1. Common Spinal Deformities Lordosis Excessive anterior curvature of the spine Exaggeration of normal curves in the cervical & lumbar spines

2. Common Spinal Deformities  Lordosis causes: › Postural deformity › Lax muscles (esp. abs) › Heavy abdomen › Compensatory mechanisms › Hip flexion contracture › Spondylolisthesis › Congential problems › Fashion (high heels)

3. Common Spinal Deformities Kyphosis Excessive posterior curvature of the spine Round back Humpback/gibbus Flat back Dowager’s Hump

4. Scoliosis Abnormal spinal curvature of various degrees or severity involving shortening of muscles and ligaments.

6. Common Spinal Deformities  Scoliosis › Nonstructural  “Functional”  May be related to leg length discrepancy › Structural  Lacks normal flexibility  Asymmetric movements

7. Common Spinal Deformities Scoliosis Ideopathic Approx. 75-85% of all structural cases are ideopathic Stretch concave curve Strengthen convex curve

8. Patient History History of injury? Any previous back or neck pain? Any positions of comfort? Family history? Previous illnesses, surgeries, or severe injuries? Hx of other conditions (connective tissue diseases such as Marfan’s Syndrome)?

9. Marfan Syndrome? Marfan syndrome is one of the more common disorders of connective tissue that can affect the Eyes, Skeleton, Lungs, Heart and Blood Vessels, and may be life-threatening. The effects of Marfan syndrome varies between individuals, some people only being mildly affected. Marfan syndrome is a hereditary

10. Rehabilitation Non surgical treatment + P.T. Surgical treatment + P.T. Stretched & strengthening technique. Orthotics. Hydrotherapy.

11. 0°- 30° Treated with signs of progression 30°- 45° Orthotic Intervention 45° < Surgical Intervention

12. Low Profile TLSO for Scoliosis Worn when sleeping only Made of semi-rigid plastic and foam Charleston Bending Orthosis Providence Orthosis

13. BRACING……then

14. BRACING Milwaukee Brace

15. BRACING

16. BRACING…..now

18. AIS Types – Milwaukee Effective Self image – Boston brace Not effective above T7 – Wilmington brace – Charlston brace part time at night 8 hrs

19. SURGERY

20. Table Handle Locks

21. Treatment Demonstration: Charite Disc Replacement/Dextrorotatory Scoliosis This is a case of L4 Charite Disc Replacement with and L5 Disc herniation and dextrorotatory scoliosis. The Rule of 50% is discussed in relation to the treatment plan to relieve S1 dermatome pain.

22. Hyperkyphosis & Scheuermann's Disease treated in the supine position.

23. Hyperkyphosis / Scheuermann's Disease / Osteoporosis / Any Condition needing thoracic adjusting Dr. Cox demonstrates flexion-distraction long-y- axis decompression spinal adjusting (low-velocity, low- amplitude adjusting) for any condition needing gentle thoracic spinal adjusting. Patients working on computers and carry much stress really appreciate this care.

24. Hyperkyphosis / Scheuermann's Disease / Upper Thoracic Spine Low-Velocity/Low- Amplitude (LVLA) Adjusting using the Cervical Headpiece Highlights: Use of the cervical spine restraint to treat the thoracic spine curvature. Long Y axis automated distraction with cervical headpiece restraint in place. Goals: drop intradiscal pressures increase foraminal area restore physiological ranges of motion

25. Hyperkyphosis / Thoracic Spine Adjusting in the Side-Lying Position For some patients, this very gentle application is preferred.

26. Compression Fracture Treated in the Supine Position

27. Ideal stretched position & TO for kyphotic pt.

28. Stretching Exercise

29. Total Body Rotation

31. Stretching &strengthening of the trunk

32. Polly therapy

33. Stretching &strengthening of the trunk

34. Hydro therapy

35. The right & wring position

36. THANK YOU