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• Bone mechanical properties describe how bones respond to different types of forces.

Compression

• Compression is the best load for bone, resulting in bone formation.
• Moderate, consistent compression is ideal.
• Bone is at its strongest when loaded under compression.

Tension

• Bone has good strength against tension when loaded parallel to its long axis.
• Excessive tension can lead to bone resorption.

Torsion

• Bone is relatively weak under torsion, making it susceptible to fractures.
• Small torsional loads can actually increase bone strength.

Shear

• Shear force is another weak point for bones, easily causing fractures.
• Similar to torsion, small shear loads can improve bone strength and trabeculae formation.

Bone-Healing

• Bone-healing occurs in stages: inflammation, soft callus formation, hard callus formation, and remodeling.

Inflammation Phase

• This initial phase occurs on the day of injury.

Soft Callus Formation

• Lasts for the first 3-4 weeks.
• The callus is fragile during this stage, requiring continued immobilization.
• The callus becomes more stable as the phase progresses.

Hard Callus Formation

• Occurs between 3-4 months and 4-6 weeks.
• Indicates the point when normal activity can be gradually resumed as the bone stabilizes.
• Characterized by a hard, bony union.

Remodeling Phase

• Can last from 1-2 years, as the bone reshapes itself.

Fixation

• Involves methods to hold the bone in position during healing.

Closed Reduction

• Utilizes casts, splints, boots, or braces to maintain bone alignment.
• Proper alignment achieved without surgery.
• May require anesthesia.

Open Reduction

• Surgically realigns the bone for proper healing.
• Necessary if proper alignment cannot be achieved or maintained without surgery.
• Midshaft fractures of long bones can be challenging.
• Fractures near muscle attachments can be difficult due to muscle tension.
• Smaller bones with limited blood flow can complicate open reduction.

Open Reduction Internal Fixation (ORIF)

• Involves the use of rods, pins, wires, screws, or plates.
• Carries a higher risk of infection, even years later.
• Involves large incisions, which impact healing time and ability.
• May lead to faster healing compared to Open Reduction External Fixation (OREF).
• May not result in long-term strength gains.
• Usually a permanent solution.

External Fixation

• Uses pins or wires to create an external scaffolding for bone stabilization.
• Allows for compression or traction to be applied.
• Used in post-traumatic situations, limb reduction/lengthening, arthrodesis, and limb salvage.
• Results in less soft tissue and periosteum disruption.
• May lead to increased long-term bone strength.

Fracture

• Stress fractures occur when the bone is unable to withstand the applied load

Factors That Modify Ability of Bone to Resist Load

• Genetics
• Nutrition
• Endocrine status
• Activity history
• Diseases
• Medications

Other Factors

• Loading (biomechanics, training, strength etc)

Fibrous Connective Tissue (Tendons and Ligaments)

• Fibroblasts are present in the extracellular matrix structure.
• Histology is 20% fibroblasts.
• Structure contains: collagen, elastin, ground substance (80%).
• Mechanical properties are similar to Davis's Law and Wolf's Law.

Tendons

• Have more organized collagen and a more specific function.
• Transmit tensile forces from muscle to bone.
• Compress bone when acting as a pulley.
• About 20% of its length comes from crimp, which contributes to its ability to stretch.

Ligaments

• Contain less collagen volume and is less organized.
• Serves a less specific function.
• Resist multiple directions of movement.
• Contain mechanoreceptors for proprioception.

Response to Forces

• Fibrous connective tissue is destructive when compressed.
• Responds well to tension.
• Can be weak to torsion or shear.

Viscoelasticity

• Exhibits time-dependent mechanical behavior.
• Stress and strain relationship is not constant.
• Creep and stress relaxation are examples.

Creep

• It is the time-dependent deformation of a material under sustained load

Primary Creep

• Is the initial stage of deformation.
• Exhibits a non-linear, high creep rate.
• The strain rate decreases over time.

Secondary Creep

• Reaches a stable stage with a constant rate of deformation.
• Has a minimum creep rate.
• Contributes the majority of the total strain experienced by the material.

Tertiary Creep

• Marks the final stage of deformation.
• Involves a very high strain rate, which leads to failure.

Stress Relaxation

• Stress relaxation occurs when a material is held at a constant deformation over time.
• Decreases in stress are observed as a function of time.

Tendinopathy

• Refers to tendon disorders.

Reactive Tendinopathy

• Involves the activation of cells and increased proteoglycans.

Dysrepair

• Characterized by extracellular matrix disruption with vascular ingrowth.

Degenerative Tendinopathy

• Marked by cell death, ECM degeneration, and neovascularization.

Tendon Healing and Rehab

• Load is necessary for healing.
• Tendons synthesize and increase stiffness with loading.
• Begin with isometrics, then isotonics (eccentric and concentric), and finally plyometrics.
• Isometric and isotonic exercises decrease pain.

Rehab

• Do not completely rest; reduce load to beneficial levels.
• Avoid compressive and rapid loads.
• Do not stretch early in the rehab process.
• Avoid pain and limit increases to no more than 2 points.
• Limit passive treatments.
• Tendon changes take at least 12 weeks, with significant changes taking 6 months.

Ligament Injury

• Is classified by Grade

Grade 1

• Microscopic tears in substance with no effect on stability.

Grade 2

• Macroscopic tear involving a partial tear that decreased joint stability, but the ligament still partially intact.

Grade 3

• Complete disruption with significant laxity in the direction that the ligament restrains

Intra-Articular Ligament Injuries

• Exhibits limited ability to heal.
• Surgical repair is typically needed for non-copers.
• Healing depends on the type of repair.

Graft Normally Strongest

• Occurs initially within ~2 weeks.

Graft Then Degrades and "Ligamentizes"

• Occurs at ~4 weeks.

Normal Healing Process

0-4 Weeks

• Structurally weak stage requiring protected ROM and minimal strength training.

4-6 Weeks

• Stage where structural union occurs.
• Begin achieving normal ROM, but be cautious and careful.

6 Weeks-3/4 Months

• Protected strength training period.

Three Quarters to 8 months

• Fibers are becoming stronger, full ROM strengthening exercises, and possibly begin athletics.

Eight to Twelve Months

• Remodeling of fibers requires loading the fibers.
• Return to full activity with full ROM, neuromuscular integration, and strength.

Cartilage

• Articular cartilage is hyaline cartilage.
• It is composed of chondrocytes.
• The extracellular matrix => collagen (type II), proteoglycan and a small amount of elastin.
• It is avascular and not innervated.
• It has 4 zones => superficial, transitional, deep (radial), tidemark (transition), calcified

Cartilage Injury

• Can result from a single incident or degeneration.

Impact of Forces

• High-impact forces or repetitive sub-threshold loads.
• Compression: responds well to slow, low loads. High speed and high force is destructive.
• Torsion and shear: can cause tears.

Chondral Damage

• Occurs w/o visible disruption (cartilage at risk).

Disruption

• Occurs in in Cartilage alone or in Cartilage and subchondral bone (osteochondral injury)

Cartilage Classification

• Is graded by a scale of 0-4.

Grade 0

• Normal cartilage.

Grade 1

• Cartilage with softening and swelling is at risk.

Grade 2

• Partial-thickness defect with fissures on the surface that do not reach the subchondral bone or exceed 1.5 cm in diameter.

Grade 3

• Fissuring to the level of subchondral bone in an area with a diameter more than 1.5 cm.

Grade 4

• Exposed subchondral bone.

Surgical Procedures

Microfracture

• Most common tears <4cm and can be performed arthroscopically.
• Pointed object is used to make tiny holes in subchondral bone.
• Not recommended for patients over 65 years old who have poor knee alignment, RA, or non-full thickness tears.

Complications include:

• Mild transient pain
• "Gritty" sensation
• Catching
• Effusion

Osteochondral Autograft Transplantation (OATs)

• Involves transfer of cartilage and bone "plugs" from the non-weightbearing portion of the joint repair site.
• Outcome is better long term than with microfracture.
• Indicated for young, active patients without arthritis.
• Requires a good donor site.

Matrix-Induced Autologous Chondrocyte Implantation (MACI)

• Is a two step procedure.
• Chondrocytes are harvested from the patient in the first surgery.
• Expanded in a culture and then seeded into a collagen scaffold.
• In a second procedure, the matrix is cut to fit and secured with a fibrin glue.
• Indicated for patients 18-55 years old.
• Should have a full thickness tears less than 3x5 cm without severe osteoarthritis.

Nerve Interface

• Common peroneal at fibular head.
• Dura mater @ L4.
• Radial N attachment to radial head.
• Suprascapular N to suprascapular notch.
• Spinal nerve roots @ facet joints.
• Spine tension points: C6, T6, L4.

Neurodynamic Slump

• Tension points exist at C6, T6, L4, and the popliteal area.
• Neural tissue ideally moves in relation to the movement of the spinal canal.
• The length of the spine increases ~9cm from extension to flexion.
• Tensile stress applied longitudinally to a peripheral nerve creates an elongation of the nerve (an increase in strain).
• The greatest transverse contraction during elongation occurs at the middle of the section that is undergoing tensile strength.

Indications

• Subacute and chronic radiculopathy (cervical+lumbar).
• Adherent nerve root.
• Peripheral neuropathy (peripheral nerve entrapment).
• Status post severe trauma.

Contraindications

• Malignancy.
• Acute Inflammation.
• Spinal Cord Injury.
• Suspected HNP.
• Cauda Equina.
• CNS conditions.
• Deterioration of neurological symptoms.

Proposed Mechanisms of NM

• Involve Physiological, Central, and Mechanical effects.

Physiological

• Decrease intraneural edema.
• Increased neural vascularity.

Central Effects

• Decrease dorsal horn and supraspinal sensitization (cortical and subcortical reorganization seen with neuropathic pain).

Mechanical

• Increase nerve excursion.
• Restore movement in neural tissues and surrounding nerve interface.

Neurodynamic Assessment

• Identifies tension points.

SLR (Straight Leg Raise)

• Classic SLR involves sensitizing movements of hip adduction + ankle DF.
• It identifies the Sciatic & Tibial nerve

Sensitizing Movements Test Which Structure

• Ankle DF+Eversion=>Tibial.
• Ankle DF+Inversion=>Sural.
• Ankle PF+Inversion=>Common Peroneal.

ULTT (Upper Limb Tension Test)

Shldr abd 110°, Flexion Tests

• Shldr ER, forearm supination, wrist & finger ext, elbow ext=>Median Nerve
• Shldr ER, forearm supination, wrist & finger ext, elbow ext=>Musculocutaneous Nerve
• Shldr abd 50°, forearm pronation, shldr MR, wrist & finger flex+wrist UD+elbow ext=>Radial Nerve.
• Shldr abd 90°, elbow flex, wrist & finger ext, shldr LR=>Ulnar Nerve.

Treatment Techniques

• Include sliders/flossing and tensioners.

Sliders/Flossing

• Combinations of joint movement that tense nerves at one end of the nerve bed.
• Simultaneously releases nerves at the other end of the nerve bed.

Goal

• Glide nerve in relation to surrounding tissues.

Tensioners

• Combination of joint movements that elongate the nerve at both ends.

Goal

• Improve viscoelastic properties of the nerve.

Treatment Principles

• Focuses on treating Irritable and Non-irritable tissue

Irritable Tissue

• Start with indirect techniques, removed from symptom area.
• The technique should be pain-free initially.
• Use large amplitude (grade II) performed rhythmically through range.
• Repeat for about 20 seconds, then release.
• Progress by oscillating for longer periods and with greater amplitudes, adding tension at different points along the nerve.

Constantly Monitor

• Symptoms

Non-Irritable Tissue

• Larger longer oscillating mvmts when extra-neural restrictions exist (interfacing tissues).
• Smaller quicker oscillations w/ intra-neural disorders.
• Optimal component mvmts should be explored (direct vs indirect, addition of sensitizing mvmts, sequencing of mvmts).

Muscle Energy Techniques (MET)

• MET are voluntary contraction of a muscle in a controlled direction.
• Performed at varying levels of intensity.
• Performed against a specific counterforce by an examiner.
• Used to lengthen short/contracted/spastic muscle, strengthen a weak muscle, and reduce local edema.
• Effective at mobilizing an articulation that is restricted due to contractile tissue dysfunction.

Indications for MET

• Restoring normal tone in hypertonic muscles.
• Strengthening weak muscles.
• Preparing muscles for subsequent stretching.
• Increasing joint mobility.
• Increasing local circulation.
• Improving function.

Physiological Principles.

• Focuses on Extrafusal and Intrafusal.

Extrafusal

• Skeletal muscle tissue is comprised of both extrafusal and intrafusal muscle fibers.
• Extrafusal fibers are typical skeletal muscle fibers innervated by alpha motor neurons.
• Golgi tendon organ lies within extrafusal fibers.
• Muscle contracts or is put on stretch, tension in golgi tendon organ inhibits alpha motor neuron activity causing muscle to relax.
• Golgi tendon organ responds to increased tension by inhibiting further muscle contraction (protective mechanism).

Basis Behind

• "POST ISOMETRIC RELAXATION".

Post-Isometric Relaxation (PIR)

• Tension is caused by isometric contraction.
• Inhibition from GTO=>PHC=>AHC occurs when sustained.
• Reduction in tone lasts 20-25 seconds.
• Tissues can then be lengthened.

Intrafusal

• Intrafusal fibers comprise the muscle spindle and are innervated by gamma and beta motor neurons.
• Respond to the amount and rate of change in length of a muscle.
• Serve a proprioceptive function.
• The muscle spindle gives constant “real time” feedback to the muscle regarding length.
• In response to stretch, muscle spindle discharges nerve impulses that increase contraction, thus preventing over stretching.
• Excitatory activity of agonist muscle results in inhibitory activity in antagonist.

Basis Behind

• "RECIPROCAL INHIBITION".

Reciprocal Inhibition (RI)

• The excitatory impulse of the contracting agonist has a 20 second refractory period.
• The inhibitory impulse of antagonist may be less effective than PIR.
• Reducing tone of agonist can be used if contraction of muscle is painful.

Method of Application

• Take joint to point of resistance (point of bind).
• Ask the patient to isometrically contract the muscle to be treated at 20% of the max force.
• Slow contraction for 6-8 seconds.
• Move the joint further into ROM during exhale of deep breath.
• Avoid discomfort and ensure patients breathe.
• Rest 15-30 seconds in the new ROM.
• Hold final position 25-30 seconds.

Keys to Success

• No pain should be caused by MET
• Keep contractions light (20-30% of strength)
• Communicate effectively and ensure the client is not experiencing discomfort at any time.
• The patient helps locate tissue tension or the restriction barrier.
• Never over-stretch the muscle

Spine Key Considerations

• Findings must be interpreted in the context of the patient's clinical condition.
• Must be considered a multi-dimensional model to understand spine pain.
• Morphological changes occur as a result of loading/stress on spinal structures.
• The clinical picture may reflect pathological changes in spine tissue structure and function.

Models and Theories

• Used in Kinesiopathology, Pathokinesiology, and Mixed.
• Models are Interactive-movement impairment.

Kinesiopathology

• Movement impairment precedes pathological change.

Pathokinesiology

• Injury leads to movement impairment.

Mixed Models

• Movement impairment contributes to abnormal loading on tissues and structural changes alters movement.

Physical Stress Theory (PTS)

• Relates to "SAID” principle

Stands For

• Specific Adaptation to Imposed Demand.

Characteristics Responses of Tissues to Stress:

• Includes Atrophy, Maintenance, Hypertrophy. Injury and Death

Atrophy

• Refers to Not enough load.

Maintenance

• Refers to Constant load.

Hypertrophy

• Refers to Too much load.

Injury

• Refers to Overload

Death

• Refers to Way Too Much

Functional Spinal Unit AKA Motion Segment

• Smallest physiological motion unit of the spine exhibiting similar biomechanical characteristics to the entire spine.
• Composed of: two vertebrae, the zygapophyseal joints, the Intervertebral Disc (IVD), and soft tissue structures

FSU Concept

• Illustrates the interdependence of all boney and soft tissue structures.

Clinical Relevance

• The concept of no pathological process existing without affecting the function of other parts of the FSU

Degenerative Disc Disease

• Involves Cartilaginous end plates, collagen and innervation.

Cartilaginous End Plates

• Hyaline cranially and caudally at junction of vertebral bodies (weak junction).

Collagen

• Type II collagen in NP and type I in AF.

Innervation

• By sinuvertebral nerves, ventral rami, and gray rami communicantes.

Water Content

• Water content in IVD decreases with age.

Age Related

• There are age-related changes in molecular composition of the disc.

Environmental Factors

• Is believed to be a secondary consideration (i.e. weightlifters have lower than expected prevalence).

Types of Phases

• Facet Joints, Dysfunction, Instability, and Stabilization are the 3 types of Phases

Facet Joint Characteristics

• Includes Synovitis, Hypermobility, Subluxation, and Enlargement of Articular Phases

Instability Characteristics

• Includes Internal Disruption, Capsular Laxity, and Loss of Disc height.

Stabilization Characteristics

• Included Enlargement of Articular Processes, Joint Hypomobility, and Osteophytes

Dysfunction Phase

• Physologic changes.
• Predominate, structural changes are minimal.
• Facet joint.
• Inflammation=>synovitis.
• Formation of intraarticular.
• Adhesions and synovial folds.
• Disruption of articular cartilage.
• Joint hypermobility.
• Annular fiber tearing: circumferential/radial

Type 1

• Vascular development in vertebral body, no bone damage or red marrow changes (inflammation and pain).

Type 2

• Fatty replacement of red marrow.

Type 3

• Fractures of trabecular bone.

Spinal/Sacroiliac Tests

• Sacroiliac, Distraction, Compression, and Neurological.
• SLR test +/- for referred leg pain.

Disc Herniation w/ NR Involvement

• Requires SLR test + for referred leg pain.
• 3/5 history or physical examination findings:
• dermatomal pain location in concordance w/ a nerve root.
• corresponding sensory deficits.
• diminished reflex.
• motor weakness.

Supplementary physical exam test

• Crossed SLR test may be +.

Sacroiliac Joint (SIJ)

• No centralization of symptoms.
• Dominant pain in SIJ.
• 3/5 physical examination findings:
• distraction.
• compression.
• thigh thrust.
• Gaenslen's test.
• Sagittal thrust.

Types of Spinal Stenosis

• Lateral Canal and Central.
• Spinal Stenosis refers to Lower Back related complications.
• Spinal Stenosis with Radiculopathy refers to Lateral Spinal complications.
• Flexion may decrease symptoms.

Neurological Symptoms

• Dermatomal sensory loss.
• Diminished reflexes.
• Motor loss (depends on severity).
• Variable nerve tension signs.

Special Tests

• SLR/Slump test +.
• Quadrant test +.

Supplementary physical exam findings

• Improved walking tolerance with spine in flexion
• Relief by sitting/ bending forward

Spinal Stenosis (Central) History

• Age more than 48 hours.
• Bilateral symptoms.
• Leg pain is more than back pain.
• Pain during walking/standing.
• Pain relief upon sitting/flexion.

Spondylolisthesis

• Intervertebral slip inspection or palpation.

General Considerations

• No valid tests for facet joint pain.
• Local pain and joint mobility impairment when active or passive.

Triage by levels

• Initial Patient Triage.
• First contact healthcare provider. ==Level
• Rehab Provider --> Level 2

Rehabilitation Management

• Considers Bio-psychosocial of LBP and the physiological condition, and
• Risk assessment/ factors
• Consists for level I classifications

Levels of Rehabilitation/ Tx Classifications.

• Level I- Level III
• Level I --> Medical, Rehabilitation, self
• Level II --> Symptoms, Controls, functionality
• Level III --> Subgroups etc

Level 1 Classifications

Medical Management

• Patients are referred for appropriate medical care due to suspicion of serious pathology.

Rehabilitation Management

• Patients who can be managed by physical therapy.
• Self-care Management-->Pts who do not require primary care or treatment.

Level 2 Classifications

Symptom Modulation

• Severe pain and high levels of disability that is consistent with a high-level of stress-related disorder.

Movement Control

• Pain severity is categorized as low to moderate.
• Moderate disability with stable symptoms.
• Main goals => resolution of symptoms and improvement of function.

Functional Optimization

• Pain is low or absent with low disability.
• Main goals => return to previous level of high function without causing reoccurrence injuries.

Level 3: Treatment-Based Subgroups

• Focuses on Stages, Impairment, and Exercise

Treatment-Based Stages

• Manipulation
• Stabilization
• Traction
• Specific exercise

Treatment focuses.

• Flexibility Impairment
• Endurance Impairment
• Cardiovascular Impairments
• Poor body mechanics

Patient Exam involves level I and level II Triage

• Detailed History is needed.
• Medical screenings are also used (StarT Back Tool)

Special Tests

• FABQ score
• Start Back Tool (Screening Tool)
• ODI score = pain and disability

Start Back Screening Tool

• 9 Validated Item Testing. Focuses on:
• Risk Factors -Categories for low , medium, high outcomes that can be modified
• Back strain and lower pain
• Psychological symptoms

Subgroups of LBP (Lumbar-Back- Pain)

Treatment For Back Pain Conditions

• Manipulations
• Exercise ( stabilization ) and the reduction of the patients pain sensation
• Traction

Spinal Manipulation Approach

Spinal Manipulation techniques directed to lumbar-pelvic region

• Active Lumbar ROM exercises
• Prescribed with spinal manipulations.
• The Criteria would have to be Positive.

Spinal Manipulation Indications

• Not sx below knee
• Hip can do at least 35 degrees
• Recent with hypomobility of the spine (short-term).

Exercise (Stabilization) Approach

• Aims to strengthen spine (global stabilizers)
• Increase contraction and the co-contraction of global spine

Spinal (stabilization) Indications

• flexibility or hyper-mobility the individual requires stabilization program.
• • test with instability ( hyper mobility, ligament laxity etc )

Tractive Exercise Program

• Used for Signs Root Compression
• Focuses on mechanical function with leg involvement.
• Can be applied.

Tractive Exercise Indications

S&S of nerve root compression.

• (If the exam exam does not centralize pain)

Lower Extremity Injuries

• Exercises that include:
  • Extension +End range extensions exercises
  • mobilization to stimulate extension and endurance
  • Flexion
    • mobilization to stimulate flexion to treat flexion problems
  • exercises that will improve ROM and impairment
  • weightlifting during exercises
  • Lateral
  • Exercises that focus for lateral, pelvis and posture

Cervical Spine Problems

• Mobility is important. No root compressions are the goal! The patient should be able to reach the 60-degree mark. Low number is not good.

Special Tests

• Distal reach and shoulder problems. There should be no sharp acute pains with mobilization and manipulation.

Interventions (for spinal and nerve pain)

• Strength, exercises for nerves, upper limb, and scapula

Pain Considerations

• Important factors include Whilplashes due to MOI or trauma with Cervical spine injury. ROM should improve by improving strength

MDT BASIC Training

• System that focuses on pt based intervention not extension but flexibility and power
• The approach focuses on loading stategies
• Manual therapy only to add specific force MDT
• Encourages pt to trust that a treatment will be effective due to the high rates of positive results
• Tx that may be effective

Conditions

• Deragngment can be defined as a state where the area is displaced, has a nerve root etc
• Where normal spine is normally where the motion is felt
• Dysfunction where shortening tissue is due to scars / adhesion nerve
• Posture where the tissue has been in a position for prolonged amount of time

Considerations that MUST be observed!

Red - if your symptoms worsen dont continue

Conditions that MUST Be observed!

• Medial , not responsive --> lack movement/ non -responsive
• Shorting - pain + no stretch = tissue damage

Treatment

Aim is to remodel

Posture

• Is where muscles can be strained --> Postures assumed.
• Tx is postural correction or re- education if any conditions are assumed!

Disc herniations

• Where the spine is being bend forward and loading starts

Lumbar instability

• There are either mechanical or functional instabilities

Copers v Non- Copers

• Functional and muscular weakness are common problems

Clinical Lumbar Instability signs & sx

• Pain where sustined positions are held to long

Physical Examination

• Where there's hyper- mobility and flexion can only be done by qualified doctors.
• Prone lumber for instability test only.

Lumbar Stabilization

• • Tests are there . if positive may have lumber failure
• Must find two items that predictive.
• Prone

There is always some type of sub system for issues in spinal.

• Either ligament, joint capsule or neural control system. (Spinal Stability )

To address these injuries the Body has to be in a particular location.

• Either "Local " where can control the muscles, or through muscles.
• Loss in balance due loss of muscle etc.

Muscles used - the Global Local Stablizers

• Multifidis and TA , abodminal obliques
• the trunk MUST be controlled.

Posture with Mvmt

• Must note patient's position or their movements.

Gludius area

Where the medial area has to be worked to reduce a person's pain, or Maximum MVIC.

How to manage LBP (Lower Back Pain)

• Examines the body adaptations with the muscular contraction.
• Inhibiation has been found, with stiffness in spine

Contra indications for LSE are

• Serious pathology
• Neurological deficits
• Severe acute pain
• Cardiovascular distress
• C-Spine is important for -Muscular flexion
• For a Test.
• Craniocervical Flexion Test = test motor control of lower limbs
• "Normal " range --> 26 - 30 MMHG

Side not

• Understand that these note are condensed and maybe missing key details.
• These notes act as aides to learning and understanding the main concepts.
• But further research and/or more detailed descriptions must be consulted for further explanations.
• Do NOT substitute by only using this document alone..
• Use caution and consider this when understanding the various concepts!
• Take from this what you will.
• Good Luck and have a great day!!