September 5th – 8th 2013Nottingham Conference Centre, United Kingdom

www.nspine.co.uk

Welcome to NSpine

Introduction• Introduction to the CSSS• The thinking behind the program• The speakers – surgical, osteopathic &

research• Interactive and forum for discussion• Networking • Exposure for the profession• Highlighting the work in the CSSS

The Centre for Spinal Studies and SurgeryQMC one of Europe’s largest teaching

hospitals.Recognised National and International

referral centre for complex spinal pathologies.

8 Consultant Spinal Surgeons.5 Senior Spinal Fellows.>8200 outpatient consultations pa.>80% referrals are not offered/choose not

to have surgery.

The ProgrammeCommon spinal conditions managed in CSSS.Surgical management vs. osteopathic.Sharing experience.Supported by data.

The SpeakersSurgical colleaguesOsteopathic teamGuest speakersKey note speakersPanel discussionsInteractive

And what’s more…Opportunity to network with osteopaths and

other healthcare professionals.Opportunity for osteopathy is be present and

represented at a large spinal conference.Opportunity to raise awareness of what

osteopaths are doing in CSSS.

Introduction to Examination Techniques & Treatment Strategies used by the Osteopathic Team

at the QMC

Osteopathic Assessment & Treatment

• Background• Case history• Examination• Special tests• Imaging• Treatment strategies• Exercises • Management

Patient Types• All patients are chronic.• All referrals are tertiary.• Majority of patients investigated.• Majority of patients have mostly had multiple

interventions.• Many patients have co-morbidities.• Many patients take substantial amounts of

medication.• Patients are often ‘fed up’.

Case History

Referral letters and medical notes.Take osteopathic case history.Often little background information.MOI.Lifestyle/occupational factors particularly

important in chronic patients.

ExaminationMany patients will comment that this is the

first time they have been physically examined.

Visual assessment.Standing, sitting & supine examination.Flexion and extension – gross & segmental.Sacrum to OAJ.Palpation.

Examination

Aim for a consistency in examination throughout the osteopathic team at QMC.

Pictorial format for recording findings.Keep it universal and quick glance

annotations.

Spinal Examination UsedThumbs placed on transverse processes in neutral.

Flexion: Right thumb rides up but left remains down & more prominent. Indicates failure of left facet joint to open.

Extension: thumbs ride down & back equally.

Pelvis: The right thumb is higher than the left, indicating stiffness of the right side of the pelvis.

Diagram to show movement of the facets & Annotation used

Neutral Flexion Extension

Restriction of flexion at left facet joint, causing left sidebending & left rotation of upper vertebra on lower.

Normal opening on flexion, but right facet fails to close.

Annotation

T3 ˄ ˅

T3 ˄ ˅

Ref: Bourdillon, JF & Day, EA; Spinal Manipulation; 1987; pp. 46, 86, 87.

Specific Tests often used• Neurological examinations where necessary• Gillets• Fabers• Laguere’s• Piedallu’s• Gaenslens• Femoral shear• Adsons• Allens

ImagingVast majority have imaging.MRI, CT, X-Ray, DEXA.Not all imaging is reported.Advantages and disadvantages.Treat the man, not the scan…

Treatment strategies12 treatment sessions are allocated in

addition to assessment appointments.By using a universal examination procedure,

same diagnosis & treatment strategy should be reached across the team.Treatment plan is unaffected if different

practitioner treats.Consistency – one aim.Maintains robust data.

Treatment StrategiesGenerally work from the base upwards.First 2-3 sessions involve general mobilisation and soft

tissue techniques.Usually see a change by 4th treatment.Techniques used include articulation, mobilisation,

manipulation, MET, passive stretching, inhibition.Treat identified flexion and extension restrictions.Once segmental restrictions have been addressed, focus

moves to global movements.Long levers used on pelvic and shoulder girdles.Strong techniques to change things mechanically – not just

symptom chasing.

Treatment StrategiesManage patient expectations.Re-examine & treat according to findings at each

session.Adhere to the treatment plan – no deviation

according to patient complaining of new symptoms.Aim towards stable and neutral at all spinal

segments.If mechanically stable & neutral, symptoms should

diminish.Let nature take its course.May not – we have failed!

Exercise StrategiesMany patients have tried and failed

physiotherapy.Avoid exercises early on.Introduce exercises at week 6.Repetitive isometric and isotonic stretches.Keep regime short.Physio referral post-treatment if appropriate.

Long term managementFollow up assessment at 3, 6 & 12 months.Further treatment prescribed where

necessary.Certain conditions will need follow up.