prevention & treatment of cervical & lumbar injury
DESCRIPTION
A presentation from Florida to a group of Opthalmic Surgeons on how to prevent/manage neck and back painTRANSCRIPT
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PREVENTION & TREATMENT OF CERVICAL & LUMBAR INJURY
FOR THE OCULOFACIAL SURGEON
Renée Ostertag, DPT, MPT, COMT
Denver, Colorado
ASOPRS Spring Meeting, 2011- Amelia Island
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Objectives
Increased awareness to aid in prevention of injury
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Anatomy Review
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Physiology of a Disc
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Cervical Physiology
Cervical Protrusion and Retraction
Cervical Flexion and Extension
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Lumbar Disc Physiology
Lumbar Flexion Lumbar Extension
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Load to Lumbar Disc
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Load to Lower Cervical Disc
Neutral Head Position is 12 lbs.
Forward Head Position is 36 lbs.
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Pathophysiology Stage #1
Microscopic tears Weakens annulus
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Pathophysiology Stage #2
Disruption of inner layers of annulus
No innervation of inner 1/3 of disc
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Pathophysiology Stage #3
Tissue Damage has reached innervated tissue
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Pathophysiology Stage #4
Marked displacement of nerve root
Symptoms:Severe neck/UE painUE weakness and/or
incoordinationLoss of sensation and
reflexes+/- surgery
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Operating Room Suggestions
Avoid sustained end range loading
Practice “Neutral Spine” posture
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Take a knee
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Position Change
Standing Sitting
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Take breaks!
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More Practical Suggestions Set your ideal posture first
Adapt the patient and environment to you Avoid sustained end range positions
Take breaks from positions every 15-20 min. Avoid loupes/head lamps as able
High Powered Reading Glasses as alternative? Dictation
Headpiece vs. holding phone to ear
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Exercises 1. Head Retraction
Common ErrorsTipping head backTensing up neck/shouldersThoraco-lumbar
compensation Variations
Add “overpressure”Stand at a wall Repeated or sustained
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Exercises 2. Posture Correction
Slouched Overcorrected Less 10%= IDEAL
“Neutral Spine”
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Exercises 3. Back Extension in Standing
VariationsBend back over
counter/chair
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Exercises 2. Back Extension in Prone
Common ErrorsTensing back/buttocksLetting hips come off
VariationsRepeated or sustainedSustain position by
propping on elbowsRest on pillows
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Guidelines for Self-Care
GREEN LIGHTNo current symptoms
○ Neck and Back exercises 5-10 reps, ≥5x/dayCurrent symptoms: local neck, scapular or shoulder
pain/stiffness○ Neck and Back exercises
5-10 reps, 10x/day○ Symptoms reduce/eliminated
during and/or immediately
after exercise
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Guidelines for Self-Care
YELLOW LIGHTI/M neck/back symptoms that respond to
position change or movementSymptoms produced or increased during
exercise○ no worse or better immediately after
Neck and/or Back exercises
5-10 reps, 10x/day
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Guidelines for Self-Care
RED LIGHT – seek medical attention!Constant neck/back symptomsI/M or Constant radicular painLoss of/change in extremity power,
sensation, coordination
Symptoms that are worse or
peripheralized after exercise
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Further Reading
Robin McKenzie“Treat Your Own Back”“Treat Your Own Neck”