+ Nancey Trevanian Tsai, M.D. Justin Price, M.A..

+

Nancey Trevanian Tsai, M.D.Justin Price, M.A.

+TOPICS TO BE COVERED

Anatomy and Pain Generators Where is the problem? Studies? Diagnoses and codes? Assessments Exercises

+Before we get started…

We will be discussing functional, integrative, dynamic anatomy

Upper body is affected by lower body

Focus is on functional relief of chronic pain

+ANATOMY/PAIN GENERATORS

Muscle

Joint

Bone

Nerve

Organ

Cramping, spasm

Twinge, ache

Sharp, stabbing

Burning, radiating

Pressure, ‘anxious’

Anatomical element Pain

+Fundamental Movements

Push

Pull

Swing

Squat

Rotate

Postural Slings

Anterior oblique Ext oblique Contralat int oblique Contralat adductors Ant abdominal fascia

Lateral Gluteus medius/minimus TFL Lateral thoracopelvic

stabilizers

Posterior oblique Lat dorsi Contralat gluteus maximus

via thoracodorsal fascia

Longitudinal Peroneals Biceps femoris Sacrotuberous ligament Deep thoracodorsal fascia Erector spinae

Neutral Posture

Typically described as cervical curve over lumbar curve

“Ear over Shoulder over hip over knee”

+Studies?

Radiography X-ray CT MRI

Labs

EMG

Ultrasound

Indicated for neurological sx’s Radiating pain Myelopathy

Constitutional sx’s

UMN vs LMN

Localized sx’s

+Needs Further Workup

Constitutional symptoms: F/C/N/V/D

Significant weight gain or loss

Appears “ill”

Neurological asymmetries: pupil, autonomic, seizures, LOC

Where is the problem?

Neck Arms

Upper back Chest

Diagnoses and codes

Neck pain

9: 223.1

10: M54.2

HNP C-spine

9: 722.0

10: M50.20

Cervical stenosis

9: 723.0

10: M48.02

Facet pain

9: 723.8

10: M53.82

Diagnoses and Codes

Arm pain

9: 729.5

10: 79.609

Parsonnage Turner

9: 353.5

10: G54.5

Shoulder bursitis/RTC enthesopathy

9: 726.10

10: M75.50

Unsp neuralgia

10: M79.2 (UE)

10: M54.1 (brach)

Diagnoses and Codes

TMJ

9: 524.6X

10: M26.6X

OSA

9: 373.23

10: G47.33

Glossopharyngeal neuralgia

9: 352.1

10: M54.81

GERD

9: 530.81

K21.9

Diagnoses and Codes

Occipital Neuralgia

9: 723.8

10: M 54.81

Brach Plex Inj

9: 353.2 (unsp)

10: S14.3 (unsp)

Inflam spondy

9: 720.9

10: M46.92

Arthralgia (unsp)

9: 719.40

10: M25.50

Diagnoses and Codes

Intercostal pain

9: 786.59

10: R07.82

Rib subluxation

9: 839.61

10: M99.18

Costochondritis

9: 733.6

10: M94.0

TOS/Cerv Rib

9: 353.0

10: Q76.5

Diagnoses and Codes

Precordial CP

9: 786.51

10: R07.2

Non-precord CP

9: 786.5

10: R07.9

Pleurisy

9: 786.52

10: R07.1

Chronic post-op

9: 338.28

10: G89.28

Diagnoses and Codes

Postural Kyphosis

9: 737.10

10: M40.00

Repetitive strain

9: 723.1

10: M54.2

Cervico-thoracic

10: M40.03

Thoracic:

10: M40.04

+COMMON IMBALANCES

Overpronation – Lack of Dorsiflexion – Medial Knee Displacement – Anterior

Pelvic Tilt – Excessive Lumbar Lordosis - Excessive Thoracic

Kyphosis – Protracted Scapula – Internally Rotated Arms – Elevated

Scapula – Forward Head – Excessive Cervical Lordosis

+WHICH ASSESSMENTS?

• Find and fix the part to

mend the whole• Toe touch test and ball

under foot

+WHICH ASSESSMENTS?

• Get the patient involved

• Keep it simple• Psychology of authority

ASSESSMENTS

VerbalVisual

Hands-On

ASSESSING THE UPPER BODY

Visual/Hands-On Assessment

Excessive Thoracic Kyphosis

1st Rib to 1st Thoracic Vertebrae



Internally Rotated Arms

Position of thumb (i.e., Styloid Process)



Forward Head Position

Sitting on chair with imaginary plumb line from cheek to collarbone



Level of Hips

Use dowel rod on back of hips to check if they are level



Level of Shoulders

Use dowel rod on top of scapula to check if they are level



Position of Head

Observe side bend of neck to check which way is easier

EXERCISES

“Chew The Gum First”

1. Ball On Upper Back/Shoulders

2. Ball and/or Theracane on Neck

3. Ball On Front Of Shoulder

4. Ball On Hip Flexors

5. Ball On Side of Hip(s)/Lower Back

EXERCISES

“Then Blow The Bubble”

1. Neck Side Stretch

2. Hip Flexor Stretch

3. The “Why’ Stretch

4. Door Frame Stretch

+

Questions?

THANK YOU FOR ATTENDING

+

[email protected]

[email protected]

THANK YOU FOR ATTENDING

+ Nancey Trevanian Tsai, M.D. Justin Price, M.A..

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