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This Concept Map, created with IHMC CmapTools, has information related to: Sara Nugent, Sara Nugent gymnast grade 2 spondylolisthesis confirmed by imaging ???? Interventions -core stabilization post. pelvic tilt pelvic clock adductor squeezes pelvic neutral stretch iliopsoas and IT band quadruped camel? posture awareness- position changes massage for myofascial tone? Later: multifidi for rotational motions (chops and lifts) quadruped with UE and LE movements, Sara Nugent gymnast grade 2 spondylolisthesis confirmed by imaging ???? spondylolisthesis grades 1-2 conservative treatment grade 3+ surgery indicated once healed, fx fuses hypermobility preceds hypomobility! manips for hypomobility will need to be done chronically unless adress source of hypermobility, Depression ???? behavioral modification therapy, Sara Nugent gymnast grade 2 spondylolisthesis confirmed by imaging ???? triad syndrome amenorrhea & osteoporosis disordered eating clinical depression recommend nutritional counseling, Sara Nugent gymnast grade 2 spondylolisthesis confirmed by imaging ???? Goals: stabilization of core/spinal muscles prevent exacerbation of injury posture training technique education- coach education, Sara Nugent gymnast grade 2 spondylolisthesis confirmed by imaging ???? single leg stance with extension, PT Diagnosis: Pt. presents to PT with LBP secondary to * hypermobility at L34,45,51 (4-5/6) *increased myofasical tone in lu PSM *tight iliopsoas *oswestry 33% *step deformity at L45 ???? Assessment Pt. is a17y/o female gymnast who presents to PT with medical dx of grade 2 spondylolisthesis and 8/10 LBP. Pt presents with PT diagnosis of lu hypermobility and falls under stabilization TBC. Pt. exhibits thigh climbing upon return from fwd bend. Pt. is unable to compete or sit for prolonged periods without pain. Pt. would benefit from PT to address these impairments and return to previous level of function., Sara Nugent gymnast grade 2 spondylolisthesis confirmed by imaging ???? movement system impairments (MSI) extension category may also have pain with flexion due to iliopsoas stabilizing pelvis/spine, Sara Nugent gymnast grade 2 spondylolisthesis confirmed by imaging ???? PT Diagnosis: Pt. presents to PT with LBP secondary to * hypermobility at L34,45,51 (4-5/6) *increased myofasical tone in lu PSM *tight iliopsoas *oswestry 33% *step deformity at L45, Sara Nugent gymnast grade 2 spondylolisthesis confirmed by imaging ???? Prognosis: spodylolisthesis+lysis= poor prognosis degree of wedge deformity more severe slip/ grade= worse prognosis for conservative treatment Surgery vs. conservative severe spondylolisthesis had surgery used oswestry disability scale surgery has better outcomes than not (grades not given) brace early + PT= better strengthen multifidi, PART 2 ???? Depression, Sara Nugent gymnast grade 2 spondylolisthesis confirmed by imaging ???? Examination: pain for 2 years LBP: 8/10 at rest, 10/10 at end of practice aggravated by landing cannot compete now student, capt. of team unable to sit comfortably for prolonged period BP: 100/65 no bowel/bladder issues centralized pain- middle no radiating pain denies N/T meds: naproxen? hurts to cough sometimes OBJECTIVE repeated movements AROM/PROM Joint play L34,L5S1 --> 4/6 L45 --> 5/6 empty end-feel with pain palpation- step deformity (L45) hypermobility increased myofascial tone in paraspinals relatively tight hamstrings increased lordosis limited iliopsoas and IT band reflexes,sensation, proprioception- r/o nerve involvement +prone instability test +spring test for hypermob at L45 may have hypomobile thoracic spine, Treatment Based Classification: manip spe exercise *stabilization traction ???? hypermobility, Depression ???? Prozac, Sara Nugent gymnast grade 2 spondylolisthesis confirmed by imaging ???? spondylolysis scotty dog fx of pars interarticularis micro or macrotrauma repetitive loading with end-range extension, spondylolysis scotty dog fx of pars interarticularis micro or macrotrauma repetitive loading with end-range extension ???? braces: lumbosacral orthoses used for immature skeletal frame prevents further slipping ə/3 slippage activity restriction grade 1-2 --> 80% success rate with conservative treatment 3-4 with surgery --> 80-85% success rate, Sara Nugent gymnast grade 2 spondylolisthesis confirmed by imaging ???? STG (2wks) Pt. will be indep. in HEP Pt. aware of posture correction and pain management Pt. tolerate sitting for 45 min w/o pain Pt. will have increased ROM/flexibility of iliopsoas LTG (6wks) Pt. will have grade 3/6 mobility in L34,45,51 Pt. return to gymnastics pain-free Pt. exhibit oswestry 0-20%, Sara Nugent gymnast grade 2 spondylolisthesis confirmed by imaging ???? MDT- pt. does not fit well other category more pain with extension flexion principle to decrease pain, Sara Nugent gymnast grade 2 spondylolisthesis confirmed by imaging ???? Treatment Based Classification: manip spe exercise *stabilization traction, PART 2 ???? spinal fusion pars interatricularis wiring prognosis precautions