prevention & treatment of cervical & lumbar injury

Download Prevention & Treatment Of Cervical & Lumbar Injury

Post on 12-Jun-2015



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A presentation from Florida to a group of Opthalmic Surgeons on how to prevent/manage neck and back pain


  • 1. Prevention & Treatment of Cervical & Lumbar Injury for the Oculofacial Surgeon
    Rene Ostertag, DPT, MPT, COMT
    Denver, Colorado
    ASOPRS Spring Meeting, 2011- Amelia Island

2. Objectives
Increased awareness to aid in prevention of injury
3. Anatomy Review
4. Physiology of a Disc
5. Cervical Physiology
Cervical Protrusion and Retraction
Cervical Flexion and Extension
6. Lumbar Disc Physiology
Lumbar Flexion
Lumbar Extension
7. Load to Lumbar Disc
8. Load to Lower Cervical Disc
Neutral Head Position is 12 lbs.
Forward Head Position is 36 lbs.
9. Pathophysiology Stage #1
Microscopic tears
Weakens annulus
10. Pathophysiology Stage #2
Disruption of inner layers of annulus
No innervation of inner 1/3 of disc
11. Pathophysiology Stage #3
Tissue Damage has reached innervated tissue
12. Pathophysiology Stage #4
Marked displacement of nerve root
Severe neck/UE pain
UE weakness and/or incoordination
Loss of sensation and reflexes
+/- surgery
13. Operating Room Suggestions
Avoid sustained end range loading
Practice Neutral Spine posture
14. Take a knee
15. Position Change
16. Take breaks!
17. 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?
Headpiece vs. holding phone to ear
18. Exercises 1. Head Retraction
Common Errors
Tipping head back
Tensing up neck/shoulders
Thoraco-lumbar compensation
Add overpressure
Stand at a wall
Repeated or sustained
19. Exercises 2. Posture Correction
Slouched OvercorrectedLess 10%= IDEAL
Neutral Spine
20. Exercises 3. Back Extension in Standing
Bend back over counter/chair
21. Exercises 2. Back Extension in Prone
Common Errors
Tensing back/buttocks
Letting hips come off
Repeated or sustained
Sustain position by propping on elbows
Rest on pillows
22. Guidelines for Self-Care
No current symptoms
Neck and Back exercises 5-10 reps, 5x/day
Current 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
23. Guidelines for Self-Care
I/M neck/back symptoms that respond to position change or movement
Symptoms produced or increased duringexercise
no worse or better immediately after
Neck and/or Back exercises
5-10 reps, 10x/day
24. Guidelines for Self-Care
RED LIGHT seek medical attention!
Constant neck/back symptoms
I/M or Constant radicular pain
Loss of/change in extremity power, sensation, coordination
Symptoms that are worse or
peripheralized after exercise
25. Further Reading
Robin McKenzie
Treat Your Own Back
Treat Your Own Neck


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