rule (Raney et al, 2009) Peripheralization with mobility testing C4-C7 (+) Shoulder Abduction Test Age 55 (+) Upper Limb Tension Test (+) Cervical Distraction Test 79.2% Success rate with 3 factors 94.8% Success rate with 4 factors

23 Manual Cervical Traction

24 Traction/Trigger Point Pressure

25 Cervical Traction Patients with radicular symptoms of less than 12 weeks reported a reduction in pain and perceived disability with mechanical traction (Moeti & Marchetti, 2001). Centralization can be accomplished through a combination of traction and retraction exercises (Werneke & Hart, 2003).

26 Cervical Traction More recent research (Chiu et al. 2011, Young et al., 2009) suggests that traction is not a necessary addition to the treatment protocol when treating chronic and/or radicular pain with manual therapy and therapeutic exercise. Bottom line: Utilize the CPR for optimal results

27 Thoracic Thrust Mobilization

28 Thoracic Thrust Mobilization CPR (Cleland et al, 2007) Symptoms < 30 days No symptoms distal to the shoulder Looking up does not aggravate symptoms FABQPA score <12 Diminished upper spine kyphosis Cervical extension ROM < 30 3 or more = 86% success rate

29 Thoracic Mobilization Evaluation

30 Thoracic Mobilization Evaluation

31 Thoracic Mobilization

32 Thoracic Mobilization

33 Thoracic Spine Thrust Mobilization Thoracic spine thrust mobilization results in significantly greater short-term reductions in pain and disability than does thoracic nonthrust mobilization in people with neck pain (Cleland et al., 2007)

34 Thoracic Thrust Mobilization CPR 2010 update (Cleland et al.) Validity of original CPR not supported Long and short term improvements in pain and neck disability TTM supported as a viable treatment for all patients with mechanical neck pain

35 Therapeutic Exercise

36 Chin Tuck Maneuver

37 Chin Tuck With Bladder

38 Chin Tuck Progression Start on the table in anatomical position 1. Progressive Tension 22, 24, 26, 28, Elbow flexion and extension 3. GH Internal/external rotation 4. GH abduction and flexion/extension 5. Scapular protraction, depression, elevation 6. Diagonal patterns (PNF)

39 Chin Tuck Progression

40 Moving Off The Table

41 Progression Off The Table

42 Therapeutic Exercise Resistance exercise, when training volume is appropriate, can significantly reduce neck pain and disability (Ylinen et al. 2003). Dynamic and isometric training of the neck musculature significantly increases pressure pain threshold (PPT) in neck muscles (Ylinen et al. 2005).

43 Loading Patients must possess sufficient strength to cope with tasks that require higher loading levels during recreational and work activities. (Ylinen, 2007) Long term moderate to high intensity training of the neck musculature is appropriate for reduction and prevention of chronic neck pain (Ylinen, 2007)

44 Conclusions Electrotherapy is viable treatment option Mobilization and traction techniques are useful when indicated Posture and the Kinetic Chain Thoracic mobility Rehabilitation Deep Neck Flexors Progressive Loading Treatment of cervical spine should always follow a multimodal approach (Miller et al., 2010)

45 References Chiu TT; Ng JK; Walther-Zhang B et al. A randomized controlled trial on the efficacy of intermittent cervical traction for patients with chronic neck pain. Clin Rehabil. 2011;25: Chiu TW, Hui-Chan WY, Cheing G. A randomized clinical trial of TENS and exercise for patients with chronic neck pain. Clin Rehabil. 2005;9: Cleland JA, Mintken PE, Carpenter K, et al. Examination of a clinical prediction rule to identify patients with neck pain likely to benefit from thoracic spine thrust manipulation and a general cervical range of motion exercise: Multi-center randomized clinical trial. Phys Ther. 2010;90: Cleland JA, Glynn P, Whitman JM, et al. Short-term effects of thrust versus non-thrust mobilization/manipulation directed at the thoracic spine in patients with neck pain: A randomized clinical trial. Phys Ther. 2007;87: Cleland JA, Childs JD, Fritz JM et al. Development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck pain: use of thoracic spine manipulation, exercise and patient education. Phys Ther. 2007;87:9-23. Cote P, Cassidy JD, Carrol LJ, et al. The annual incidence and course of neck pain in the general population: a populationbased cohort study. Pain. 2004;112: Fuentes JP, Olivio SA, Magee DJ et al. Effectiveness of Interferential Current Therapy in the Management of Musculoskeletal Pain: A Systematic Review and Meta-Analysis. Phys Ther. 2010;90: Hou CR, Tsai LC, Cheng KF, et al. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil. 2002;83: Kroeling P, Gross A, Goldsmith CH, et al. Electrotherapy for neck pain. Cochrane Database of Systematic Reviews 2009, Issue 4. Miller J, Gross A, D sylva J, et al. Manual therapy and exercise for neck pain: A systematic review. Manual Therapy. 2010;15: Moeti P, Marchetti G. Clinical outcome from mechanical intermittent cervical traction for the treatment of cervical radiculopathy: A case series. JOSPT. 2001;31(4): Raney NH, Petersen EJ, Smith TA, et al. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise. Eur Spine J. 2009;18: Werneke M, Hart DL. Discriminant validity and relative precision for classifying patients with nonspecific neck and back pain by anatomic pain patterns. Spine. 2003;28: Ylinen J, Takala EP, Kautiainen H. et al. Effect of long-term neck muscle training on pressure pain threshold: A randomized controlled trial. Eur J Pain. 2005;9: Ylinen J, Takala EP, Nykanen M et al. Active neck muscle training in the treatment of chronic neck pain in women: A randomized controlled trial. JAMA. 2003;289: Ylinen J. Physical exercises and functional rehabilitation for the management of chronic neck pain. Eura Medicophys. 2007;43: Young IA; Michener LA; Cleland JA et al., Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomized clinical trial. Phys Ther. 2009;89:

46

Pain Management. Practical Applications in Electrotherapy

Pain Management. Practical Applications in Electrotherapy Pain Management Practical Applications in Electrotherapy The TENS Advantage Deliver Immediate Pain Relief using a unique waveform designed to help prevent nerve accommodation. Manage Dynamic Pain by adjusting

More information

Objectives. Clinical Decision making for Neck Pain: Use of Clinical Prediction Rules and Current Evidence for Manual Therapy.

Objectives. Clinical Decision making for Neck Pain: Use of Clinical Prediction Rules and Current Evidence for Manual Therapy. Clinical Decision making for Neck Pain: Use of Clinical Prediction Rules and Current Evidence for Manual Therapy John Schmitt, PT, PhD, CMT Chris Kramer, PT, DPT, OCS, FAAOMPT Objectives Discuss factors

More information

Neck Pain & Cervicogenic Headache Integrating Research into Practice: San Luis Sports Therapy s Approach to Evidence-Based Practice

Neck Pain & Cervicogenic Headache Integrating Research into Practice: San Luis Sports Therapy s Approach to Evidence-Based Practice Neck Pain & Cervicogenic Headache Integrating Research into Practice: San Luis Sports Therapy s Approach to Evidence-Based Practice PROBLEM: Neck Pain and Cervicogenic Headache 66% Proportion of individuals

More information

Cervical Traction. Distinguishing Features and Benefits 2. Cervical Traction Frequently Asked Questions 2

Cervical Traction. Distinguishing Features and Benefits 2. Cervical Traction Frequently Asked Questions 2 Cervical Traction Distinguishing Features and Benefits 2 Cervical Traction Frequently Asked Questions 2 Evidence for Saunders Cervical Traction Protocols in Peer-Reviewed Literature 5 Peer Reviewed Article

More information

1 REVISOR 5223.0070. (4) Pain associated with rigidity (loss of motion or postural abnormality) or

1 REVISOR 5223.0070. (4) Pain associated with rigidity (loss of motion or postural abnormality) or 1 REVISOR 5223.0070 5223.0070 MUSCULOSKELETAL SCHEDULE; BACK. Subpart 1. Lumbar spine. The spine rating is inclusive of leg symptoms except for gross motor weakness, bladder or bowel dysfunction, or sexual

More information

Standard of Care: Cervical Radiculopathy

Standard of Care: Cervical Radiculopathy Department of Rehabilitation Services Physical Therapy Diagnosis: Cervical radiculopathy, injury to one or more nerve roots, has multiple presentations. Symptoms may include pain in the cervical spine

More information

Notice of Independent Review Decision DESCRIPTION OF THE SERVICE OR SERVICES IN DISPUTE:

Notice of Independent Review Decision DESCRIPTION OF THE SERVICE OR SERVICES IN DISPUTE: Notice of Independent Review Decision DATE OF REVIEW: 08/15/08 IRO CASE #: NAME: DESCRIPTION OF THE SERVICE OR SERVICES IN DISPUTE: Determine the appropriateness of the previously denied request for physical

More information

Ron Schenk PT, PhD 1

Ron Schenk PT, PhD 1 Ron Schenk PT, PhD 1 Objectives Describe the anatomy of the neck (cervical spine) and low back (lumbar spine) Describe the risk factors associated with neck and low back injury Describe physical therapy

More information

ISPI Newsletter Archive - Whiplash

ISPI Newsletter Archive - Whiplash ISPI Newsletter Archive - Whiplash March 2005 Widespread Sensory Hypersensitivity Is a Feature of Chronic Whiplash - Associated Disorder but not Chronic Idiopathic Neck Pain. Clin J Pain. 2005 Mar-Apr;21

More information

SPINE. Postural Malalignments 4/9/2015. Cervical Spine Evaluation. Thoracic Spine Evaluation. Observations. Assess position of head and neck

SPINE. Postural Malalignments 4/9/2015. Cervical Spine Evaluation. Thoracic Spine Evaluation. Observations. Assess position of head and neck SPINE Observations Body type Postural alignments and asymmetries should be observed from all views Assess height differences between anatomical landmarks Figure 25-9 Figure 25-10 Figure 25-11 & 12 Postural

More information

PT and Physician Perspectives

PT and Physician Perspectives PT and Physician Perspectives Specialists in evaluating and treating movement disorders Restore, maintain, and promote optimal physical function, as well as, optimal wellness and fitness and optimal quality

More information

Thrust Joint Manipulation for the Cervical Spine: New Thoughts on Benefits and Risks

Thrust Joint Manipulation for the Cervical Spine: New Thoughts on Benefits and Risks Thrust Joint Manipulation for the Cervical Spine: New Thoughts on Benefits and Risks Louie Puentedura, PT, DPT, OCS, FAAOMPT Paul Mintken, PT, DPT, OCS, FAAOMPT Incidence of Neck Pain 54% of individuals

More information

Reverse Total Shoulder Protocol

Reverse Total Shoulder Protocol Marion Herring, M.D. Advanced Orthopaedics Sports Medicine Center PH: (804) 270-1305 FX: (804) 273-9294 www.advancedortho.me Reverse Total Shoulder Protocol General Information: Reverse Total Shoulder

More information

New York State Workers' Comp Board. Mid and Lower Back Treatment Guidelines. Summary From 1st Edition, June 30, 2010. Effective December 1, 2010

New York State Workers' Comp Board. Mid and Lower Back Treatment Guidelines. Summary From 1st Edition, June 30, 2010. Effective December 1, 2010 New York State Workers' Comp Board Mid and Lower Back Treatment Guidelines Summary From 1st Edition, June 30, 2010 Effective December 1, 2010 General Principles Treatment should be focused on restoring

More information

Updates into Therapeutic Exercise Programs for Patients with LBP. Maximizing Patient Motivation and Outcomes Alice M.

Updates into Therapeutic Exercise Programs for Patients with LBP. Maximizing Patient Motivation and Outcomes Alice M. Updates into Therapeutic Exercise Programs for Patients with LBP Maximizing Patient Motivation and Outcomes Alice M. Davis, PT, DPT Objectives Review Statistics on LBP Discuss current research findings

More information

Manual treatment for neck pain; how strong is the evidence?

Manual treatment for neck pain; how strong is the evidence? Manual treatment for neck pain; how strong is the evidence? 1 SIMON DAGENAIS, DC, PHD ASSISTANT PROFESSOR, DEPARTMENT OF EPIDEMIOLOGY AND COMMUNITY MEDICINE, DIVISION OF ORTHOPEDIC SURGERY UNIVERSITY OF

More information

Biceps Tenotomy Protocol

Biceps Tenotomy Protocol Department of Rehabilitation Services Physical Therapy The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone

More information

OUTPATIENT PHYSICAL AND OCCUPATIONAL THERAPY PROTOCOL GUIDELINES

OUTPATIENT PHYSICAL AND OCCUPATIONAL THERAPY PROTOCOL GUIDELINES OUTPATIENT PHYSICAL AND OCCUPATIONAL THERAPY PROTOCOL GUIDELINES General Therapy Guidelines 1. Therapy evaluations must be provided by licensed physical and/or occupational therapists. Therapy evaluations

More information

Design System review of Medline, CINAHL, AMED, PEDro, and Cochrane databases till August 2010.

Design System review of Medline, CINAHL, AMED, PEDro, and Cochrane databases till August 2010. The McKenzie Institute International 2013 Vol. 2, No. 2 LITERATURE REVIEWS Summary and Perspective of Recent Literature Stephen May, PhD, MA, FCSP, Dip. MDT, MSc (UK) May S, Comer C. Is surgery more effective

More information

Joshua A. Cleland, PT, DPT, PhD, OCS, FAAOMPT

Joshua A. Cleland, PT, DPT, PhD, OCS, FAAOMPT Joshua A. Cleland, PT, DPT, PhD, OCS, FAAOMPT Franklin Pierce University Presentations at Scientific Meetings: Changes in Pain and Cervical Range of Motion after Cervical or Thoracic Thrust Manuscript

More information

Care and Prevention of Sedentary Workplace Injuries. By: Colin Beattie, BKIN, mpt, cafci Registered physical therapist & medical acupuncturist

Care and Prevention of Sedentary Workplace Injuries. By: Colin Beattie, BKIN, mpt, cafci Registered physical therapist & medical acupuncturist Care and Prevention of Sedentary Workplace Injuries By: Colin Beattie, BKIN, mpt, cafci Registered physical therapist & medical acupuncturist Learning Objectives By the end of this presentation you should

More information

Types of Epidural Injections

Types of Epidural Injections Safety and Efficacy of Epidural Injections Robert Gamburd, MD The Physiatry Medical Group / SOAR 500 Arguello St. #100 Redwood City, California Types of Epidural Injections Blind or Xray guided Caudal

More information

33 % of whiplash patients develop. headaches originating from the upper. cervical spine

33 % of whiplash patients develop. headaches originating from the upper. cervical spine 33 % of whiplash patients develop headaches originating from the upper cervical spine - Dr Nikolai Bogduk Spine, 1995 1 Physical Treatments for Headache: A Structured Review Headache: The Journal of Head

More information

Whiplash Associated Disorder

Whiplash Associated Disorder Whiplash Associated Disorder The pathology Whiplash is a mechanism of injury, consisting of acceleration-deceleration forces to the neck. Mechanism: Hyperflexion/extension injury Stationary vehicle hit

More information

6/3/2011. High Prevalence and Incidence. Low back pain is 5 th most common reason for all physician office visits in the U.S.

6/3/2011. High Prevalence and Incidence. Low back pain is 5 th most common reason for all physician office visits in the U.S. High Prevalence and Incidence Prevalence 85% of Americans will experience low back pain at some time in their life. Incidence 5% annual Timothy C. Shen, M.D. Physical Medicine and Rehabilitation Sub-specialty

More information

SLAP Repair Protocol Arthroscopic Labral Repair Protocols (Type II, IV and Complex Tears)

SLAP Repair Protocol Arthroscopic Labral Repair Protocols (Type II, IV and Complex Tears) SLAP Repair Protocol Arthroscopic Labral Repair Protocols (Type II, IV and Complex Tears) This protocol has been modified and is being used with permission from the BWH Sports and Shoulder Service. The

More information

COX TECHNIC FLEXION-DISTRACTION CASE REPORT OF 35 YEAR OLD MALE C6-C7 CERVICAL POSTEROCENTRAL DISC PROTRUSION

COX TECHNIC FLEXION-DISTRACTION CASE REPORT OF 35 YEAR OLD MALE C6-C7 CERVICAL POSTEROCENTRAL DISC PROTRUSION COX TECHNIC FLEXION-DISTRACTION CASE REPORT OF 35 YEAR OLD MALE C6-C7 CERVICAL POSTEROCENTRAL DISC PROTRUSION Dr. Joel Dixon (B. APP Sci (Chiro) J.P, Certified Cox Practitioner) From Melbourne Spine Clinic

More information

Biceps Tenodesis Protocol

Biceps Tenodesis Protocol Department of Rehabilitation Services Physical Therapy The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone

More information

Clinical Practice Guideline for the Chiropractic Treatment of Adults with Neck Pain

Clinical Practice Guideline for the Chiropractic Treatment of Adults with Neck Pain Clinical Practice Guideline for the Chiropractic Treatment of Adults with Neck Pain March 2014 Available Online: www.chiropracticcanada.ca This material was developed by the Guidelines Development Committee

More information

Cervical Spondylosis and Neck Pain. British Medical Journal March 10, 2007;334: Presenting Features of Cervical Spondylosis

Cervical Spondylosis and Neck Pain. British Medical Journal March 10, 2007;334: Presenting Features of Cervical Spondylosis Cervical Spondylosis and Neck Pain 1 Allan I Binder, consultant rheumatologist British Medical Journal March 10, 2007;334:527-531 Presenting Features of Cervical Spondylosis SYMPTOMS * Cervical pain aggravated

More information

Thanks to the National Board of Chiropractic Examiners for permission to reproduce these abstracts.

Thanks to the National Board of Chiropractic Examiners for permission to reproduce these abstracts. Thanks to the National Board of Chiropractic Examiners for permission to reproduce these abstracts. The Effectiveness of Chiropractic Care A substantial number of systematic reviews of literature and meta-analyses

More information

Shoulder and Related Upper Extremity Radiating Pain

Shoulder and Related Upper Extremity Radiating Pain Shoulder and Related Upper Extremity Radiating Pain ICD-9-CM codes: 723.3 Cervical brachial syndrome ICF codes: Activities and Participation Domain codes: d4301 Carrying in the hands (Taking or transporting

More information

1 Neck Exercises. In the cervical spine, we are looking to increase range of motion in

1 Neck Exercises. In the cervical spine, we are looking to increase range of motion in 1 Neck Exercises Stretching and Increasing Mobility Below you will find stretching exercises specifically for the neck. If you suffer from a stiff neck or a pinched nerve in the neck, these exercises with

More information

Spinal Decompression

Spinal Decompression Spinal Decompression Spinal decompression is just one more tool we have to treat radiculopathy. With appropriate education and exercises, this modality has been proven to assist in the resolution of symptoms

More information

Carpal Tunnel Syndrome Educational Pamphlet

Carpal Tunnel Syndrome Educational Pamphlet Carpal Tunnel Syndrome Educational Pamphlet SOUTH SOUND PAIN RELIEF CLINIC Relieving Pain and Restoring Health Through Manual Methods Ph: 360-943-2940 Michael W. Neely, DC 2009 South Sound Pain Relief

More information

Headaches. Dr Simon Pumfrey 1 BSc MSc DC

Headaches. Dr Simon Pumfrey 1 BSc MSc DC Headaches Dr Simon Pumfrey 1 BSc MSc DC Dr Simon Pumfrey BSc MSc DC 2 3 Sick Care vs. Health Care Dr Simon Pumfrey BSc MSc DC Tension type Migraines Cervicogenic Cluster 4 Temporal arteritis Sinusitis

More information

Whiplash: a review of a commonly misunderstood injury

Whiplash: a review of a commonly misunderstood injury 1 Whiplash: a review of a commonly misunderstood injury The American Journal of Medicine; Volume 110; 651-656; June 1, 2001 Jason C. Eck, Scott D. Hodges, S. Craig Humphreys This review article has 64

More information

Abstract Objective: To review the mechanism, surgical procedures, and rehabilitation techniques used with an athlete suffering from chronic anterior

Abstract Objective: To review the mechanism, surgical procedures, and rehabilitation techniques used with an athlete suffering from chronic anterior Abstract Objective: To review the mechanism, surgical procedures, and rehabilitation techniques used with an athlete suffering from chronic anterior glenohumeral instability and glenoid labral tear. Background:

More information

Management pathway: whiplash-associated disorders (WAD)

Management pathway: whiplash-associated disorders (WAD) Management pathway: whiplash-associated disorders (WAD) This management tool is a guide intended to assist general practitioners and health professionals delivering primary care to adults with acute or

More information

SHOULDER EXAMINATION

SHOULDER EXAMINATION 1 SHOULDER EXAMINATION Depending upon the clinical scenario, you may need to examine the cervical spine and elbow. INSPECTION Swelling (especially joints) Sternoclavicular Acromioclavicular Glenohumeral

More information

Important rehabilitation management concepts to consider for a postoperative physical therapy rtsa program are:

Important rehabilitation management concepts to consider for a postoperative physical therapy rtsa program are: : General Information: Reverse or Inverse Total Shoulder Arthroplasty (rtsa) is designed specifically for the treatment of glenohumeral (GH) arthritis when it is associated with irreparable rotator cuff

More information

The Effects of Cox Decompression Technic in the Treatment of Low Back Pain and Sciatica in a Golf Professional

The Effects of Cox Decompression Technic in the Treatment of Low Back Pain and Sciatica in a Golf Professional Cox Technic Email Case Report 72, June 2009, James Schantz DC 1 The Effects of Cox Decompression Technic in the Treatment of Low Back Pain and Sciatica in a Golf Professional James E. Schantz, D.C. Leading

More information

Clinical guidance for MRI referral

Clinical guidance for MRI referral MRI for cervical radiculopathy Referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of spine for a patient 16 years or older for suspected: cervical radiculopathy

More information

Nonoperative Management of Herniated Cervical Intervertebral Disc With Radiculopathy. Spine Volume 21(16) August 15, 1996, pp 1877-1883

Nonoperative Management of Herniated Cervical Intervertebral Disc With Radiculopathy. Spine Volume 21(16) August 15, 1996, pp 1877-1883 Nonoperative Management of Herniated Cervical Intervertebral Disc With Radiculopathy 1 Spine Volume 21(16) August 15, 1996, pp 1877-1883 Saal, Joel S. MD; Saal, Jeffrey A. MD; Yurth, Elizabeth F. MD FROM

More information

Document Author: Frances Hunt Date 03/03/2008. 1. Purpose of this document To standardise the treatment of whiplash associated disorder.

Document Author: Frances Hunt Date 03/03/2008. 1. Purpose of this document To standardise the treatment of whiplash associated disorder. Guideline Title: WHIPLASH ASSOCIATED DISORDER Document Author: Frances Hunt Date 03/03/2008 Ratified by: Frances Hunt, Head of Physiotherapy Date: 16.09.15 Review date: 16.09.17 Links to policies: All

More information

PNF Proprioceptive Neuromuscular Facilitation

PNF Proprioceptive Neuromuscular Facilitation PNF Proprioceptive Neuromuscular Facilitation Assistant professor of Sports Medicine Department of Sports Medicine Tehran university of Medical Sciences Following injury, soft tissue loses some of its

More information

Current Concepts of Low Back Pain. Terry L. Grindstaff, PhD, PT, ATC, SCS, CSCS

Current Concepts of Low Back Pain. Terry L. Grindstaff, PhD, PT, ATC, SCS, CSCS Current Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ATC, SCS, CSCS 28% population reports LBP in past 3 months (CDC 2010) 60% recurrence rate (Turner et al, 1992) Low Back Pain Low Back Pain

More information

WHAT IS STENOSIS? DO I NEED SURGERY OR CAN POSTURAL THERPAY HELP?

WHAT IS STENOSIS? DO I NEED SURGERY OR CAN POSTURAL THERPAY HELP? WHAT IS STENOSIS? DO I NEED SURGERY OR CAN POSTURAL THERPAY HELP? Stenosis is a narrowing of the spinal canal. It usually occurs in the lower back (lumbar spine) or the neck (cervical spine) It occurs

More information

Rehabilitation Documentation and Proper Coding Guidelines

Rehabilitation Documentation and Proper Coding Guidelines Rehabilitation Documentation and Proper Coding Guidelines Purpose: 1) Develop a guide for doctors in South Dakota to follow when performing reviews on rehabilitation cases. 2) Provide doctors in South

More information

MOVEMENT and MANUAL THERAPY

MOVEMENT and MANUAL THERAPY YES! MOVEMENT and MANUAL THERAPY ROTATION EXTENSION FLEXION Main Objective * Combining Manual Therapy and Movement can effectively improve your patients quickly and empower the patient with tools for prevention

More information

A Patient s Guide to Shoulder Pain

A Patient s Guide to Shoulder Pain A Patient s Guide to Shoulder Pain Part 2 Evaluating the Patient James T. Mazzara, M.D. Shoulder and Elbow Surgery Sports Medicine Occupational Orthopedics Patient Education Disclaimer This presentation

More information

Temporo-Mandibular Joint Complex Exercise Suggestions

Temporo-Mandibular Joint Complex Exercise Suggestions Temporo-Mandibular Joint Complex Exercise Suggestions I. Exercise Generalizations: A. Patients with post-traumatic TMJ problems or with recent-onset dysfunction that is largely posture-related will generally

More information

CLINICAL GUIDELINES RECOMMENDATIONS..2 INTRODUCTION...5. CLINICAL GUIDELINES: Impairment/Function-Based Diagnosis 14

CLINICAL GUIDELINES RECOMMENDATIONS..2 INTRODUCTION...5. CLINICAL GUIDELINES: Impairment/Function-Based Diagnosis 14 CLINICAL GUIDELINES 1 John D. Childs PT, PhD, Joshua A. Cleland PT, PhD, James M. Elliott PT, PhD, Deydre S. Teyhen PT, PhD, Robert S. Wainner PT, PhD, Julie M. Whitman PT, DSc, Bernard J. Sopky MD, Joseph

More information

Rotator Cuff Repair Rehabilitation Protocol Dr. Mark Adickes

Rotator Cuff Repair Rehabilitation Protocol Dr. Mark Adickes Rotator Cuff Repair Rehabilitation Protocol Dr. Mark Adickes Introduction: This rehabilitation protocol has been developed for the patient following a rotator cuff repair. This protocol will vary in length

More information

Spine Vol. 30 No. 16; August 15, 2005, pp 1799-1807

Spine Vol. 30 No. 16; August 15, 2005, pp 1799-1807 A Randomized Controlled Trial of an Educational Intervention to Prevent the Chronic Pain of Whiplash Associated Disorders Following Rear-End Motor Vehicle Collisions 1 Spine Vol. 30 No. 16; August 15,

More information

Using Outcome Measures in the Clinic

Using Outcome Measures in the Clinic Using Outcome Measures in the Clinic Jennifer Harwood BscPT, FCAMPT and Andrew White BPE, BScPT, FCAMPT Outcome measures are a way for clinicians to measure clinical change in patients over time. There

More information

Saunders Cervical Traction

Saunders Cervical Traction The Saunders Group, Inc. Saunders Cervical Traction Effective Treatment for Neck Pain and Dysfunction A comprehensive guide to unique features and therapeutic benefits of the Saunders Cervical HomeTrac

More information

Nonoperative Treatment For Rotator Cuff Tendinitis/ Partial Thickness Tear-- Dr. Trueblood

Nonoperative Treatment For Rotator Cuff Tendinitis/ Partial Thickness Tear-- Dr. Trueblood Nonoperative Treatment For Rotator Cuff Tendinitis/ Partial Thickness Tear-- Dr. Trueblood Indications: Subacromial impingement syndrome charateristically Relieving Pain Patients who present with SIS will

More information

Spinal Anatomy. * MedX research contends that the lumbar region really starts at T-11, based upon the attributes of the vertebra.

Spinal Anatomy. * MedX research contends that the lumbar region really starts at T-11, based upon the attributes of the vertebra. Spinal Anatomy Overview Neck and back pain, especially pain in the lower back, is one of the most common health problems in adults. Fortunately, most back and neck pain is temporary, resulting from short-term

More information

Natural Modality in the Treatment of Primary Headaches. William S. Mihin, D.C. Catharine Helms, M.S. Michelle M. Anderson, M.S.N., F.N.P.

Natural Modality in the Treatment of Primary Headaches. William S. Mihin, D.C. Catharine Helms, M.S. Michelle M. Anderson, M.S.N., F.N.P. Natural Modality in the Treatment of Primary Headaches William S. Mihin, D.C. Catharine Helms, M.S. Michelle M. Anderson, M.S.N., F.N.P. Abstract Headaches are both a prevalent and disabling condition.

More information

Mechanical Diagnosis And Therapy of the Cervical Spine. The McKenzie Method. Allan Besselink, PT, Dip.MDT Smart Sport International Austin, Texas

Mechanical Diagnosis And Therapy of the Cervical Spine. The McKenzie Method. Allan Besselink, PT, Dip.MDT Smart Sport International Austin, Texas Mechanical Diagnosis And Therapy of the Cervical Spine The McKenzie Method Allan Besselink, PT, Dip.MDT Smart Sport International Austin, Texas Background Physical Therapist Queen s s University 1988 McKenzie

More information

SLAP Lesion Repair Rehabilitation Protocol Dr. Mark Adickes

SLAP Lesion Repair Rehabilitation Protocol Dr. Mark Adickes SLAP Lesion Repair Rehabilitation Protocol Dr. Mark Adickes Introduction: This rehabilitation protocol has been developed for the patient following a SLAP (Superior Labrum Anterior Posterior) repair. It

More information

Case Studies Updated 10.24.11

Case Studies Updated 10.24.11 S O L U T I O N S Case Studies Updated 10.24.11 Hill DT Solutions Cervical Decompression Case Study An 18-year-old male involved in a motor vehicle accident in which his SUV was totaled suffering from

More information

UHealth Sports Medicine

UHealth Sports Medicine UHealth Sports Medicine Rehabilitation Guidelines for Arthroscopic Rotator Cuff Repair Type 2 Repairs with Bicep Tenodesis (+/- subacromial decompression) The rehabilitation guidelines are presented in

More information

Tension Type Headaches

Tension Type Headaches Tension Type Headaches Research Review by : Dr. Ian MacIntyre Physiotherapy for tension-type Headache: A Controlled Study P. Torelli, R. Jenson, J. Olsen: Cephalalgia, 2004, 24, 29-36 Tension-type headache

More information

Appendix A - Low Back Pain Scope

Appendix A - Low Back Pain Scope Appendix A - Low Back Pain Scope Low back pain: full guideline DRAFT (September 2008) Page 1 of 10 NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Low back pain: the acute

More information

Latissimus Dorsi Tendon Transfer

Latissimus Dorsi Tendon Transfer Rehabilitation Protocol Latissimus Dorsi Tendon Transfer Department of Orthopaedic Surgery Lahey Hospital & Medical Center, Burlington 781-744-8650 Lahey Outpatient Center, Lexington 781-372-7020 Lahey

More information

Effects of Vertebral Axial Decompression (VAX-D) On Intradiscal Pressure

Effects of Vertebral Axial Decompression (VAX-D) On Intradiscal Pressure Effects of Vertebral Axial Decompression (VAX-D) On Intradiscal Pressure Gustavo Ramos, M.D., William Marin, M.D. Journal of Neursurgery 81:35-353 1994 Departments of Neurosurgery and Radiology, Rio Grande

More information

UTILIZING STRAPPING AND TAPING CODES FOR HEALTH CARE REIMBURSEMENT:

UTILIZING STRAPPING AND TAPING CODES FOR HEALTH CARE REIMBURSEMENT: UTILIZING STRAPPING AND TAPING CODES FOR HEALTH CARE REIMBURSEMENT: A GUIDE TO BILLING FOR SPIDERTECH PRE-CUT APPLICATIONS AND TAPE Billing and coding taping and strapping services can be a complex issue.

More information

Crosswalk of Common Spine ICD-9-CM Codes to ICD-10 Codes

Crosswalk of Common Spine ICD-9-CM Codes to ICD-10 Codes Crosswalk of Common Spine ICD-9-CM Codes to ICD-10 Codes As of October 1, 2015, all health care entities covered by the Health Insurance Portability and Accountability Act (HIPAA) will be required to use

More information

Instability concept. Symposium- Cervical Spine. Barcelona, February 2014

Instability concept. Symposium- Cervical Spine. Barcelona, February 2014 Instability concept Guillem Saló Bru, MD, Phd AOSpine Principles Symposium- Cervical Spine Orthopaedic Depatment. Spine Unit. Hospital del Mar. Barcelona. Associated Professor UAB Barcelona, February 2014

More information

Symptoms and Signs of Irritation of the Brachial Plexus in Whiplash Injuries

Symptoms and Signs of Irritation of the Brachial Plexus in Whiplash Injuries 1 Symptoms and Signs of Irritation of the Brachial Plexus in Whiplash Injuries J Bone Joint Surg (Br) 2001 Mar;83(2):226-9 Ide M, Ide J, Yamaga M, Takagi K Department of Orthopaedic Surgery, Kumamoto University

More information

ICF Project Methodology. Overview of Project Methodology. Workgroups: 7 Workgroups & Leaders: 5 Tasks: Identify M-S Conditions:

ICF Project Methodology. Overview of Project Methodology. Workgroups: 7 Workgroups & Leaders: 5 Tasks: Identify M-S Conditions: Overview of Project Methodology James Irrgang PT PhD ATC Center for Sports Medicine University of Pittsburgh Medical Center and Department of Orthopaedic Surgery University of Pittsburgh Workgroups: 7

More information

Cervical Conditions: Diagnosis and Treatments

Cervical Conditions: Diagnosis and Treatments Cervical Conditions: Diagnosis and Treatments Mark R Mikles, M.D. Cervical Conditions: Diagnosis and Treatment Cervical conditions Neck Pain Radiculopathy Myelopathy 1 Cervical Conditions: Diagnosis and

More information

Whiplash Associated Disorder Integrating Research into Practice: San Luis Sports Therapy s Approach to Evidence-Based Practice

Whiplash Associated Disorder Integrating Research into Practice: San Luis Sports Therapy s Approach to Evidence-Based Practice Whiplash Associated Disorder Integrating Research into Practice: San Luis Sports Therapy s Approach to Evidence-Based Practice PROBLEM: WHIPLASH ASSOCIATED DISORDER (WAD) Injury Impact may result in bony

More information

Reotherapy Provides Functional Gains in Traumatic Brain Injury Patient Four Years After Completing Traditional Therapy Services (Case Study)

Reotherapy Provides Functional Gains in Traumatic Brain Injury Patient Four Years After Completing Traditional Therapy Services (Case Study) 1 of 7 Reotherapy Provides Functional Gains in Traumatic Brain Injury Patient Four Years After Completing Traditional Therapy Services (Case Study) John Heinz, Allied Health Services- Wilkes Barre, PA

More information

Cervicogenic Headaches

Cervicogenic Headaches Cervicogenic Headaches Definition/Description Cervicogenic headaches refer to headache type sensations felt in the head and/face that originates from the neck, most commonly the upper cervical zygapophyseal

More information

Anterior Capsular Repair Rehabilitation Program Methodist Sports Medicine Center, Indianapolis, IN Department of Physical Therapy

Anterior Capsular Repair Rehabilitation Program Methodist Sports Medicine Center, Indianapolis, IN Department of Physical Therapy Anterior Capsular Repair Rehabilitation Program Methodist Sports Medicine Center, Indianapolis, IN Department of Physical Therapy Anterior Capsule reconstruction is a surgical procedure utilized for anterior

More information

The multitude of symptoms following a whiplash injury has given rise to much discussion because of the lack of objective radiological findings.

The multitude of symptoms following a whiplash injury has given rise to much discussion because of the lack of objective radiological findings. HELPFUL PERSONAL INJURY INFORMATION COURTESY OF RIVERVIEW CHIROPRACTIC FROM ABSTRACT: Dynamic kine magnetic resonance imaging in whiplash patients Pain Research and Management 2009 Nov-Dec 2009;Vol. 14,

More information

THE LUMBAR SPINE (BACK)

THE LUMBAR SPINE (BACK) THE LUMBAR SPINE (BACK) At a glance Chronic back pain, especially in the area of the lumbar spine (lower back), is a widespread condition. It can be assumed that 75 % of all people have it sometimes or

More information

The Neck: Whiplash & Central Ligament Sprains. Presented by Dr. Ben Benjamin

The Neck: Whiplash & Central Ligament Sprains. Presented by Dr. Ben Benjamin Debilitating Orthopedic Injury Sampler #1 The Neck: Whiplash & Central Ligament Sprains Presented by Dr. Ben Benjamin Instructor: Ben Benjamin, Ph.D. 2 1 Instructor: Ben Benjamin, Ph.D. drben@benbenjamin.com

More information

ROTATOR CUFF REPAIR REHAB PROTOCOL

ROTATOR CUFF REPAIR REHAB PROTOCOL Joshua D. Stein, M.D. Trinity Clinic Orthopaedic and Sports Medicine 1327 Troup Hwy Tyler, TX 75701 (903) 510-8840 ROTATOR CUFF REPAIR REHAB PROTOCOL This rehabilitation protocol has been developed for

More information

William J. Robertson, MD UT Southwestern Orthopedics 1801 Inwood Rd. Dallas, TX 75390-8882 Office: (214) 645-3300 Fax: (214) 3301 billrobertsonmd.

William J. Robertson, MD UT Southwestern Orthopedics 1801 Inwood Rd. Dallas, TX 75390-8882 Office: (214) 645-3300 Fax: (214) 3301 billrobertsonmd. Arthroscopic Rotator Cuff Repair Postoperative Rehab Protocol Starting the first day after surgery you should remove the sling 3-4 times per day to perform pendulum exercises and elbow/wrist range of motion

More information

Cervical Fusion Protocol

Cervical Fusion Protocol REHABILITATION DEPARTMENT Cervical Fusion Protocol The following protocol for physical therapy rehabilitation was designed based on the typical patient seen at the Texas Back Institute for the procedure

More information

Dr. Enas Elsayed. Brunnstrom Approach

Dr. Enas Elsayed. Brunnstrom Approach Brunnstrom Approach Learning Objectives: By the end of this lab, the student will be able to: 1. Demonstrate different reflexes including stimulus and muscle tone response. 2. Demonstrate how to evoke

More information

Cervical Spine Radiculopathy: Convervative Treatment. Christos K. Yiannakopoulos, MD Orthopaedic Surgeon

Cervical Spine Radiculopathy: Convervative Treatment. Christos K. Yiannakopoulos, MD Orthopaedic Surgeon Cervical Spine Radiculopathy: Convervative Treatment Christos K. Yiannakopoulos, MD Orthopaedic Surgeon Laboratory for the Research of the Musculoskeletal System, University of Athens & IASO General Hospital,

More information

Thoracic Region Pain. ICD-9-CM: 724.4 Thoracic or Lumbosacral neuritis or radiculitis, unspecified

Thoracic Region Pain. ICD-9-CM: 724.4 Thoracic or Lumbosacral neuritis or radiculitis, unspecified Thoracic Region Pain ICD-9-CM: 724.4 Thoracic or Lumbosacral neuritis or radiculitis, unspecified ICF codes: Activities and Participation Domain code: d4108 Changing basic body position, other specified

More information

Neck and Headache Pain

Neck and Headache Pain Neck and Headache Pain ICD-9-CM code: 723.2 cervicocranial syndrome ICF codes: Activities and Participation Domain code: d4158 Maintaining a body position, other specified - specified as: maintaining the

More information

Inland Orthopaedic Surgery & Sports Medicine. Post Operative Rotator Cuff Rehabilitation Protocol (Modified from Matsen, Bach, Cohen, and Romeo)

Inland Orthopaedic Surgery & Sports Medicine. Post Operative Rotator Cuff Rehabilitation Protocol (Modified from Matsen, Bach, Cohen, and Romeo) Inland Orthopaedic Surgery & Sports Medicine Dr. Ed Tingstad 825 SE Bishop Blvd., Suite 120 Pullman, WA 99163 (509)332-2828 Post Operative Rotator Cuff Rehabilitation Protocol (Modified from Matsen, Bach,

More information

Postoperative Protocol For Posterior Labral Repair/ Capsular Plication-- Dr. Trueblood

Postoperative Protocol For Posterior Labral Repair/ Capsular Plication-- Dr. Trueblood Postoperative Protocol For Posterior Labral Repair/ Capsular Plication-- Dr. Trueblood Indications: Posterior shoulder instability is a relatively uncommon finding in normal adult shoulders. The most common

More information

Spinal Stenosis and Radiculopathy: A Case Report. Nicole Miller, SDPT. 68 Year Old Female with. A Case Report. Nicole Miller, SDPT 12/30/2009

Spinal Stenosis and Radiculopathy: A Case Report. Nicole Miller, SDPT. 68 Year Old Female with. A Case Report. Nicole Miller, SDPT 12/30/2009 Spinal Stenosis and Radiculopathy: A Case Report Nicole Miller, SDPT Graphics Concept A 68 Year Old Female with Spinal Stenosis and Radiculopathy: A Case Report Nicole Miller, SDPT 2 Graphics Concept B

More information

Arthroscopic Labral Repair Protocol-Type II, IV, and Complex Tears:

Arthroscopic Labral Repair Protocol-Type II, IV, and Complex Tears: Department of Rehabilitation Services Physical Therapy This protocol has been adopted from Brotzman & Wilk, which has been published in Brotzman SB, Wilk KE, Clinical Orthopeadic Rehabilitation. Philadelphia,

More information

IMPINGEMENT REVISITED. W. Ben Kibler, MD. From what angle are you looking at impingement -WHAT IS IT - EVALUATION - TREATMENT GUIDES

IMPINGEMENT REVISITED. W. Ben Kibler, MD. From what angle are you looking at impingement -WHAT IS IT - EVALUATION - TREATMENT GUIDES IMPINGEMENT REVISITED -WHAT IS IT - EVALUATION - TREATMENT GUIDES W. Ben Kibler, MD Medical director From what angle are you looking at impingement Bone spur- Acromion type 1, 2, 3 Rotator cuff injury

More information

UHealth Sports Medicine

UHealth Sports Medicine UHealth Sports Medicine Rehabilitation Guidelines for Arthroscopic Rotator Cuff Repair with Bicep Tenodesis Type 1 Repairs (+/- subacromial decompression) The rehabilitation guidelines are presented in

More information

Headache. Neuromuscular changes in cervicogenic headache and implications for practice. Cervicogenic Headache. Cervicogenic Headache

Headache. Neuromuscular changes in cervicogenic headache and implications for practice. Cervicogenic Headache. Cervicogenic Headache Headache Neuromuscular changes in cervicogenic and implications for practice Deborah Falla Headache is a common complaint which only 1% of the population escape in their lifetimes The most common are the

More information

Cervical Exercise: How important is it? What can be done? The Backbone of Spine Treatment. North American Spine Society Public Education Series

Cervical Exercise: How important is it? What can be done? The Backbone of Spine Treatment. North American Spine Society Public Education Series Cervical Exercise: The Backbone of Spine Treatment How important is it? What can be done? North American Spine Society Public Education Series Important: If you have had an accident that started your neck

More information

Cervicogenic Headache: A Case Report of Spinal Manipulative Therapy

Cervicogenic Headache: A Case Report of Spinal Manipulative Therapy Cervicogenic Headache: A Case Report of Spinal Manipulative Therapy By: Don Ross Sanchez Doctoral Candidate University of New Mexico School of Medicine Division of Physical Therapy Class of 2014 Advisor:

More information

CERVICAL DISC HERNIATION

CERVICAL DISC HERNIATION CERVICAL DISC HERNIATION Most frequent at C 5/6 level but also occur at C 6 7 & to a lesser extent at C4 5 & other levels In relatively younger persons soft disk protrusion is more common than hard disk

More information

Gregory N. Lervick, MD Jason Ash, ATC, PA-C POSTSURGICAL CORACOACROMIAL DECOMPRESSION REHABILITATION PROTOCOL

Gregory N. Lervick, MD Jason Ash, ATC, PA-C POSTSURGICAL CORACOACROMIAL DECOMPRESSION REHABILITATION PROTOCOL Phase 1: Weeks 0-4 Gregory N. Lervick, MD Jason Ash, ATC, PA-C POSTSURGICAL CORACOACROMIAL DECOMPRESSION REHABILITATION PROTOCOL Acromioplasty Coracoplasty Distal clavicle resection Biceps tenodesis Rotator

More information

An Outpatient Physical Therapy Intervention Program

An Outpatient Physical Therapy Intervention Program St. Catherine University SOPHIA Doctor of Physical Therapy Research Papers Physical Therapy 2-2011 An Outpatient Physical Therapy Intervention Program Rebecca K. Henderson St. Catherine University Follow

More information