Interventions for the Spine
PTA 104 Ortho Dysfunctions

Review of Structure and Function

Functional Components of the Spine

• anterior pillar: vertebral bodies and intervertebral discs; weight bearing and shock absorbing
• posterior pillar: vertebral arch = articular processes and facet joints; provides motion and bony levers as points of attachment for dynamic and stabilizing muscles

 Spinal Motion Animation

Impairment-Based Categories

Stages of Recovery

Common Spinal Impairment Classification

Treatment-based classification strategies can help prioritize interventions based on the PT examination findings. Symptoms of spinal pathology can overlap, therefore, the physical therapist will develop a plan of care based on special tests and measures which lead to a movement-based syndrome classification.

In this lesson, we will follow the Treatment-Based Classification system by Delitto. In your clinical practice, you will encounter references to other approaches (e.g., McKenzie exercises, Sahrmann approach, Williams flexion). If you can focus your exercise application on a solid rationale of kinesiology, keen observation, patient input, and understanding of pathology, then you can successfully collaborate with your PT partner on treatment planning and modification to reach maximum function.

Impairment-Based Categories

1. Non-weight Bearing Bias (Traction-Syndrome)
2. Extension-Bias (Extension Syndrome)
3. Flexion Bias (Flexion Syndrome)
4. Stabilization/Immobilization
5. Mobilization/Manipulation
6. Muscle and Soft Tissue Lesions

Active Learning Exercise

Before selecting the most appropriate exercise for your patient, it is important to have a firm understanding of involved structures and tissues as well as risk for recurrence or further injury. PTAs provide an extensive amount of education to patient's during all stages of healing. By integrating kinesiology and pathological knowledge, the patients you work with will be more likely to understand the why of the exercise. Patients want to get better, and PTAs can assure them that performing the selected exercises, movements and positions is time well spent.

Create a table with columns for each of the following:

Summary of Management Guidelines and Scope of Practice

Boxes 15.5, 15.7, 15.8 provide an excellent summary of interventions for each tissue healing stage.

Notice the Impairments and Functional Limitations listed for each stage. PTAs can use the physical therapy plan of care to integrate any/all of the general management guidelines listed. When thinking about your role, plan for data collection, options for modifications, and indications to communicate with the PT. By planning ahead, you can have multiple interventions to choose from based on the patient presentation and response. Most importantly, you can be listening, feeling, and watching for signs and symptoms which indicate the patient is unable to safely participate in physical therapy.

Using the PTA Problem Solving Algorithm

Asking questions

Movement classification systems can overlap. When patients leave the clinic, or after the physical therapy staff has gone home for the day, patients continue to move, work , lift, sit, etc. Fragile structures can experience further damage. What initially presented as a soft tissue strain, could progress into a loss of nerve and/or motor function.

First, do YOU have any questions about the patient's condition and readiness for treatment? Do you have any questions or concerns about your own confidence and skill set to move forward with treatment? Are you uncertain about elements in the plan of care (including precautions and contraindications) or the PTs directions?

Ask your patient about their signs and symptoms before initiating treatment

Ask your patient if they are 1) better, 2) worse, 3) about the same

Ask your patient if anything else has changed since their last visit.

Make comparisons

Given the responses, and your own knowledge skills and abilities, are you ready to begin treatment? Do you need any guidance from the PT? Do you have some ideas for progression to share with the PT before the session?