Sprouting Up Therapy

06/01/2026

June is National Awareness Month for:

National Safety Month
Scoliosis Awareness Month
National Cancer Survivors Day (June 6)
Family Health and Fitness Day (June 12)
National PTSD Awareness Month
National Men's Month
National Great Outdoors Month
National Candy Month

05/31/2026

Whiplash

Mechanism
Force translation from acceleration/deceleration, hyperflexion followed by extensor recoil

Signs and Symptoms
Neck pain, stiffness, radicular symptoms, headaches, cognitive impairments

Conservative Intervention
NSAIDS, trigger point treatments, antidepressants, anticonvulsants, radiofrequency neurotomy, pt education, opioids

Surgical Intervention
None unless disc herniation or fracture

05/30/2026

Spondylosis w/ myelopathy

Mechanisms of Injury
Generative OA, ossification of posterior spinal ligament, hypertrophy of ligamentum flavum, repetitive movements, age >50 year old

Signs and Symptoms
Neck pain/stiffness, uni/bi lateral arm, body pain, upper limb weakness, lower limb stiffness, paresthesia, incontinence, imbalance, falls, hyper reflexive, Lhemitte’s sign

Conservative Treatment (mild cases)
Cervical manipulation contraindicated, thoracic mobilization/manipulation, cervical traction, C/S strengthening, coordination, DNF training, postural strength & stabilization

Surgical Intervention (moderate to severe cases)
Anterior cervical discectomy w/fusion (ACDF)
Anterior cervical corpectomy w/fusion
Laminectomy (posterior approach)
Laminoplasty (posterior approach)

Post-Surgery
Soft/hard collar 4-6 weeks, PT started at 4 weeks

05/29/2026

Discogenic pain w and w/o radiculopathy

Mechanisms of Injury
Degenerative changes, Most common C6-C7 and C5-C6, females>male, trauma: MVA, sports

Chemical/mechanic compression-disc herniation

Mechanical-bony osteophyte

Non-degenerative causes-infection, herpes zoster, tumor, acute demyelination Guillain-Barre

Signs and Symptoms
Localized, diffuse or radiating pain, worse with flexion, forward head posture

Conservative Intervention
NSAIDs, oral steroids, opioids (not recommended), epidural steroids at involved level,
Cervical traction (mechanical + manual), thoracic manipulation/mobilization, upper quarter + nerve mobilization techniques, cervical + scapular strengthen/endurance exercises, DNF training

Surgical Intervention
Indication-failed non-surgical rx, acute deterioration of neurological function
surgery NOT indicated/recommended when pain localized to neck

Anterior cervical discectomy w/out fusion (ACD)
Anterior cervical discectomy w/fusion (ACDF)
Posterior-laminectomy, partial discectomy, or foraminotomy
Cervical Disc Replacement (CDR)

Risks of Surgery
Dysphagia-secondary to esophageal retraction & intubation transient
Vocal cord paralysis-hoarseness
Incidental dural tears w/CSF leak
C5 palsy

05/28/2026

Cervical Osteoarthritis
Associated with Degenerative Disc Disease, failure of synovial, most common at C3-C5, >65 yo, males>females, higher BMI, heavy lifting

Signs and Symptoms
C1-C3: occipital, headaches
C4-C7: posterior scapular region, shoulder girdle
Deep aching pain, limited ROM, ipsilateral side, stiffness, no neuro symptoms

Conservative Treatment
Pharmacologic: NSAIDs, corticosteroids
Injections-(diagnostic or intervention): lidocaine, triamcinoclone
Medial branch block: image guided meds injected to medial branch nerves that supply facet
Radiofrequency neurotomy: ablation procedure that denatures medial branch = temp pain relief that can last 1-2 yrs (until regeneration)
PT: thoracic manipulation/mobilization, cervical manipulation/mobilization, scapulothoracic & shoulder strengthening & endurance, stretching, dry needling of associated muscle trigger points MTrPs, general fitness training (aerobic for analgesic effects)

Prognosis: 3 months non-surgical care, only 21% pts with facet OA or other spondylotic neck sx w/out radiculopathy may have complete sx relief

High recurrence rate

05/27/2026

Lumbar Radiculopathy
-Mechanical or chemical compression of a nerve root
-90% are compression of lumbar disc on a nerve
-posterolateral and affecting nerve below level
-risk factors: age (45-65), smoking, stress, lifting, vibratory

Signs and Symptoms
-unilateral leg pain
🔹 L3 — Pain in the front of the thigh
🔹 L4 — Inner shin and ankle discomfort
🔹 L5 — Outer thigh, shin, and top of foot
🔹 S1 — Pain down the back of the leg to the pinky toe
-slump test, SLR
-neuro exam-hypo reflexive

Conservative Intervention
-conservative management tried for 6-8 weeks
-NSAIDs, injections (little evidence for steroids)
-EDUCATION is most important
-non-thrust, manual therapy, mobilization (NOT MANIPULATIONS)
-centralizations
-dynamic trunk stabilization
-neuro dynamics

Surgical Intervention
-microdiscectomy (gold standard)
-highest success rate in young athletic population, L5-S1 level
-patients with sequestered disc, symptoms over 6 months and high pain levels benefit most

-fusion

Post-surgical Rehab
-no BendingLiftingTwisting for 6 weeks, limit sitting 20-30 minutes
-early PT focuses on hamstring and hip mobility, neural dynamics, trunk stabilization

05/26/2026

Lumbar Spondylolisthesis

-anterior shearing of vertebrae following a pars interarticularis fracture
-degenerative or with poly fracture
-risk factors: people over 50, RA, scoliosis, spina bifida occulta
-grade 1-5

Signs and Symptoms
-intermittent and localized low back pain
-hamstring contracture
-pain with standing/walking/flexion/ supine lying
-neuro symptoms if nerve is compressed

-progression is more common in those under 20 b/c growth plates are not ossified
-degeneration can result in instability, OA, stenosis, nerve compression, neurogenic claudication

Conservative Intervention
-grade 1 and 2
-lumbar epidural injections have a 48% success rate at 2 years
-PT is first line of defense! Work on strengthening muscle imbalance, trunk stabilization, hip flexor and hamstring length, education, postural adjustments
-PT can help a lot but can not alter structural damage

Surgical Intervention
-grade 3-5 surgery is controversial
-indicated if pending neuro signs or ADL limitations

-Direct repair of the pars (favored method)

-Posterolateral fusion if multilevel, increases stability but lose motion-- really good outcomes for spondy

-interbody fusion-- mostly used with curvatures (spondy), cage used to fix disc height and “spinal fusion into body”, more complicated procedure, risks nerve root

05/25/2026

05/22/2026

Lumbar spondylolysis
-fracture of pars interarticularis
-can be unilateral or bilateral
-most common at L5
-most common in young and athletic pop w/ low bone density

Mechanism of Injury
-repetitive loading with extension/rotation or trauma
-older adults with facet OA/ DDD

Signs and Symptoms
-pain can be dull- more sharp with movement
-lateral if injury is unilateral
-no tenderness to palpation
-pain with one-legged hyperextension
-pain-free flexion, erector spinae spasm and hamstring contracture

Conservative (Non-Surgical) Management
Most patients — especially adolescents and adults without neurologic deficits — improve without surgery.

Common Conservative Approaches
Activity Modification
Reduce activities that increase lumbar extension/rotation
Temporary avoidance of sports, heavy lifting, or repetitive bending
Medications
NSAIDs such as Ibuprofen or Naproxen
Sometimes muscle relaxants for spasm
Injections

Physical Therapy focuses on:
Core stabilization
Hip flexibility
Hamstring stretching
Lumbar stabilization mechanics
Bracing

Surgical Management
Surgery is usually considered when:
-Pain persists after 6–12 months of structured conservative care
-There is progressive neurologic compromise
-Significant instability or high-grade spondylolisthesis develops
-Daily function is severely impaired

Main Surgical Options
Direct Pars Repair-The surgeon repairs the pars defect while preserving spinal motion.

Fusion Procedures
Instrumented lumbar fusion (often L5–S1)- Most common when there is instability, disc degeneration exists, or vertebral slippage is significant

Decompression-performed if nerve compression severe.
Sometimes combined with fusion.

05/21/2026

Lumbar Stenosis

-lateral (unilateral) and central (bilateral)
-degeneration of Intervertebral Disc→ instability of facet joints → reducal spinal dimensions→ neurogenic claudication
-women more than men-- especially older

Signs and Symptoms
-most common symptom centrally is neurogenic claudication in buttocks and post thigh
-heavy, fatigued LE
-intermittent, dull and localized back pain
-aggravated in standing/ extension and relieved in flexion (shopping cart sign)
-neuro exam and SLR is usually normal
-severe cases have neurogenic bladder

Conservative Intervention
-NSAIDS, muscle relaxants, opioids, epidural injections
-EDUCATION IS BIG
-thrust/non-thrust
-dynamic lumbar stabilization
-more suitable for natural histories than mechanical corrections
-CAN improve mobility and control of lumbar spine

Surgical Intervention
-for severe pain and functional decline
-decompressive laminectomy: most common for stenosis, lamina removed w/ or without fusion, not great outcomes→ maybe better late than never situation