T-Spine Interventions

Question 1

describe general intervention strategies for treating Scheurmann’s Disease

Answer 1

1. postural control muscle performance
2. activity modifications (aggravating)
3. strengthen and stretch the trunk
   
   • seated rotation
   • extension in lying/prone
   • thoracic extensor strengthening
   • scapular abductor strengthening
4. Bracing may be utilized

Question 2

describe PT interventions that may be utilized when treating a patient with Ankylosing Spondylolitis

Answer 2

1. spine extension and peripheral joint exercises
2. breathing exercises
3. prone lying (multiple times a day, 10 min at a time)
   
   • for spine and hip extension
4. sleep on firm mattress, avoid SL position
5. swimming

Question 3

T/F: Scoliosis is a condition that can be reveresed with rigorous PT

Answer 3

FALSE

we cannot correct the posture only manage/limit progression of curvature

Question 4

List goals for conservative management of scoliosis

Answer 4

1. strengthen postural muscles
2. address muscle length/strength impairments of extremity muscles
3. maintain/improve respiration and chest mobility
4. address back pain
5. resume functional tasks
6. strengthen abdominals

Question 5

T/F: there are standarized supported treatment protocols for T4 syndrome

Answer 5

FALSE

poor evidence supports standarized intervention

Question 6

describe general intervention strategies for T4 syndrome

Answer 6

1. thoracic manual techniques
   
   • mobilizations
   • thrust manipulations
2. scapulothoracic motor performance
3. thoracic extensor strengthening

Question 7

what specific intervention may be used to treat disc lesions in the T-Spine?

Answer 7

Traction (used to address radicular symptoms)

continous or intermittent

pt positioned sitting or lying

duration: 2 min - 24 hours

Question 8

list contraindications to traction at the T-Spine

Answer 8

1. acute lumbago
2. instability
3. respiratory or cardiac insufficiency
4. respiratory irritation
5. painful reactions
6. large (disc) extrusion
7. medial disc herniation
8. altered mental state
   
   • includes pt being unable to relax

Question 9

list common impairments that may be observed in zygopophyseal joint pain

Answer 9

1. muscle guarding
2. joint hypomobility
3. acute irritation/dysfunction
4. pain
5. ROM: commonly motions that close joint

Question 10

List interventions that may be used to treat zygopophyseal joint pain

Answer 10

1. Manual therapy
   
   1. mobilizations
      
      1. oscillations
      2. stretch mobilizations
   2. manipulations
2. Exercise
   
   1. targeting pain and guarding inhibitions
   2. neuro re-education

Question 11

what types of interventions may be used in the managment of rib dysfunction?

Answer 11

1. rib mobilizations
   
   • oscillations
   • static stretch mobilizations
2. rib manipulations
3. soft tissue mobilizations

Question 12

when treating TOS how should we approach treatment?

Answer 12

consider impairments and determine treatment goals based on ICF model

Question 13

list interventions that may be used in the management of TOS

Answer 13

1. Nerve glides
2. work/activity modifications
3. shoulder, upper rib/thoracic manual therapy
   
   • T/S manipulations are great here
4. scapulothoracic motor performance
5. address tissue extensibility anterior trunk musculature

Question 14

List 5 generalizations for treatment/intervention planning

Answer 14

1. Stability vs Mobility
2. Patient education
3. Reduce pain
4. address impairments
5. improve functional activity performance and participation

Question 15

List some examples of exercises that may help improve thoracic mobility

Answer 15

1. quadruped thoracolumbar AROM
   
   • flexion/extension
   • rotation reaching diagonally in front/OH
2. lying thoracic extension
   
   • prone press up
   • prone on elbows
   • supine over soft object
3. sitting rotation, extension
4. assisted extension w/towel

Question 16

what muscle groups should be targeted in resistance training for T-Spine related conditions?

Answer 16

peri-scapular musculature

thoracic paraspinals

Question 17

what muscles will be targeted during a prone row?

Answer 17

Mid trapezius

Rhomboids

levator scapulae

Question 18

List specific exercises that target the Lower Trap

Answer 18

1. prone full can
2. prone shoulder ER at 90º of shoulder abduction
3. prone horizontal abduction with 90º shoudler abduction and ER
4. bilteral shoulder ER in shoulder neutral

Question 19

list specific exercises that target the rhomboids and levator scapula

Answer 19

1. prone extension with shoulder ER
2. prone row
3. prone horizontal abduction with 90º shoulder abduction and ER

Question 20

List modalities that may be used in treatment of T-Spine conditions

Answer 20

1. Ultrasound
   
   1. thermal
   2. pain relief
2. Cryotherapy
   
   1. pain relief
3. E-Stim
   
   1. muscule activation/neuromuscular re-education
   2. pain relief (TENS)
   3. aid in healing (muscle pump)

Question 21

List manual therapy mobilizations techniques that can be used at the T-Spine

Answer 21

1. Prone Thoracic PA mobs
2. Seated Thoracic extension mobilization
3. Supine 1st rib mobilization
4. Costotransverse mobilization

Question 22

list manipulations that can be performed at the T-spine

Answer 22

1. “The Screw” Mobilization/Manipulation Thrust
2. Facet Gapping in Supine (“Pistol”)
3. Seated Lower Thoracic Traction Thrust
4. Upper Thoracic Distrction Thrust

Question 23

what is moving on what during a prone thoracic PA mobilization?

Answer 23

spine segment on adjacent segments

Question 24

what is moving on what during a seated thoracic extension mobilization?

Answer 24

inferior segment on superior segment

Question 25

describe the target force for the seated thoracic extension mobilizations

Answer 25

Mobilizing → posterior aspect of bilateral upper arms for superior T segments into relative extension Stabilizatin → dorsal surface of articular pillars (or spinous processes) of T segments of choice

Question 26

describe the target force and relative structural movement during the "Screw" manipulation

Answer 26

1. Mobilizaing * cranial segment → dorsal surface ipsilateral articular pillar * caudal segment → dorsal surface contralateral articular pillar 2. Structural movment * cranial segment facet on caudal segment facet