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”
