Man. Therapy in a patient mild myelopathy (Full Version)

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Kaden -> Man. Therapy in a patient mild myelopathy (March 27, 2008 7:08:57 PM)

Has anyone treated someone with mild cervical myelopathy?  What are thoughts on any kind of manual interventions with these folks, if any.  What to watch, what to avoid and when to refer on.



TexasOrtho -> RE: Man. Therapy in a patient mild myelopathy (March 27, 2008 7:38:15 PM)

Hi Kaden.  I recently had an elderly lady with cervical myelopathy.  Upper-motor neuron signs and the works.  In her case there was significant central canal stenosis in the upper C/S.  She had/has terrible balance defecits as a result.

There was no manual technique that I felt comfortable with this patient.  Her head and neck had found the position that was least likely to worsen her myelopathic symptoms.  As a result she was severely forward flexed above T1 with no hope of changing this.  In fact the surgeon having already performed multi level laminectomies pleaded with me not to allow the patient to "look up".  Pretty sad.

That being said we did a ton of education and balance activities along with general conditioning and she has experienced significant improvements in perceived function and self-efficacy.  Her neck is still a wreck, but she gets around much better than before.  I'm not sure if that helps.



T_Thom -> RE: Man. Therapy in a patient mild myelopathy (March 27, 2008 11:39:43 PM)

First off, I would do a lit search on it... 

The last article I remember reading was in JOSPT, "Intermittent Cervical Traction and Thoracic Manipulation for Management of Mild Cervical Compressive Myelopathy Attributed to Cervical Herniated Disc: A Case Series" J Orthop Sports Phys Ther. 2004;34(11):701-712.

Given this was published 4-yrs. ago, I would guess more information has been published since.



Kaden -> RE: Man. Therapy in a patient mild myelopathy (March 27, 2008 11:56:37 PM)

Thanks guys,

Rod good advice.  T_Thom, I have seen this article as well.  This article defined the management of grade I cervical myelopathy (not sure the parameters but remember that much).

What if a patient presents in the direct access setting with some degree of myelopathy.  Does one refer this person out immediately prior to attempting any treatment?  My gut would say yes that I would like to know the degree of myelopathy.  Any thoughts?



T_Thom -> RE: Man. Therapy in a patient mild myelopathy (March 28, 2008 12:15:02 AM)

I would address balance in that visit if indicated (i.e. instructions for gait device), but would refer out swiftly due to ddx conditions.



TexasOrtho -> RE: Man. Therapy in a patient mild myelopathy (March 28, 2008 12:25:17 AM)

I think in a direct access situation, a neurosurgeon would need to provide the lead in managing the care of this patient.  Particularly if the neurological signs were strong.  To me, the more severe the pathology or closer the patient may be to needing med/surg intervention, the more a specialist should be involved.  In my case, I wouldn't have touched this patient without a neurosurgery consult first.

Phil Sizer addresses these kinds of issues in an article on red flags in an orthopedic setting.  I'll try to locate and post the file.  Can we add pdf files on this forum?



Kaden -> RE: Man. Therapy in a patient mild myelopathy (March 28, 2008 1:15:00 AM)

Rod,

Thanks for the thoughts and I agree.  I am not sure about the PDF files.  I think I have seen the article you are talking about.  I will take a look.

Thanks again



ysumpt2006 -> RE: Man. Therapy in a patient mild myelopathy (March 28, 2008 7:39:46 AM)

quote:

ORIGINAL: TexasOrtho

I think in a direct access situation, a neurosurgeon would need to provide the lead in managing the care of this patient.  Particularly if the neurological signs were strong.  To me, the more severe the pathology or closer the patient may be to needing med/surg intervention, the more a specialist should be involved.  In my case, I wouldn't have touched this patient without a neurosurgery consult first.

Phil Sizer addresses these kinds of issues in an article on red flags in an orthopedic setting.  I'll try to locate and post the file.  Can we add pdf files on this forum?


Good advice for sure. Could you point me in the direction of that article? If need be, you can email it to me at kshearer at zoominternet dot net, thanks.



TexasOrtho -> RE: Man. Therapy in a patient mild myelopathy (March 28, 2008 7:50:39 AM)

I emailed it to you this morning.



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