Spinal compression fracture

[SA Physio]

Hi there, new member, and congrats on a very nice website

I have been referred a patient in their mid 30's, 7 weeks post T12 compression fracture and I have been asked to mobilize the spine. I have yet to see the patient so I don't have too may details.
As this is the first time I see a patient with this condition any advice would be great.
I thought my treatment would consist of:
1.Neurological evaluation in case there is nerve damage or compression.
2.Active physiological movements of spinal column to determine ranges.
3.Evaluation of spinal mobility with Post-Ant mobilization.
4.Teaching the patient cat stretches and Mackenzie stretches.
5.Possibly doing some core strengthening.
6.Strengthening of the back extensor muscles.

Any advice or precautions regarding treatment of this patient would be greatly appreciated. I have read up on the causes and mechanism of this type of injury, but I am finding it hard to get physio specific info on this.
Regards
Ray

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[physiobob]

Hi Ray, sounds like your on the right track. I suppose you need to look at the mechanism of the injury to see which movements are likely to be more affected. It might have been an impact e.g. landing off a ladder, a whiplash type fracture, a landing on the head issue etc. You initial thoughts are sound. I would say gently...gently... in the beginning to restore flexion/ext and rotation. Back extensions over a large ball for example to support the extension position might be nicer for the patient that McKenzie Extension in lying to begin with.

Note also that this is a joint that is problematic anyway because you have a relatively rigid ribcage area moving on the lumbar spine. So one should look very much to the mobilisation of the thoracic spine above the issue to lessen the pressure on that pivot point. Also remember they would have been holding a rigid posture for 7 weeks+ and that side bending is a coupled movement of extension/rotation or flexion/rotation. This means simple rotation exercises, e.g. on the floor or in sitting will assist to reintegrate a more normal movement pattern.

Let us know how you get on and the mechanism of injury once you see the client

[SA Physio]

Thanks for the help physiobob, I appreciate it. I found a document that mentions limiting flexion initially, which makes sense depending on the severity of the fracture.
I'll keep you posted.

[zisuer]

hehe, I just treating a traumatic compression fracture patient. He is young and jus took off the binder. He almost loss all range of motion in lumbar area. complain low back pain. The treatment I gave him are pelvic tilt, core mucsle training. Active ROM within pain free range. Extension is his most painful position. I am thinking I may let him do some gentle stretching like what you said cat stretch or others. I also think about increase his cardiac endurance after 2 months less active life, they may need this, but I got to improve his stability first or use the binder when he exe. I would like to hear any comments.

[zisuer]

Thanks for all comments, guys.

I did a lot of research on compression #, did not find any good paper about rehab program. I worry about flexion. I was taught it should be avoid. ext should be prefered, how much flexion we can go?

Hehe, after 8 weeks immobilization in ext, my client cannot tolerate back extension. When I checked his facet jts, they are irritable. I only let him do ROM within pain free range, pelvic tilt, and core stabilization. He felt much better after 1st Rx. I want to do PIVM on him, he can't tolerate it. He can not tolerate all four position. So I believe, we have to go gradually on everything. Hehe. My teacher told me the rehab need 4-6 months. So my second Rx, I just reinforce the core training and a bit limb movement. Encourage increase walking ( increase cardiac conditioning). My client likes swimming. I am thinking let him do resistance exe in water. still thinking.

I really need a systemic review on rehab for compression #. No idea what I should do on patient next.

[Quickstart]

These fractures are difficult little devils to deal with, but I've found that it is most beneficial to follow the following regimen:

- Stage I: In the initial stages the patient is going to have lots of pain, and concommitant muscle spasm. This is the area you really want to work on first. I usually work on decreasing muscle tone in the upper thoracic and lower lumbar regions (leaving the thoraco-lumbar junction alone) until about 6weeks post injury. I also strongly recommend getting your patient a thoraco-lumbar back brace to help support the spine and core muscles. Start very gentle isometric core exercises (TA/Mult) and add some gentle weight-bearing exercise. Hydro pool gentle walking to begin with, then overground.

- Stage II: At about week 6-10 more emphasis on core strengthening, gentle mobilisations of the joints around the compression fracture (but avoiding levels immediately above or below) and soft tissue work on the affected levels. Try weaning off the brace for lighter tasks.

- Stage III: 10-20 weeks. Repeat X-ray, document healing rates. If union has occurred then mobilisation of the affected area can begin, and pilates in a neutral/flexion bias position can begin. Slowly progress to gentle extension bias. Wean off brace.