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  • Rob

2016 Level 2 Upper Weekend 2

This weekend was my second weekend but the third weekend of this course. The Level 2 Upper and Lower courses are 12 days in length. The courses are broken up into either 3 - 4 day weekends, the instructor in Calgary likes to do this, or 4 - 3 day weekends. So this weekend was the 3 of 4 weekends, in Vancouver, at UBC Friedman building.

The physiotherapists were going to learn about the CV region as well as the thoracic spine and ribs.

I was assisting on the course with Curtis W. (another assistant) and the main instructor on the course, this weekend, was Christine B. Both physiotherapists work in Vancouver at the legendary Treloar Physiotherapy.

The CV region of the body is upper cervical spine, or neck. Basically it is where the head fits on to the top of the neck and the vertebrae below. The head, also known as the occiput, or C0, sits on the first vertebrae of the neck. This first vertebrae has a couple of different names, C1 (the first cervical vertebrae) is also called the atlas. The atlas is named after the character in Roman mythology, Atlas, that carried the world on his shoulders. Click here to read about Atlas. Below the atlas is C2 or the axis. Both vertebrae, C1 and C2, are very different shaped that the rest of the vertebrae in the cervical spine (neck). One difference is that there is no disc between the occiput and the atlas or between the atlas and the axis. The first disc in the spinal column is between the C2-3 vertebrae. Oddly enough that is usually how the discs are named, i.e. the C3-4 disc.

Here is a little bit of interesting facts on the C0 - 2 region. Each joint moves in one very specific direction. C0-1 moves really well in one direction and C1-2 move really well in another direction. More specifically C0-1 joint moves really well front to back. It basically creates the motion of the ‘yes’ nod, chin poking out in front and the chin tuck to the Adam’s apple, if you are a guy. Whereas the C1-2 moves really smoothly in another direction, rotation. The C1-2 joint moves in about 40-45° to each side! That is about half the rotation of the entire neck in just one joint! If you ever hurt your neck and have an issue turning your head to one side or another, there is a good possibility that this joint could be one of the culprits of the decreased range of motion.

Back to the course, the physiotherapists were taught how to assess the motion in these joints, individually. A couple of weeks before the course, Christine asked me if I would like to teach a part of the course. We decided that I would teach the lecture on CV region pathology. It was basically a talk on headaches, different types of headaches, cervicogenic, migraines, tension-type, cluster headaches to name a few. It went REALLY well. I was super happy with the response of the class and the questions they had after the lecture. They were engaged during the lecture! I am going to change my lecture on headaches into a blog post, so stay tuned for that shortly. Not meeting Curtis or Christine before, so I was a little bit too shy to ask them to take a picture of me doing a lecture. It would have been cool to have a pic. Maybe next time.

Closing out the first night we met in three different groups, each instructor/assistant leading each group through a formal case study. Personally, I really like this addition to the courses. As a physiotherapists progresses through the Canadian Physiotherapy Association Orthopaedic Division post graduate education system, another blog post coming soon, they have to do exams. When I was going through the curriculum, part of the exam process was doing a Case Study. The Case Study was either pass or fail. I know numerous physiotherapists that failed the Case Study and some failed more than once. The issue was that if you failed you did not receive any feedback to know what you did right or wrong. Some people would fail more than once because they did not know where their thinking pattern was off. We did some case studies during the courses but they were exams as well, with no feedback. I really enjoy working with the students through the case study and helping them with their clinical reasoning development.

Saturday was another day packed with lots of learning. We worked our way through treating the CV region, again I got to teach a little snippet. How to assess the CV region in the sitting position. Most of the time, the client is lying on their back on the physio bed/ plinth. Sometimes people cannot lay down, for various reasons, so they need to be assessed in sitting. Then we moved on to the thoracic spine, aka T-spine. This area of the spine starts at the base of the neck and goes down until the ribs stop, that is where the lumbar spine starts. The thoracic spine is where the ribs are in the body. There are 12 thoracic vertebrae and 12 ribs. Again, we talked about how the thoracic spine moves and how the movement is restricted due to the ribs. In addition, as we age the spine gets stiffer and how that changes the movement. It can get pretty complex but Christine really brought it down to earth and made it very simple. I was really impressed by how she did that. There was a lot of information thrown at the physiotherapists that day. I am sure that most left the class with ‘full brains’.

Sunday morning started off with assessment of the T-spine and ribs. Curtis was lucky enough to teach stability testing of the thoracic spine and ribs. Stability testing is done if we feel that some part of the body moves too much.

For example, after a car accident, in a vehicle with low seat backs, the person’s back may bend in a funny way. That sudden stretch may lengthen/tear the ligaments in a certain direction. That may make the ligaments ‘longer’ in that direction and less able to stop unwanted movement of the spine. It is possible that this occurs in people that always want that one spot in their back ‘cracked’. The vertebrae moves too much, sometimes too much might be 1-2 mm!, gets stuck. That is the sensation of wanting to get ‘cracked’. The manipulation/ adjustment works really well to get the vertebrae moving again. Only to get caught again, if the person undergoes the specific movement again. To be clear, this does NOT happen in everyone. Every once in awhile, some of our joints get stuck. People with a hypermobility, this happens much more often.

We finished before lunch with treatment of the T-spine. After lunch we did more case studies, 4-5, as a large group. Then there was one large case study that tried to bring everything together from the course. It took the physiotherapists 90+ minutes to complete, working together. It was really well done by Christine.

I hope to make it back to Vancouver later this year, for a few more times and do some more teaching/assisting with the Level courses. I really enjoy helping the younger physiotherapists to learn and improve their skills.

If you would like an assessment of you neck or mid back, please contact New Leaf Physiotherapy, a mobile Kelowna physio clinic, and we be excited to work with you.

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