Download Spine Biomechanics

Evaluation and Treatment of the
Acutely Injured Spine
Tara J Manal PT, DPT, OCS, SCS
Greg Hicks PT, PhD
Oswestry Questionnaire
Self Report of Performance Limitation
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Personal Hygiene
Lifting
Walking
Sitting
Standing
Scale: 0
= 50
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5
No
Max
Limitations Limitations
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Sleeping
Social Activity
Traveling
Sex Life
Pain Intensity
Maximum Score
Double Score/100
%Disability
Oswestry Questionnaire
• 5 Minutes to Score
• Initial Classification
• Documentation of Outcome
Patient Staging
• Stage I Inability to Perform Stand,
Walk, Sit
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Reduce Oswestry <40%-60%
Enable to Sit > 30 min
Enable to Stand >15 min
Enable to Walk > 1/4 mile
Patient Staging
• Stage II Decreased Activities of Daily
Living
– Reduce Oswestry to <20% - 40%
– Enable to perform ADL’s
Patient Staging
• Stage III Return to High Demand Activity
– Reduce Oswestry to 20% or less
– Enable to Return to Work
Neurological Examination
• Indication - Symptoms Below the Knee
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LE Sensory Testing
Muscle Strength Assessment
Reflex Testing
Nerve Root Testing
Babinski testing
Clonus
Pelvic Assessment I
• PSIS Symmetry in
Sitting
– Unequal heights
– Positive Test
Pelvic Assessment II
• Standing Flexion Test
– Start Position
• Palpate PSIS
– Relative position
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
Pelvic Assessment III
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
Pelvic Assessment IV
• Start position
– Prone
– Palpate inferior to
lateral malleoli or
plantar aspect of
calcaneus
– Observe leg length
Prone Knee
Flexion
• End position
– Knee flexed to 90°
– Positive: change in
position from start to
finish
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
Specific Manipulation for SIJ
Re-test composite after manipulation
Pubic Manipulation
Osteology
• Innominate
• Sacrum
– Base
– ILA
Mobility of the SI Joint
• Ilial
– Rotation
– Slip
– Flare
• Sacral
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Nutation (Flexion)
Counternutation (Extension)
Rotation
Torsion
Stability of the SI Joint
• Ligamentous
• Bony (“Form Closure”)
• Muscular (“Force Closure”)
Form Closure
Force Closure
Rotations
Rotations
• If Anterior Rotation
– mob posteriorly
• If Posterior rotation
– mob anteriorly
Sacral
Bracing