Cervical Spine Continuing Education

Learn from the Expert - Carol McFarland, PT, PhD, OCS

Carol McFarland, PT, PhD, OCS, is a 1975 graduate of Boston University with a BS in physical therapy. She completed her MS in kinesiology at University of Texas at Tyler in 1986 and then received her Orthopaedic Clinical Specialist certification from the American Board of Physical Therapy Specialties in 1990, which was renewed in 1998. She practices in an outpatient spine center in Texas and has worked closely with the neurosurgeons in this practice since 1992. She collaborated with therapists throughout east Texas to develop rehabilitation protocols specifically for follow-up to many of the surgical and injection spine procedures. She presented these protocols through the Texas Physical Therapy Association and American Back Society several times, and published a book on the postsurgical protocols for the lumbar spine.

Course Objectives

• Understand and be able to perform the exercises used for spine stabilization in the post surgical spine patient
• Create a balance routine for retraining proprioception and muscle control in the lower extremities
• Integrate exercise bands into appropriate exercises routines in order to intensify the affect on targeted muscle groups.
• Perform interim testing to assess rate and path of program progression, as well as provide quantitative information for the physician and insurance provider.
• Develop a post surgical Cervical spine stabilization exercise program
• Build a comprehensive exercise program that both stabilizes and strengthen key muscle groups in the post surgical spine patient
• Explain the use of spinal surgical procedures such as lumbar microdiscectomy, kyphoplasty and vertebroplasty, artificial disk replacement and anterior cervical fusion.

The Surgeon’s Perspective

• Introduction to the interview with Dr. Charles Gordon, Board certified neurological surgein
• After a lumbar microdiscectomy, do you feel the annular wall is vulnerable, and if so for how long?
• How do you determine if a patient needs a microdiscectomy vs a laminectomy?
• Are there other procedures for spinal stenosis that are less invasive than lumbar laminectomy?
• When are lumbar fusions indicated in place of non fusion procedures?
• How do you decide on the approach of a fusion, anterior vs posterior, and how do you decide on the need to do interbody fusion vs a posteriorlateral fusion?
• What is your opinion about bone augmentation, bone stimulators or bone growth substances, and do you feel they are important?
• Regarding total disc replacements: who are the candidates for these procedures?
• Do you feel that the anterior approach to the total disc replacement is an advantage or not?
• Are there particular precautions we should observe with therapy following a total disc replacement?
• With a total disc replacement (lumbar or cervical), is it possible to remove the prosthesis is there is a problem?
• Anterior cervical discectomy and fusion: description of the surgery
• Anterior cervical fusion: reason for use of anterior plate fixation
• Kyphoplasty and vertebroplasty: surgeon's opinion on benefits of these procedures vs conservative care for compression fractures
• Stem cell research for spine procedures
• DNA analysis of patients regarding genetic spine disorders

Treatment of the Post Surgical Spine - Spine Stabilization Exercises

• Introduction to Burke, Phelps and Sizer functional spine stabilization program and some example exercises
• Basic segmental stabilization: alternate arm reach from Burke, Phelps and Sizer
• Squat with arms ups from Burke, Phelps and Sizer
• Standing hip abduction for balance and postural strengthening
• Standing hip extension for balance and postural strengthening
• Heel raises for balance and endurance, combined with postural cuing
• Static lunges demand rotary stabilization and balance
• Lunges with forward step as a progression for strength, balance and rotary stabilization
• Wide base squat with alternate heel raise to target soleus as well as spine and hip stabilizers
• Balance routine: 4 different movements with single leg support challenge balance, endurance and posture
• Standing traditional vestibular exercises that are helpful for spine stabilization, postural strength, and balance
• Using exercise loop to increase intensity of stabilization exercise: hip abduction example
• Using theraband loop to increase intensity of stabilization exercise: targetting hip extensors, then hamstrings

Treatment of the Post Surgical Spine Patient - Testing for Spinal Stabilization

• Interim Testing System for Spinal Stabilization: Hip extensor endurance with bridging
• Interim Testing System for Spinal Stabilization: Abdominal testing maintaining neutral spine
• Interim Testing System for Spinal Stabilization: Abdominal testing using curl ups with Saal protocol
• Interim Testing System for Spinal Stabilization: Quadruped testing for back extensor endurance, as well as confirming segmental stabilization capability

Treatment of the Post Surgical Spine Patient - Spine Stabilization and Mobilization

• Cervical spine stabilization exercises: segmental and global stabilization exercises
• Work for recruitment of posterior shoulder girdle for postural strengthening: scapular adduction using unilateral then bilateral shoulder horizontal abduction or extension
• Work for recruitment of posterior shoulder girdle for postural strengthening: lat pulldown
• Opposing tricep extensions combined with crown up posture for spine stabilization
• Bridging exercise using the gymastic ball
• Side plank exercises using gymnastic ball
• Example prone exercises for spine stabilization using gymnastic ball
• Thoracic extension and scapular muscle control work in chair: 1) scapular depression with upper shoulder girdle stretch; 2) thoracic extension self mob; 3) scapular depression/ adduction using chair back resistance
• Seated hamstring stretch with attention spine posture
• Seated hip rotator stretching
• Seated trunk flexion stretch to help patients reduce lumbar spinal stenosis symptoms
• Standing hip flexor stretch

The Post Surgical Spine Case Studies

• Therapist findings after lumbar microdiscectomy
• Therapist findings after lumbar laminectomy for spinal stenosis
• Working with patients in the hospital after lumbar spine fusion, part 1
• Working with patients in the hospital after lumbar spine fusion, part 2
• Working with patients in the hospital after lumbar spine fusion, part 3
• Artificial disc replacement (ADR), also known as total disc replacement
• Artificial disc replacement (ADR), also known as total disc replacement, part 2
• Description of our recent clinical trial of early PT intervention for anterior cervical fusion
• Kyphoplasty and vertebroplasty need for follow up
• Testing to justify therapy need, after kyphoplasty and vertebroplasty. Suggested program components

Course Test - Evaluate your knowledge

• Use the Healthclick proprietary online education system which provides the online student with:
• Worldwide access to high definition video, anatomical animations and images, and written information
• The highest quality film in the industry, you can see the difference!
• Stop and resume within a course, the Healthclick system will optimize your course based on your device, connection and remembers where you left off.
• Real-time course updates. We are always adding to each courses, updating content, adding animations, these are not static courses!
• Evaluate your knowledge with the course test on any device.
• Print your state course certificate for CE credit.
• Take the online test as many times as need in order to achieve a 70 % or greater score.