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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
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+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
ASSESSING THE UPPER BODY
Visual/Hands-On Assessment
Internally Rotated Arms
Position of thumb (i.e., Styloid Process)
ASSESSING THE UPPER BODY
Visual/Hands-On Assessment
Forward Head Position
Sitting on chair with imaginary plumb line from cheek to collarbone
ASSESSING THE UPPER BODY
Visual/Hands-On Assessment
Level of Hips
Use dowel rod on back of hips to check if they are level
ASSESSING THE UPPER BODY
Visual/Hands-On Assessment
Level of Shoulders
Use dowel rod on top of scapula to check if they are level
ASSESSING THE UPPER BODY
Visual/Hands-On Assessment
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
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Questions?
THANK YOU FOR ATTENDING
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