![Page 1: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/1.jpg)
+
Nancey Trevanian Tsai, M.D.Justin Price, M.A.
![Page 2: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/2.jpg)
+TOPICS TO BE COVERED
Anatomy and Pain Generators Where is the problem? Studies? Diagnoses and codes? Assessments Exercises
![Page 3: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/3.jpg)
+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
![Page 4: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/4.jpg)
+ANATOMY/PAIN GENERATORS
Muscle
Joint
Bone
Nerve
Organ
Cramping, spasm
Twinge, ache
Sharp, stabbing
Burning, radiating
Pressure, ‘anxious’
Anatomical element Pain
![Page 5: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/5.jpg)
+Fundamental Movements
Push
Pull
Swing
Squat
Rotate
![Page 6: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/6.jpg)
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
![Page 7: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/7.jpg)
Neutral Posture
Typically described as cervical curve over lumbar curve
“Ear over Shoulder over hip over knee”
![Page 8: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/8.jpg)
+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
![Page 9: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/9.jpg)
+Needs Further Workup
Constitutional symptoms: F/C/N/V/D
Significant weight gain or loss
Appears “ill”
Neurological asymmetries: pupil, autonomic, seizures, LOC
![Page 10: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/10.jpg)
Where is the problem?
Neck Arms
Upper back Chest
![Page 11: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/11.jpg)
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
![Page 12: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/12.jpg)
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)
![Page 13: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/13.jpg)
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
![Page 14: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/14.jpg)
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
![Page 15: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/15.jpg)
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
![Page 16: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/16.jpg)
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
![Page 17: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/17.jpg)
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
![Page 18: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/18.jpg)
+
![Page 19: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/19.jpg)
+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
![Page 20: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/20.jpg)
+WHICH ASSESSMENTS?
• Find and fix the part to
mend the whole• Toe touch test and ball
under foot
![Page 21: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/21.jpg)
+WHICH ASSESSMENTS?
• Get the patient involved
• Keep it simple• Psychology of authority
![Page 22: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/22.jpg)
ASSESSMENTS
VerbalVisual
Hands-On
![Page 23: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/23.jpg)
ASSESSING THE UPPER BODY
Visual/Hands-On Assessment
Excessive Thoracic Kyphosis
1st Rib to 1st Thoracic Vertebrae
![Page 24: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/24.jpg)
ASSESSING THE UPPER BODY
Visual/Hands-On Assessment
Internally Rotated Arms
Position of thumb (i.e., Styloid Process)
![Page 25: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/25.jpg)
ASSESSING THE UPPER BODY
Visual/Hands-On Assessment
Forward Head Position
Sitting on chair with imaginary plumb line from cheek to collarbone
![Page 26: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/26.jpg)
ASSESSING THE UPPER BODY
Visual/Hands-On Assessment
Level of Hips
Use dowel rod on back of hips to check if they are level
![Page 27: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/27.jpg)
ASSESSING THE UPPER BODY
Visual/Hands-On Assessment
Level of Shoulders
Use dowel rod on top of scapula to check if they are level
![Page 28: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/28.jpg)
ASSESSING THE UPPER BODY
Visual/Hands-On Assessment
Position of Head
Observe side bend of neck to check which way is easier
![Page 29: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/29.jpg)
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
![Page 30: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/30.jpg)
EXERCISES
“Then Blow The Bubble”
1. Neck Side Stretch
2. Hip Flexor Stretch
3. The “Why’ Stretch
4. Door Frame Stretch
![Page 31: + Nancey Trevanian Tsai, M.D. Justin Price, M.A](https://reader035.vdocument.in/reader035/viewer/2022062801/56649e185503460f94b04ff9/html5/thumbnails/31.jpg)
+
Questions?
THANK YOU FOR ATTENDING