THERE IS - Amazon Web Servicesmeeksbracingspinomed.s3.amazonaws.com/PowerPoint... · May June 2002....
Transcript of THERE IS - Amazon Web Servicesmeeksbracingspinomed.s3.amazonaws.com/PowerPoint... · May June 2002....
3/25/2012
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OSTEOPOROSISTHERE
ISSOMETHING YOU CAN DO ABOUT IT!
FOCUS ON BRACING WITH THE
SPINOMEDSPINAL ORTHOSIS FOR OSTEOPOROSIS
THE MEEKS METHOD
that, someday in this country and, indeed, around the world, any person, no matter their age, gender, lifestyle, ethnicity, musculoskeletal condition or any other factor, that that person can go into any environment where exercise
and movement are being taught and be given a program that is
Ideally, it will also be therapeutic. Although there is more awareness now than when I began teaching 12 years
ago, there is still a lot to be done. By taking this course, you will help me fulfill my dream.
As you learn more about movement that is
you can help me take the message of safety and therapeutic intent in movement and exercise into your own life and
into the lives of others.
WHATISTHE
MEEKS METHOD
ACOMPREHENSIVE12-POINT
PHYSICAL THERPYINTERVENTION Developed around a population of patients diagnosed with osteoporosis
useful for many diagnoses designed with a primary
objective of safety in movement from and for the bones--S.A.F.E.*
*Skeletally Appropriate For EveryoneComplements the use of the Spinomed
Orthosis for Osteoporosis
IS THEKEY
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©2000 SARA MEEKS SEMINARS
PATTERNS OF POSTURAL CHANGE
Prevent, Arrest or Reverse
ALIGNMENT
PERCH POSTURE HIP HINGE STANDING POSTURE
INTERNAL PLUMB LINE
SIT-TO-STAND & STAND-TO-SITFUNCTIONAL MOVEMENT
Inability to stand up out of a chair unaided is linked to a 2 fold increase in hip fracture risk Cummings et al 1995
Weakness of lower extremities linked to impending physical frailty Judge et al 1996 Guralnik et al 1995
Low femoral neck bone mineral density is significantly associated with a low sit-to-stand performance assessed by measurement of maximum rising strength in healthy adult women. Blain et al 2008
SIT-TO-STAND CHAIRWWW.ENDORPHIN.COM
FRONT
BACKBONE
OF
THE
PRINCIPLES OF THE MEEKS METHOD
DECOMPRESSION
FRONT of the Backbone
T E N S I L E F O R C E Single Best Exercise for Most Back Pain
UN‐LOAD the Vertebral BodiesJRF GRF Site‐Specific Exercise BRF
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What
IS
OSTEOPOROSIS ?
A musculoskeletal disorder with compromised bone
strength that predisposes an individual to increased
fracture risk
NIH Consensus Development Panel onOsteoporosis Prevention, Diagnosis, and Therapy.
JAMA 2001: 285:785‐795
•Bone Density•Bone Quality
•Architecture•Mineralization•Micro damage accumulation
BONE STRENGTH
Milner, Colin. Making Bone HealthA Priority. The Journal on Active Aging.May June 2002.
OSTEOPOROTICBONE
NORMALBONE
PRIMARY CONSEQUENCE OF OSTEOPOROSIS IS
FRACTURE
PRIMARY OBJECTIVE OF THERAPY AND BRACING IS TO PREVENT FRACTURE
• Occurs in 1 of 2 women; 1 of 4 men• Happens every 20 seconds• Can be immediately life‐altering and life‐threatening• Annual Fracture Incidence
– Vertebral—700,000– Hip—300,000– Wrist—250,000– Other Sites—300,000
• Cost – >$46 million per day– By 2020– >$178 million per day
OSTEOPOROSIS‐RELATED FRACTURE
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•Bones of spine usually first to show signs of osteoporosis•Primarily trabecular bone•Fractures occur during movement that includes
TRUNK FLEXION
VERTEBRAL BODY
•After one vertebral fracture, the risk for having a 2nd
vertebral fracture increases 5 fold!•1 woman in 5 will sustain a 2nd vertebral fracture within 1 year
•Only 20-30% of all compression fractures are symptomatic1
International Osteoporosis Foundation 2005Report of the Surgeon General on Bone Health Oct 2004
1www.nih.org accessed November 30, 2011
CLINICAL CONSEQUENCES OF SPINE FRACTURES
SYMPTOMS SIGNS FUNCTION FUTURE RISKS
Back Pain (acute/chronic)Sleep DisturbanceAnxietyDepressionDecreased Self EsteemFear of future: Falls and FracturesReduced Quality of LifeEarly Satiety
Height LossKyphosisDecreased Lumbar LordosisProtuberant AbdomenReduced Lung FunctionWeight Loss
Impaired ADL’sDifficulty Fitting ClothesDifficulty Bending, Lifting, Descending Stairs, Cooking
Increased Risk of FractureIncreased Risk of Death
Source: Papaioannou et al. 2002. Reprinted from The American Journal of Medicine, Diagnosis and management of vertebral fractures in elderly adults.113(3):220‐228
Bone Health and OsteoporosisA Report of the Surgeon General October 2004
COMPLICATIONS FROM COMPRESSION FRACTURES OF THE SPINE
Constipation
Bowel Obstruction
Prolonged Inactivity
Deep Venous Thrombosis
Increased Osteoporosis
Progressive Muscle Weakness
Loss of Independence
(Increase in Thoracic) Kyphosis
Crowding of Internal Organs
Atalectasis/Pneumonia
Prolonged Pain
Loss of Body Height
Low Self‐Esteem
Emotional & Social Problems
Increased Nursing Home Admissions
Mortality
Old JL. Vertebral Compression Fractures in the Elderly Am Fam Phy Jan 2004
QUESTIONS?
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?VERTEBROPLASTY
AND
KYPHOPLASTY
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THE
PROCEDURES
Vertebroplasty•First Use—1995
•Large bore needle to cannulate the pedicle(s), followed by injection of polymethylmethacrylate into the vertebral body
Ananthakrishnan et al. Clinical Biomechanics 20 (2005) 25-31
Kyphoplasty
•First Use—2001
•Large bore needle to cannulate the pedicle(s)
•Placement of inflatable balloon tamp within the vertebral body
•Balloon inflated under fluoroscopic visualization, which creates a void in the cancellous bone and elevates the endplate
•Procedure reduces some of the deformity and height loss associated with the fracture.
•Because specific void is created, injection pressure is lower and bone filler viscosity higher which likely reduces incidence of cement leakage
RESULTS
•Good immediate pain relief
•Immediate return to function
•Improvement in both thoracic and lumbar spinalalignment
•Restoration of vertebral body height
•Adjacent fracture is a side effect and appears to be related to the condition and not to the procedure; higher rate of subsequent fractures compared withnatural history for untreated fractures
•Cement augmentation places additional stress onadjacent levels; patients should be carefully evaluatedfor subsequent fractures
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PHYSICAL THERAPY MANAGEMENT OF PATIENTSWITH
VERTEBROPLASTY AND KYPHOPLASTY
•Generally the same as for patients with osteoporosis without surgical procedures
•Goal is prevention of further fracture
•Therapists should contact surgeons performing these procedures to inform them of the benefits of specific physical therapy
intervention
Bracing is part of a comprehensive approach to the management of
patients with
osteoporosisand/or
compressionfracture
PURPOSES OF BRACING
Support and protection Control of motion Prevent fracture
Allow weight-bearing activities
Bracing usually associated with weakeningof body part it is designed to protect
SPINOMED Spinal Orthosis for Osteoporosis
After TreatmentNo Brace
After TreatmentClam Shell
After TreatmentSpinomed
Advantages of the Spinomed
oLightweightoCan be worn under clothing -
inconspicuousoEasy to Don and DoffoStrengthens rather than weakens— if
the patient experiences discomfort from muscle activation, he/she may have to shorten wear time when first starting with the brace
oCan be fit to very severe thoracic hyperkyphosis
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Details of Fitting & Wear of the SpinomedoMake sure the brace is long enoughoDo not cut the straps too earlyoWear
oWhen people are up and active, can also be worn when sitting but more benefit obtained when up and active
oWhen walking, working out, as well as when “puttering” around the house, doing gardening, housework etc
oFit is critical o should conform exactly to curves of the back o pelvic strap below iliac crests o abdominal support in lower abdomeno serpentine strap DOES NOT pull shoulders back
Other Details of the SpinomedBacked up by a peer-reviewed research study
Michael Pfeifer, Bettina Begerow, Helmut Minne 2004
Ordered by Physician
Fit by Orthotist – orthotist should make sure patient understands how to don/doff Spinomed before leaving the office
Physician, Orthotist, Physical Therapist, & Patient work together for ultimate best fit and satisfaction
Combine with The Meeks Method Exercises for optimum results
Covered by Medicare
BRACING (with the Spinomed® brace)
– 2 Groups of Women with Osteoporosis and Compression Fracture
– 6 month trials with and without the brace
– Women who had been wearing the brace did not want to give it up
Pfeifer, Begerow, and Minne 2004
BRACING with the Spinomed®
–73% Increase Back Extensor Strength–58% Increase Abdominal Strength–11% Decrease Thoracic Kyphosis–25% Decrease Body Sway–7% Increase Vital Capacity–38% Decrease in Pain–15% Increase in Well-Being–27% Decrease in Limitations ADL’s–Increase in Body Height
Pfeifer, Begerow, and Minne 2004
BRACING WITH THE SPINOMEDSpinal Orthosis for Osteoporosis
“The Spinomed orthosis is the single, most significant advancement in the conservative
management of osteoporosis and compression fracture EVER.”
Sara M. Meeks, PT, MS, GCS
Use of the Spinomed is part of thecomprehensive approach of
The Meeks Method
Goal of Management is to Prevent the Next Fracture
Protocol for Compression Fracture Management
PROTOCOL FORCOMPRESSION FRACTURE MANAGEMENT Start early – on day of fracture if possible UN-load the spine – position in supine or as close to
supine as possible, hips and knees bent and supported to relieve pull of leg muscles on the spine
Position from least to most compression – supine, side-lying, prone, standing
Pain relief with positioning, ice, moist heat, electrical stimulation along erector spinae muscles
Isometric Back Extensor, Gluteus Maximus, Abdominal Exercises
NO OUT-OF-BED-TO-CHAIR ORDERS If seated, use reclined chair, avoid “hammock” effect Initiate weight-bearing with standing, weight shifting, gait
training using rolling walker or other support as soon as possible
Consider bracing with Spinomed-Spinal Orthosis for Osteoporosis
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Habitual Posture Best Posture Best Posture – 1 Hour Later
JAMESThoracic Kyphosis
The World’s Osteoporosis
is
Ticking
Chan et al. Bulletin of the World Health Organization 2003, 81 (11)
!! TAKE ACTION NOW !!
Best way to diffuse the world’s
OSTEOPOROSIS TIME BOMB
is to
THINK
BONEWHEN YOUR PATIENT
FIRST COMES THROUGHTHE DOOR
“BOTTOM LINE”
PREVENTION
OF THE
NEXT FRACTURE
WHAT IS
YOURNEXT STEP?
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Mikki
Rosie
Raven
For PDF’s of
PowerPoint (color) Presentation Slide on Compression Fracture
Management Re‐Alignment Routine (beginning
exercises of The Meeks Method)send email to
Reference list available through www.ptseminars.net
Check website www.sarameekspt.com for more seminars by Sara Meeks, PT, MS, GCS
Additionally, for books, DV D
and other products designed to enhance your practice
please visit
www.sarameekspt.com
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