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Vertebrae differ by
Longer spinous processs
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How many degrees of flexion and extension
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What happens to mobility in the lower thoracic
More mobility due to lack of rib articulation
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Sternum Expansion
- Pump handle
- Anterior lung expansion
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Intercostal Expansion
- Bucket handle
- -Lateral expansion
- Caliper
- - transverse, rotates ribs outward
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Internal intercostals
Exhalation
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Spine segments most to least mobile
Cervical>Lumbar>Thoracic
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What prevents rotation
Rib cage
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What prevents flexion
- Sternum
- Facet orientation in frontal plane
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Amount of lateral side bend
<20 degrees
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Amount of rotation
<20 degrees
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Per segment thoracic has more or less mobility than lumbar?
More
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As a whole lumber and thoracic have more, less, or equal mobility
Equal
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Which test is more effective for thoracic? MMT or functional?
Functional
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Most common hypomobility?
Uniside bend or limited extension
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What motion in thoracic tends to occur with side bend?
Rotation to other side
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T/F can have hypo and hyper mobility combination.
- True
- Ie functional scoliosis: L side could be hypomobile while right hyper
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If both hyper and hypo mobile what would you do to fix?
- Stabilize hypermobile motion
- Mobilize the hypomobile motion
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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
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Easiest to hardest planes for trunk exercises
Sag->Frontal->Transverse
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An elongated muscle is best trained in what position?
Shortened
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Exaggerated kyphosis can lead to the rib cage to rest on what?
Anterior iliac crest.
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Severe kyphosis can shorten or lengthen the appendicular skeleton?
Lengthen
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What is the only type of stretching an osteoporosis patient should receive?
Active
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Idiopathic vs acquired scoliosis
Structural vs functional
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Swayback is due to..
Muscle imbalances
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Common population for osteoporosis
- Post menopausal women
- Elderly men
- Smokers
- Decreased calcium or vitamin D
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What progresses osteoporosis?
- Decreased mobility
- Sedentary lifestyle
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Osteopor clinical findings
- Pain in bones, back, and muscle spasm
- Height reduction
- Kyphosis and scoliosos
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Osteopor Tx
- 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
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Scheuermann's Disease
- Greater than 45-50 degrees
- Hereditary
- Excessive thoracic associated with anterior wedging of thoracic vert
- Juvenile- Occuring in kids
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Kyphosis Tx
- 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
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Ankylosing Spondylitis
- Freezing of the joints of the spine with inflammation
- Chronic progressive
- Affects SI, intervert and costovert spaces
- 20-30 y/os
- M>F
- Remissions and exacerbations
- Possible autoimmune disorder, genetic basis
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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
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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
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Ankylosing Spondylitis Tx
- Maintain joint mob
- Breathing EX
- Decrease synovitis: NSAIDs
- Possible joint replacement
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Which side has a visible posterior rib hump in a structural scoliosis?
Convex side
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Which side can you see anterior rib flare
Concave
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Dowager's Hump
Excessively large thoracic kyphosis
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How does LLD relate to scoliosis (does it always occur?)
- Could be a compensation for scoliosis
- Not always a result of scolosis
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T/F Positive Adam's test shows functional scoliosis
- False
- Positive Adam's test shows structural. If scoliosis disappears during Adam's test it means its a functional Scoliosis.
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Functional scoliosis is usually secondary to..
- Spasm/pain in LW or midback musculature.
- ie always standing on one leg
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Severe scoliosis curves may effect
cardio pulmonary due to limited lung expansions
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Scoliosis classification
- Mild: <20 degrees
- Mod: 20-50 degrees
- Severe: >50 degrees
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Etiology of structural scoliosis
- Idiopathic 75-85%
- Usually adolescent
- F>M 10-15 y/o
- Muscle imbalance, postural control, or bone malformation
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Neuromuscular Structural Scoliosis
- CP
- Myelomeningocele
- Paraplegic
- MD
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Osteopathic structural scoliosis
- Bone malformation
- Rickets
- Fractures
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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
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Clinical findings Scoliosis
- Scap winging (on convexity of curve)
- Pelvic obliquity (crest not level)
- Waist angle changes
- Curve increases or stays with forward bending
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Interventions Scoliosis
- Exercise with cast/brace
- -Stretch and strengthen
- Casts
- Tractions
- -Usually pre-op
- Spinal bracing (boston, milwaukee)
- Estim
- -On convex side to strengthen and realign spine upright
- Surgery
- -Spinal fusion with Harrington rod >40degrees
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What side do you strengthen, which do you stretch
- Strengthen convex
- Stretch concave
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