TSPINE/RIBS Interventions

Question 1

Select interventions for SCHEUERMANN’S DISEASE ?

Answer 1

1. Postural control muscle performance
2. Modification of aggravating activities
3. Strengthening and stretching of the trunk
   - Seated rotation
   - Extension in lying (prone press up, prone on elbows, etc.)
   - Thoracic extensor strengthening
   - Scapular abductor strengthening
4. Bracing

Question 2

Pt intervention for ankylosing spondylitis:

Answer 2

Active exercises with mobility focus

1. Spine extension & peripheral joint exercises (hip/shoulder)
2. Breathing exercises (rib mobility)
3. Prone lying several times/ day for spine/ hip extension
4. Sleeping on firm mattress & avoidance of SL position (not as much flexion at night)
5. Swimming

Question 3

T/F Limited/ Poor/ No compelling evidence regarding “correction” or limiting progression of curvature for adolescent idiopathic scoliosis.

Answer 3

True

Question 4

Goal with thoracolumbar bracing in adolescent idiopathic scoliosis?

Answer 4

Prevention of curvature progression

Correction of abnormal curvature

Question 5

Goals with exercise for conservative management for adolescent idiopathic scoliosis?

Answer 5

• Strengthen postural muscle
• Address muscle length impairments/ strength impairments of extremity musculature
• Maintain/ Improve respiration & chest mobility
• Address back pain impairments
• Resume functional tasks
• Strengthen abdominals

Question 6

T/F Poor evidence that supports standardized intervention for T4 sybndrome.

Answer 6

True

Question 7

Consider the following (based on impairments) with intervention for T4 syndrome:

Answer 7

1. Thoracic manual therapy techniques (mobilization, thrust manipulation)
   - F/b thoracic mobility exercises
2. Scapulothoracic motor performance
3. Thoracic extensor strengthening

Question 8

Traction not established with disc lesions of the T-Spine, but common practice to address what symptoms?

Answer 8

Radicular

Question 9

Duration recommendation for traction intervention for disc lesions:

Answer 9

2 min - 24 hours

Question 10

Contraindications for traction:

Answer 10

1. acute lumbago (low back pain)
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; this includes inability of the patient to relax

Question 11

Common impairments due to zygapophyseal joint pain:

Answer 11

1. Muscle Guarding
2. Joint Hypomobility
3. Acute irritation/ dysfunction
4. Pain
5. ROM: commonly motions that close joint (extension, ipsilateral flexion, rotation)

Question 12

Manual therapy interventions for zygapophyseal joint pain:

Answer 12

1. Mobilizations
   - Oscillations
   - Stretch mobilizations
2. Manipulation
   - Neurophysiologic effect
   - Biomechanical theories
   - Follow up with ROM/AROM exercises to maintain benefits

Question 13

Exercise interventions for zygapophyseal joint pain:

Answer 13

1. Pain & guarding inhibition

2. Neuro re-education (postural stabilizers, osteokinematic mobilizers into painful planes

Question 14

Manual therapy interventions for rib dysfunction:

Answer 14

1. Rib mobilizations
   - Oscillations
   - Static stretch mobilizations
2. Rib manipulation (don’t manipulate lower floating ribs)
3. Soft tissue mobilization

Question 15

T/F Poor evidence that supports standardized intervention for thoracic outlet syndrome.

Answer 15

True

Question 16

Consider the following interventions (based on impairments) for TOS:

Answer 16

1. Work/ activity modification
2. Nerve glides (easy to flair people up – in clinic and follow up -> modify if provokes)
3. Shoulder, upper rib/ thoracic manual therapy techniques
4. Scapulothoracic motor performance
5. Address tissue extensibility anterior trunk musculature

Question 17

Modalities of the Tspine:

Answer 17

1. Ultrasound:
   - Thermal
   - Pain relief
2. Cryotherapy:
   - Pain relief
3. E-Stim:
   - Muscle activation/ neuromuscular re-education
   - Pain relief (TENS)
   - Aid in healing (muscle pump)

Question 18

T/F E-stim is effective for preventing progression of scoliosis.

Answer 18

False, it is NOT

Question 19

T/F Studies with Thrust demonstrate better short-term results than mobs for mechanical neck pain.

Answer 19

True

Question 20

Seated Thoracic Extension mobilization:
Rate of force - 
Direction of force - 
Target force - 
Relative structural movement - 
Patient position -

Answer 20

1. Rate of force - low velocity/static hold
2. Direction of force - anterior
3. Target force -
   - Mobilizing: posterior aspect of bilateral upper arms for superior thoracic segments into relative extension
   - Stabilizing: dorsal surface of articular pillars (or spinous process) of thoracic segment of choice
4. Relative structural movement - inferior segment on superior segment
5. Patient position - sitting, fingers interlocked behind head