102 lines
5.3 KiB
Plaintext
102 lines
5.3 KiB
Plaintext
MOBILIZATIONWEDGETHORACICDISCLESIONSPESTERPHYSIOTHERAPYBACK
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MOBILIZATION WEDGE FOR THORACIC DISC LESIONS - Olive K. Pester, M.C.S.P. M.C.P.A.
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MOBILIZATION WEDGE FOR THORACIC DISC LESIONS
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Olive K. Pester, M.C.S.P. M.C.P.A.
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Although many physiotherapists are able to diagnose and
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effectively treat patients with cervical and lumbar disc lesions,
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patients having thoracic disc lesions may suffer unnecessary pain
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or receive misguided treatment when their condition is labelled
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as fibrositis of the chest wall, pleurodynia, inter-costal
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neuritis, and so forth.
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Diagnosis is not difficult, however, if thoracic disc lesions
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are kept in mind. The influence of both posture and exertion, on
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the pain, should be elicited in the patient's history, and the
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movements of the thoracic spine should then be tested.
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Evaluation of clinical data
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The only basis for deciding whether or not to manipulate is a
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careful and informed evaluation of the clinical data. The
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articular, dural, root and cord signs should be carefully
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evaluated, and if there is any evidence of pyramidal pressure,
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manipulation is absolutely contraindicated.
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The difficult cases are those with a primary posterolateral
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onset. Root pain is felt in the anterior thorax or abdomen,
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emerging without previous backache. A physician must examine
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these patients and rule out any involvement of the viscera
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(heart, lungs, stomach, and so on). Vertebral manipulation will
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relieve pains of spinal origin, but not those correctly ascribed
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to the viscera.
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In the orthopaedic department, most patients with spinal joint
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pain are suffering from a minor displacement of a fragment of
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disc. It is immaterial whether the disc is thin or thick, or
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whether osteophytes are present or not. X-rays are used to help
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rule out the pathologies not treatable by manipulation:
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osteoporosis, ankylosing spondylitis, rheumatoid arthritis,
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fractures, tumors, neoplasms, and so on.
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The diagnosis of thoracic disc problems is arrived at by a
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"Cyriax-type assessment" which involves examining for articular
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signs and for dural signs and symptoms.
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Mobilization/manipulation technique
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The simplest and most effective method of treating thoracic
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disc problems is by a mobilization/manipulation of the thoracic
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spine. The results of the treatment, for disc problems, are
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unusually excellent. Three hundred patients having thoracic disc
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problems were treated in this manner during a recent 12-month
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period at the author's clinic. Treatment ranged from two to eight
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sessions, depending on the number of levels involved in the spine
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and the degree of stiffness, pain and symptoms present. The
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success rate has been better than 90 per cent.
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The main problem is to inculcate in the patient a desire to
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maintain the erect posture for much of his working day.
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Although slouching may be harmful for any areas of the spine, it
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is disastrous for the thoracic region. A follow-up program
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including swimming, walking, dancing, fencing - all activities
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that encourage an awareness of posture and relaxation - should be
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recommended to the patient.
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The wedge: aid to mobilization
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A common problem of the treatment, mobilization/manipulation
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of the thoracic spine, occurs when a 5'4" female physiotherapist
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attempts to mobilize the thoracic spine of a 6'2", 200 pound
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patient. By the time the physiotherapist has placed her hand
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around the chest wall of the patient, to fixate the thoracic
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spine being treated, she frequently has no power and little
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leverage left with which to mobilize the offending joint.
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A small wedge has therefore been developed by Norwegian
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physiotherapist Freddy Kaltenborn as an aid to the painless
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mobilization of the thoracic spine. It enables a physiotherapist
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to mobilize successfully, and with little physical effort, the
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thoracic spine of large, heavy patients.
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Construction: the wedge is made of molded polypropylene with a
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base measuring nine inches and a height of three and one-quarter
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inches. The central groove, in which the spinous process fits, is
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one inch across.
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Directions for use: the patient lies supine and clasps his
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neck in such a way that his elbows are brought together over his
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sternum. The therapist stands on the right side and grasps the
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patient's elbows with her left hand. She rolls him toward herself
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and firmly fixes the thoracic vertebrae to be mobilized within
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the groove of the wedge. The wedge now acts as a fulcrum and the
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physiotherapist, by leaning over the patient, can thrust through
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the patient's elbow in a downward direction. By altering the
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position of the wedge or by altering the degree of flexion of the
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thoracic spine, the physiotherapist can mobilize or manipulate
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all thoracic joints in this manner.
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Conclusion
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The wedge has been used for over a year in the author's clinic
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and is recommended in the treatment of patients with thoracic
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disc problems. In cases involving the toracic spine, it is the
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maintenance of a reduction which is difficult. After the
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mobilization manipulation procedure, a program of extension
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exercises must be initiated.
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