TLJ - MAPTA€¦ · 9/22/19 3 10th Ring L Latexion: Example O Left z-joint extends (inferior glide)...
Transcript of TLJ - MAPTA€¦ · 9/22/19 3 10th Ring L Latexion: Example O Left z-joint extends (inferior glide)...
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Assessment&TreatmentoftheThoraco-Lumbar
JunctionBobby Bemis PT, DPT, COMT, Dip. MT,
FAAOMPT
ASpecialThanksO The Institute of Manipulative Physiotherapy & Clinical
Training (IMPACT).
O Gail Molloy and Bev Parrott! I will always appreciate the time and commitment they put into me.
O Jenn Berry and Jordan Couchon. Who helped me through the grind.
O The rest of the IMPACT team who taught me the art
and the science of manual therapy.
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WhatdoestheTLJconsistof?
O T10 - T11 (10th Ring) O T11 - T12 (Rotational Segment) O T12 - L1 (Transitional Segment) O 11th Rib O 12th Rib
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Definitions
O Rotexion: Rotation and ipsilateral side bending.
O Latexion: Side bending and contralateral side
bending
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The10thRing O The z-joints flex and extend O The ring rotates in latexion or rotexion O The ring translates laterally
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10thRingRRotexion:Example
O Right z-joint extends (inferior glide) O Left z-joint flexes (superior glide) O Entire ring translates left O Right rib slides antero-medial O Left rib slides postero-lateral
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10thRingLLatexion:Example
O Left z-joint extends (inferior glide) O Right z-joint flexes (superior glide) O Side bending compresses L rib and creates a
superior posterior moment that creates a pull by the L rib and thus creating a R rotation of the segment.
O R rib slides antero-medial
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TheRotationalSegment O False rib does not limit rotational motion of z-
joints. O Flexes and extends the same as rest of the
thoracic spine. O False rib embedded in Q/L and is
hypothesized to increase the power output of this muscle. Example: Patella for Quad.
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TheTransitionalSegmentO One vertebrae shaped like thoracic and one
shaped like lumbar O The nature of the shape of this segment
allows for more form closure for stability, especially from forces above.
O Rotexion, Latexion, Flexion and Extension are reinforced by the shape of this segment.
O When forces are coming from below L1 moves under T12 creating a latexion moment that is required for gait.
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AssessmentoftheTLJ
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Set-upforTLJAssessmentinStanding
O Patient: Standing with arms crossed O Therapist: Standing to one side
O Fixation: Therapist’s lateral hip stabilizes against the patient’s lateral hip. The therapist places their arm between the patient’s arm with hand on patient’s shoulder opposite of the hip fixation.
O Localization: Start with 10th rib and find T10 – T11
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Assessmentofthe10thRinginStanding
O Latexion: Side bend toward therapist and and rotate away.
O Rotexion: Rotate away and side bend away.
O Unilateral Extension: Side bend away and either inferior glide from above or superior glide from below.
O Unilateral Flexion: Side bend toward and either superior glide from above or inferior glide from below
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AssessmentoftheRotationalSegmentinStanding
O Unilateral Extension: Same as T10-T11 O Unilateral Flexion: Same as T10-T11
O Rotation: Perform pure axial rotation bilaterally
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AssessmentoftheTransitionalSegmentinStanding
O Latexion: Side bend away and rotate toward
then glide L1 superior underneath T12
O Unilateral flexion and extension is the same.
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The11thand12thribsO Subluxation of these ribs typically occur due
to:
O Large contraction of the Q/L pulls the rib laterally
O A prolonged segmental hypomobility of any
other TLJ joints and a large rotation and/or contraction of the Q/L is required
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Assessmentof11th&12thribsO Patient c/o of chronic cramping or spasm of
Q/L local to the ribs. O Exquisite tenderness over the costo-vertebral
joint. O Restricted rotation toward the subluxed rib
side. O No motion when you glide the rib.
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TreatmentTechniques
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11th&12thRib“Gap”Techniques
O “Gap”: 11th & 12th rib in side-lying
O “Gap”: 11th & 12th rib in prone
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Extension&RotationTechniques
O Side-lying Extension: All segments
O Supine Extension: All segments
O Rotation: T11 – T12
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Latexion&RotexionTechniques
O Latexion: T10 – T11 & T12 – L1 O Rotexion: T10 – T11 & T12 – L1
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TheEndTheBeginning
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References1. Lee, D. Biomechanics of the thorax – research
evidence and clinical expertise. J Man Manip Ther. 2015: 23(3), 128-138.
2. Meadows, James T.S. Orthopedic Differential Diagnosis in Physical Therapy: A Case Study Approach. New York: McGraw-Hill, Health Professions Division, 1999. Print.
3. Molloy, G. Thoracic Spine Assessment and Manipulation. Denver, CO: Course Notes; 2015.
4. Pettman, E. Manipulative Thrust Technique: An Evidence Based Approach.
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