Hi all,
Hope your new placements have begun well! I am presently completing a placement in musculo outpatients.
Last Friday I was doing some preparation for a 67 year old male pt that I have this Tuesday with Tx spinal pain and limited rotation ROM (especially to the right). Going through the Veterbral Assessment Form I came to the PPIVMs box and could not for the life of me remember how to do this. On looking at the 651 manual I realised that we never did PPIVMs for the Tx spine in class.
So what I would like to know is:
(a) do you need to to this in your Ax and is it relevant for the Tx spine (especially if you can't find anything unusual on PAIVMS or other in other areas of the Ax)? and
(b) how do you do this?
(c) can you use PPIVMs to treat in this area and how?
I gather that you would want to do PPIVMS only for rotation (and maybe lateral flexion) as the Tx vertebrae are designed to limit flexion and extension. My guess is that you would do rotation/side flexion for the lower half in side lying like in the Lx spine and the top half in supine like in the Cx spine.
Looking on the internet I found a site that described a PPIVMs Ax in sitting where the physio sits next to the pt then laterally flexes the pt away and then rotates the pt towards themselves (the PT) down to each level palpating with the non rotaing hand looking for movement in the interspinous space. However this sounds very awkward.
So if anyone has any ideas about this your help would be greatly appreciated.
Cheers!!
nico
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2 comments:
Good question Nico as I’ve already seen a couple of patients with thoracic spine immobility, probably a common problem with people who do prolonged sitting. I think you can assess thoracic physiological rotation at each level by having the patient in a sidelying position, then palpate the interspace between each vertebral joint while passively rotating the thorax down to each level by pressing on the patient’s shoulder. Very much like rotation PPIVM in the lumbar spine.
And treatment of a restriction in thoracic physiological rotation is most likely similar to the lumbar treatment. By blocking the caudad segment/level of the restricted joint (i.e T5/6 restriction, block T6) and then rotating the thorax passively, you'll be able to improve the rotation movement at that level. Actually now that you bring it up, I think I’ll assess my patient’s thoracic PPIVMs this week.
See you Monday
Gareth
Hi Nico,
I've found some notes I hope it helps.Thoracic Spine-PPIVMS to improve rotation you can do in sidelying and sitting.
Sidelying( esp.for T4 down)Ax and Rx
- starting position: opposite side to rotation direction (ie (R)side lie for (L)rotation)
- provide rotatory pressure across clavicle to rotate the thorax, stabilize thorax below with palpating arm,
-palpate closing of interspinous space with index finger
- for Rx you can stabilize spinous process below and/or assist upper spinous process movement with cephalad-lateral glide
-for above T4 you can use hand to support head and other hand to assist segmental rotation(ie cervical rotation)
Sitting Ax and Rx
-starting position:patient sits on side of plinth with arms crossed either behind head (upper Tx) or across chest (mid-low Tx)
- physio contacts patient's anterior shoulder (under pt's hands) than laterally flexes patient away and then rotates pt towards themselves down to level to be tested (palpating interspinous space)
- for Rx you can assist upper vertebrae movement ceph-medially towards opposite shoulder or fixate level below, alternatively you can add ME technique.
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