Evaluation and Treatment of the Acutely Injured Spine Tara J Manal PT, DPT, OCS, SCS Greg Hicks PT, PhD

Oswestry Questionnaire Self Report of Performance Limitation Personal Hygiene Lifting Walking Sitting Standing Sleeping Social Activity Traveling Sex Life Pain Intensity Scale: 0 - 5Maximum Score = 50 No MaxDouble Score/100 Limitations Limitations%Disability

Oswestry Questionnaire 5 Minutes to Score Initial Classification Documentation of Outcome

Patient Staging Stage IInability to Perform Stand, Walk, Sit –Reduce Oswestry <40%-60% –Enable to Sit > 30 min –Enable to Stand >15 min –Enable to Walk > 1/4 mile

Patient Staging Stage II Decreased Activities of Daily Living –Reduce Oswestry to <20% - 40% –Enable to perform ADL’s

Patient Staging Stage III Return to High Demand Activity –Reduce Oswestry to 20% or less –Enable to Return to Work

Neurological Examination Indication - Symptoms Below the Knee –LE Sensory Testing –Muscle Strength Assessment –Reflex Testing –Nerve Root Testing –Babinski testing –Clonus

Pelvic Assessment I PSIS Symmetry in Sitting –Unequal heights –Positive Test

Pelvic Assessment II Standing Flexion Test –Start Position Palpate PSIS –Relative position

Pelvic Assessment II Standing Flexion Test –End Position –Full Flexion Palpate PSIS –Relative position compared to standing Positive Test –Change in relationship –Start to Finish

Pelvic Assessment III

Supine to Sit Posterior rotation - leg lengthens (A) Anterior rotation - leg shortens (C) Supine to Sit Test –Start Position Palpate inferior medial malleoli Positive test –Change in relative leg length –Start to Finish

Pelvic Assessment IV Start position –Prone –Palpate inferior to lateral malleoli or plantar aspect of calcaneus –Observe leg length

Prone Knee Flexion End position –Knee flexed to 90° –Positive: change in position from start to finish

Pelvic Assessment Results 3 of 4 Tests Composite –Reliability k=.88 If (-) Palpate Iliac Crest Heights –Correct difference with heel lift If (+) SIJ Manipulation Indicated –Manual Techniques –Manipulation

Specific Manipulation for SIJ Re-test composite after manipulation

Pubic Manipulation

Osteology Innominate Sacrum –Base –ILA

Mobility of the SI Joint Ilial –Rotation –Slip –Flare Sacral –Nutation (Flexion) –Counternutation (Extension) –Rotation –Torsion

Stability of the SI Joint Ligamentous Bony (“Form Closure”) Muscular (“Force Closure”)

Form Closure

Force Closure

Rotations

If Anterior Rotation –mob posteriorly If Posterior rotation –mob anteriorly

Sacral

Bracing