RehabEdge Physical Therapy Forum

Forums  Register  Login  Forgot Login?
  My Profile 
My Subscription
  My Forums 
Search
  FAQ  Log Out
Follow @RehabEdge

Rehab guidelines for acute traumatic lumbar compression fracture

 
Logged in as: Guest
Users viewing this topic: none
  Printable Version
All Forums >> [RehabEdge Forum] >> Orthopedics >> Rehab guidelines for acute traumatic lumbar compression fracture Page: [1]
Login
Message << Older Topic   Newer Topic >>
Rehab guidelines for acute traumatic lumbar compression... - February 18, 2011 7:33:09 PM   
Kaden

 

Posts: 517
Joined: June 18, 2007
Status: offline
Just curious if anyone has any good resources or guidelines they can share on management of acute traumatic compression fractures of the lower thoracic and lumbar spine region.

I have done some internet and literature search and not found much and advice from MD's on this patient population seems to be all over the place.

Any help pointing me in a direction I could learn a little more would be greatly appreciated. 
Post #: 1
RE: Rehab guidelines for acute traumatic lumbar compres... - February 25, 2011 4:49:00 PM   
JohnFeil

 

Posts: 123
Joined: January 13, 2009
From: Long Island, NY
Status: offline
I too would be interested in that.  I have a pt that techically not acute (L1 fx 2 weeks ago), but was referred to my practice by a neurosurgeon and not sure what I sould do.

Obviously no motion @ that joint.  But what about abdominal bracing of the transverse abdominus?

Pt is wearing a L/s brace OOB most of the day.

any other ideas?

_____________________________

John Feil PT, DPT, OCS, MCMT, CSCS, CKTP

(in reply to Kaden)
Post #: 2
RE: Rehab guidelines for acute traumatic lumbar compres... - February 25, 2011 9:21:26 PM   
Eric E Douglass, PT, DPT, OCS, FAAOMPT

 

Posts: 69
Status: offline
The advent of the kyphoplasty has totally changed what i see with these folks, in fact I rarely see them any more, when I used to see a lot of them we would avoid flexion, promote extension and promote healing with pain free weight bearing activities

(in reply to JohnFeil)
Post #: 3
RE: Rehab guidelines for acute traumatic lumbar compres... - February 27, 2011 10:34:24 AM   
VagusX

 

Posts: 338
Joined: March 27, 2003
From: Savannah, GA, USA
Status: offline
I usually will see these patient's, mostly workers comp, after the fall off roofs etc. I see them mostly getting braced until good union. I hardly every see a patient while they are in their brace. It would help if they did to decrease all their secondary disability and depression.

And to answer your question, I don't think there is any steadfast practive guidlines for these patients. I would like to know if there is. OCS 1 week!
Post #: 4
RE: Rehab guidelines for acute traumatic lumbar compres... - February 27, 2011 8:29:17 PM   
SJBird55

 

Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
The spinomed brace is one brace that is supported in literature: http://tinyurl.com/4ttreqj
http://www.nature.com/nrrheum/journal/v4/n1/full/ncprheum0702.html

A word of caution... the spinomed isn't a brace just plopped on and left. The orthotist needs to work with the patient and adjust the brace as changes occur, IF they occur.

Well, a fracture is a fracture... vertebral compression fractures hurt a lot. Initially, I don't think there is much you can do except have the person in bracing. Of course, the person can do activities for the upper extremities and the lower extremities as long as the spine does not have an increase in symptoms. If I were to guess... I believe around the 8 week post compression fracture point in time would be a good time to begin physical therapy.

(in reply to VagusX)
Post #: 5
RE: Rehab guidelines for acute traumatic lumbar compres... - March 1, 2011 4:58:32 PM   
Kaden

 

Posts: 517
Joined: June 18, 2007
Status: offline
Thanks for the replies.

My patient was not braced at all and no real guide lines given.  I had heard at one point to try to work on gentle extension and have been doing lumbar stability work.  Other than that not a to sure what to do.

Interestingly when I see this (only a couple of time mind you) in younger patients there has not been a push to avoid motion at the joint as John suggested.  It seems reasonable to do so but these patients don't seem to be given this advice.

(in reply to SJBird55)
Post #: 6
RE: Rehab guidelines for acute traumatic lumbar compres... - March 1, 2011 10:19:53 PM   
bonez

 

Posts: 701
Joined: August 29, 2007
Status: offline
Really can't we consider stable vs unstable fx? Usually those involving the anterior vertebral body are generally thought of as stable. Bracing was used as it was thought to decrease deformity but I have not seen a lot that suggests it does. Kyphoplasty has changed management for many.

In many cases why can't these be thought of similarily to rib fractures. mobility to tolerance in painfree directions promote extension and trunk activation as a functional brace then restore mobility at boney healing.

(in reply to Kaden)
Post #: 7
RE: Rehab guidelines for acute traumatic lumbar compres... - March 3, 2011 3:04:55 AM   
Kaden

 

Posts: 517
Joined: June 18, 2007
Status: offline
Good points Bonez.

I often wondered why MD's were not more concerned about limiting movement when an acute compression fracture is present.  But maybe, as you imply, most of these are anterior only and considered stable and thus rehab can progress as tolerated.

But I do still struggle with not wanting to limit motion in this population as it seems like the logical thing to do but maybe MD's just are not seeing a big difference in healing response.

I tend to progress as bonez suggested with mobility to tolerance, gentle extension work and some gentle core work and patient education to avoid flexion and loaded positions.

But I got many different opinions when I brought this topic up to colleagues (some with an approach similar to Bonez and some suggesting immobilization) and that is why I though I would post here.

Thanks again.

(in reply to bonez)
Post #: 8
RE: Rehab guidelines for acute traumatic lumbar compres... - March 4, 2011 11:13:26 AM   
SJBird55

 

Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
bonez... you'd be impressed with the spino-med brace. Excellent research on it.

Compression fractures hurt a lot... the patients I have had the opportunity to suggest the spino-med brace were actually pleased with how it also decreased symptoms. No, I haven't done a study... but they were satisfied with it AND wore it - sometimes even longer than I had advised. It's okay wearing that brace longer because it does have strengthening benefits.

Kyphoplasty is a disaster, in my opinion. That "quick fix" has horrible outcomes. Check the research on it... most definitely not impressive.

(in reply to Kaden)
Post #: 9
Page:   [1]
All Forums >> [RehabEdge Forum] >> Orthopedics >> Rehab guidelines for acute traumatic lumbar compression fracture Page: [1]
Jump to:





New Messages No New Messages
Hot Topic w/ New Messages Hot Topic w/o New Messages
Locked w/ New Messages Locked w/o New Messages
 Post New Thread
 Reply to Message
 Post New Poll
 Submit Vote
 Delete My Own Post
 Delete My Own Thread
 Rate Posts



Google Custom Search
Forum Software © ASPPlayground.NET Advanced Edition 2.5.5 Unicode

0.141