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The lumbar post was written about a month ago. For those of you who read it, you can just skip to the Objective portion below.
I previously wrote about how I feel about special tests, so I won't bother including them. Can it be done? Is it like cats and dogs, living together? Mass hysteria?
I started my post graduate training with Stanley Paris and faculty at St. Augustine. After finishing the MTC, I immediately started MDT training and then became CertMDT. It was like having two worlds collide. After some trial and error, plus experience, I formed my own decision making process and successfully combined the best of both approaches. The following is not meant to be comprehensive, but merely suggest go to movements/patterns of dysfunction to assess if you're having trouble. They also can be quickly used if you're following up with a patient who ends up on your schedule when you didn't do the initial evaluation. After all, EACH visit is an evaluation.
Subjective: Mechanism of injury or symptom history. including symptom behavior (location, frequency, intensity, and duration), what activities/positions make the complaints better and worse, functional limitations, and goals. Depending on the type of patient, this should take you 5-15 minutes. This depends of course on how much education you have to present to the patient about their dysfunction. This should also include postural correction for spinal/shoulder conditions for cause and effect. Correct/overcorrect their posture and see if the symptoms change, improve, or centralize. Have them slouch again to see if it returns. Cause and effect is a very powerful teaching tool and should be introduced at the beginning, and not the end. This emphasizes the importance of posture. For follow ups, obviously this is abbreviated.
Objective:
- posture/structural
- AROM
- PROM, accessory motion testing, springing, overpressure
- what's the importance of this? - EVERY Joint should have passive motion great than active, it prevents excessive stress to the joint in ADLs
* I don't use repeated motion testing for the cervical spine, but do use MDT for the HEP.
You will often find what I call patterns in dysfunction. The patterns for the cervical spine are:
- OA in forward bending
- PIVM restricted in downglide more than upglide, in the upper and lower cervical facets
- this is because most patients are in flexion, causing the facets to lose backward bending
- CT junction restrictions
- T1-3 often restricted in backward bending and/or bilateral rotation
- 1st rib limitation in inferior glide, most likely on the dysfunctional side
- myofascial restrictions
- occiput lateral to medial
- cervical paraspinals, SCM, scalenes in proximal to distal
- neural container treatment
- scalenes
- pec minor
- medial upper arm for median, ulnar
- lateral upper arm for radial
- anterior radial bony contours for median
- posterior radial bony contours for radial
- pronator teres for median
- you will find after treating the above areas, that neurodynamic treatment/assessment is less painful for the patient, thus making HEP easier to prescribe!
The suggested triad of treatment is 1) STM/TASTM 2) Joint Manipulation 3) Neuromuscular reeducation. Each ST technique should be performed for 3-5 minutes per area and totaling quarters 10-15 minutes. You will find that previously tested PIVM and extremity passive accessory motions may change in their end feels and excursions after STM. If there is still a joint restrictions, use thrust or non-thrust manipulation.
You should question the use of stabilization for all patients. It is not only difficult for the patient to do correctly, but most are not willing to buy a pressure cuff for an exercise they will not be performing for the rest of their life. If a patient is not progressing, or plateaus with MDT for HEP, only then do I teach them stabilization.
In contrast, it is very easy to teach cervical retractions for HA or cervical pain patients. If they have unilateral complaints, teach them retraction with overpressure into sidebending toward the painful side. After their symptoms are centralized, progress them to cervical retraction with overpressure, and/or extension. This is demonstrated in the video below. I hope the patterns and suggestions help fine tune your cervical evaluation and exercise prescriptions. If you have any questions or comments, contact me below through the contact me button in the blog sidebar.
In contrast, it is very easy to teach cervical retractions for HA or cervical pain patients. If they have unilateral complaints, teach them retraction with overpressure into sidebending toward the painful side. After their symptoms are centralized, progress them to cervical retraction with overpressure, and/or extension. This is demonstrated in the video below. I hope the patterns and suggestions help fine tune your cervical evaluation and exercise prescriptions. If you have any questions or comments, contact me below through the contact me button in the blog sidebar.
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