prevention & treatment of cervical & lumbar injury

PREVENTION & TREATMENT OF CERVICAL & LUMBAR INJURY

FOR THE OCULOFACIAL SURGEON

Renée Ostertag, DPT, MPT, COMT

Denver, Colorado

ASOPRS Spring Meeting, 2011- Amelia Island

Objectives

Increased awareness to aid in prevention of injury

Anatomy Review

Physiology of a Disc

Cervical Physiology

Cervical Protrusion and Retraction

Cervical Flexion and Extension

Lumbar Disc Physiology

Lumbar Flexion Lumbar Extension

Load to Lumbar Disc

Load to Lower Cervical Disc

Neutral Head Position is 12 lbs.

Forward Head Position is 36 lbs.

Pathophysiology Stage #1

Microscopic tears Weakens annulus

Pathophysiology Stage #2

Disruption of inner layers of annulus

No innervation of inner 1/3 of disc

Pathophysiology Stage #3

Tissue Damage has reached innervated tissue

Pathophysiology Stage #4

Marked displacement of nerve root

Symptoms:Severe neck/UE painUE weakness and/or

incoordinationLoss of sensation and

reflexes+/- surgery

Operating Room Suggestions

Avoid sustained end range loading

Practice “Neutral Spine” posture

Take a knee

Position Change

Standing Sitting

Take breaks!

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

Exercises 1. Head Retraction

Common ErrorsTipping head backTensing up neck/shouldersThoraco-lumbar

compensation Variations

Add “overpressure”Stand at a wall Repeated or sustained

Exercises 2. Posture Correction

Slouched Overcorrected Less 10%= IDEAL

“Neutral Spine”

Exercises 3. Back Extension in Standing

VariationsBend back over

counter/chair

Exercises 2. Back Extension in Prone

Common ErrorsTensing back/buttocksLetting hips come off

VariationsRepeated or sustainedSustain position by

propping on elbowsRest on pillows

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

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

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

Further Reading

Robin McKenzie“Treat Your Own Back”“Treat Your Own Neck”