Osteoporosis is the most common metabolic bone disease in the United States. It is clinically silent until there is a fracture of the bone. It is due to the insufficient bone formation or excessive bone absorption or a combination of the two. It is a progressive loss of trabeculae and decreases the ability of the bone to withstand loading. There are two classifications.
Type 1 or postmenopausal
Type 2 or senile which is associated with the elderly
hematologic and neoplastic disorders
Bone mineral density (BMD) is measured with a central DXA test
T-score within 1 SD (+1 or -1) of young adult mean is normal
T – score of -1 to -2.5 osteopenia
T-score of -2.5 SD or more below the young adult indicates osteoporosis
T-score of -2.5 SD or more below with fragility fractures indicates severe osteoporosis
Z scores adjust for age, sex, ethnicity or race
Z-scores of -2.0 or lower are below the expected range for age
Z-scores above -2.0 are within the expected range for age.
• Risk factors that are associated with osteoporosis are genetics, female, family weight of less than 85% of the norm or 127 lbs. Other factors include early or surgical menopause , pregnancy at a young age, sedentary lifestyle, alcoholism, poor nutrient absorption (celiac), low body fat, low calcium intake, low vitamin D levels, prolonged bed rest and anorexia.
• Vitamin D
• Medication such as corticosteroids, thyroid hormone medication and diuretics can increase bone loss.
• Exercise early in life, resistance and high impact exercises and aerobic activity is beneficial in reducing bone loss.
HEADACHE: CLASSIFICATIONS FROM THE INTERNATIONAL CLASSIFICATION OF HEADACHE DISORDERS
• Tension-type headache
• Trigeminal autonomic cephalgias
• Other primary headache disorders
• Cluster headache
• Headache attributed to trauma or injury to the head and or neck
• Headache attributed to cranial or cervical vascular disorder
• Headache attributed to non- vascular intracranial disorder
• Headache attributed to a substance or its withdrawal
• Headache attributed to infection
• Headache attributed to disorder of homeostasis
• Headache attributed to disorders of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure
• Headache attributed to psychiatric disorder
CRANIAL NEUROPATHIES OR OTHER FACIAL PAIN AND OTHER HEADACHES
For more on headaches, refer to my kindle “Differential Diagnosis of the Spine” on Amazon.com. Soon to be available in soft cover format.
Differential Diagnosis of the Spine Book
CLINICAL PREDICTION RULE FOR LUMBAR SPINAL STENOSIS
One clinical prediction rule for lumbar spinal stenosis has the following predictor variables.
• bilateral symptoms
• leg pain is greater than back pain
• pain is present during walking and standing
• pain is resolved with sitting
• age is greater than 48
Variables Sensitivity Specificity +LR -LR Post test
1 .96 .20 1.2 .19 44%
2 .68 .62 1.80 .51 55%
3 .29 .88 2.50 .80 63%
4 .06 .98 4.60 .95 76%
5 .01 1.0 ∞ .99 99%
1. What are the Clinical Prediction rule variables for Cervical Myelopathy.
Cluster test for cervical myelopathy
1. gait deviation/ataxia or unsteadiness
2. (+) Hoffman’s sign
3. (+) Inverted supinator sign
4. (+) Babinski
5. over the age of 45
If three of five or four of five of these signs are present, the probability of the diagnosis is 94-99%.
Clinical prediction rules (CPR) are a mathematical, statistical guideline which incorporates multiple predictors such as; medical signs, symptoms, and other findings, into a combination that will assist in predicting a diagnosis or treatment outcome. It is an evidence-based tool which can help diagnose certain conditions as well as help to select the most appropriate method of treatment for that diagnosis. It assists the Therapist in making the wisest decision on the appropriate treatment.
There are three types of CPR; Prognostic, diagnostic and prescriptive or interventional. Studies related to predictive factors dealing with the diagnosis are considered diagnostic CPR. Prognostic CPR deals with predicting outcomes of a specific treatment or procedure. CPR’s that deal with finding the most effective interventions or procedures is called prescriptive or interventional. In the field of rehabilitation, CPR’s are mainly prescriptive.
Why am I doing this? I am ready to retire after 37 years of practice so why am I spending hours developing seminars, writing websites and marketing. Because I hear too many of my patients say,”I have never had Therapy like this before, why don’t other Therapists do this?” In my last few years of practice, my goal is to spread the word and teach. I feel I have something to offer after 37 years and a Fellowship (FCAMPT). I have great hands and feel I can teach others this gift. It is a gift to be able to palpate individual spinal joints and determine if it feels “right” or not.
I love to teach. It is a passion of mine and I feel small classes are most effective for learning and being able to teach the finer points of manual therapy. That is what it is “Manual Therapy”. It is the gift of touch that must be learnt with continued practice but must be taught correctly.
Class sizes are under 20 students and in my Palm Harbor office, 12 is maximum.
Come learn with us.
Debra Dent BPT, Dip Manip PT, OCS, FCAMPT
Simplicity of a home exercise plan (HEP) will ensure compliance. In my experience, most patients will falter with their HEP after a short time. The trunk stability program that I have developed for Spine Health and Trunk Stability has been the most accepted and patient compliant program that I have seen in many years.
Education is the first component and of utmost importance to ensure compliance. Once the patient understands how this system works, they will follow it. In my experience with this program, once the patient notes an overall feeling of comfort and well being from doing the very simple exercises, they continue. I have heard many times, “I am not sure what is doing it but I feel I can breathe better, I am not so short of breath, my neck feels better and so does my back.”. It is a very simple but patient compliant program.
In numerous classes for this seminar, I find countless Therapists with their own issues with breathing, diaphragm dysfunction and core weakness. I had a PT who stated that she could plank all day and her core wasn’t weak. On evaluation, she was unable to do the simple stage one of the program. Her eyes were opened and she was going to add these simple steps to her own personal program.
What is a Fellowship in Manual Therapy? It is an educational program that meets the standards of the I International Federation of Orthopaedic Manipulative Physiotherapists (IFOMPT). There are two IFOMPT accredited programs in Canada: The Canadian Physiotherapy Association’s Orthopaedic Division’s courses as well as the University of Western Ontario’s Masters of Clinical Science Degree in Manipulative Physiotherapy. Both programs have their own syllabus and supervise their own examinations. CAMPT is a separate organization that monitors both programs. Those who have successfully completed either programs respective courses and passed all required exams could than become Fellows of CAMPT.
The American Academy of Orthopedic Manual Physical Therapy also has a Fellowship designation:. FAAOMPT.
A Physical Therapist who attains Fellowship status has studied for years to receive this honor. There are two Fellowship trained Physical Therapists at Cross Border Seminars. Come learn from the best!