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Introduction

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In theory, treating impairments and activity limitations (functional limitations) related to the tissues of the spinal column and trunk is the same as treating tissue injuries of the extremities. The major complicating factor in the spine is the close proximity of key structures to the spinal cord and nerve roots. The challenge for the therapist is to recognize the complex functional relationships of the facet joints, the intervertebral joints, the muscles, the fascia, and the nervous system and know how to examine and evaluate the individual who presents with pain and functional limitations. Activity, rather than prolonged bed rest, is accepted as important in the management of patients with spinal and postural pain2,111,161 but defining what are beneficial and safe activities during the process of healing and rehabilitation is the task of the therapist.

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The medical model of diagnosis does not lend itself to direct therapeutic exercise intervention strategies, particularly because patients' complaints of back or neck pain often do not relate to specific pathologies. Efforts are being made to determine the most effective way to categorize patients with symptoms affecting spine and trunk function in order to be more accurate with outcome research.23,33,48,101,102,138,145 In addition, results from research studies have begun to provide the criteria for predicting outcomes in subgroups of patients with back and neck pain, so therapists can better identify the interventions that are more likely to result in positive outcomes.6,9,24,27,66,93,136,154,164 The approach described in this text supports the importance of treatment based on presenting structural and functional impairments while respecting the pathomechanics, pathophysiology, and precautions of specific medical diagnoses.

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The content of this chapter has three major emphases. The first section reviews the pathology and pathomechanics of spinal structures. The focus of the second section is on principles and guidelines for managing patients with impaired function in the spine. This section includes principles of interventions for the broad categories of acute, subacute, and chronic spinal conditions and also expands on specific interventions for impairment-based diagnostic categories. Techniques geared toward treating unique impairments are described in these sections.

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The third major section contains medical diagnoses unique to the thoraco-lumbopelvic and upper thoraco-craniocervical regions. Because the function of the temporomandibular joint (TMJ) is closely related to the cervical spine, management guidelines for impairments related to the TMJ are also described. Musculoskeletal headaches can often be triggered by poor posture and cervical muscle imbalances. Thus, this chapter will conclude with a description of physical therapy interventions for patients experiencing headaches.

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General therapeutic exercise techniques of intervention for all spinal and postural impairments are described in Chapter 16. Chapters 14, 15, and 16 are written with the assumption that the reader has ...

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