Need Explanation on this Ortho Concept

[jimmydicks101]

Can someone please explain to me why choice #2 is the right answer? I've never quite understood the whole gapping and closing thing... Thanks so much!

"A 21 year old female patient presents with neck pain and stiffness that has gradually worsened over the last two weeks. Upon examination, the patient is noted to have left-sided pain with left side bending with left rotation and reports pain at the left C5-6 junction. Hypomobility is also noted with right side-gliding of C6. Which of the following techniques will be most appropriate to decrease pain?"

1. Closing technique for the mid-thoracic spine.
2. Closing manipulation in extension for C5-C6
3. Gapping manipulation in flexion for C5-C6.
4. Flexion/opening manipulation for mid-thoracic spine

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[PT2Bee]

when you left side bend or L rotate, the L facet space is being "closed", while the R facet "gaps". If there is pain w L SB and rotation, the facet is having an issue with closing down for a variety of possible reasons. Therefore closing manipulation should assist with that and make the movement more fluid again. Kind of like when pts have pain going into lumbar extension, PAs may make them feel better as it is helping mobilize the joint into the deficient direction. It's late at night, so if that was a jumbled mess, my bad lol 😴

 

[starrsgirl]

This patient has trouble "closing" her facet joints on the left side. In other words, when she bends her head to the left, the superior and inferior facet joints of the cervical vertebrae on the LEFT side must slide past each other to decrease the space. This sliding past each other mechanism is also called "closing". I like to think that the joint space is less when it is closed.

Conversely, when the patient is bending left, her right side facet joints are opening (i.e. getting more space in them) as they stretch apart to accommodate the movement. This is called gapping.

Bottom line is you treat the impairment. The pt has trouble closing on the left (i.e. bending toward the left and decreasing joint space) so push her in this direction for therapy. Adding "extension" to the movement just accentuates the closing even more.

 

[jimmydicks101]

This patient has trouble "closing" her facet joints on the left side. In other words, when she bends her head to the left, the superior and inferior facet joints of the cervical vertebrae on the LEFT side must slide past each other to decrease the space. This sliding past each other mechanism is also called "closing". I like to think that the joint space is less when it is closed.

Conversely, when the patient is bending left, her right side facet joints are opening (i.e. getting more space in them) as they stretch apart to accommodate the movement. This is called gapping.

Bottom line is you treat the impairment. The pt has trouble closing on the left (i.e. bending toward the left and decreasing joint space) so push her in this direction for therapy. Adding "extension" to the movement just accentuates the closing even more.

Okay got it. So here's a couple follow-up question if you don't mind answering.

1) Does rotation alone cause "closing" and "gapping" on the opposite side?

2) Will coupling motions affect the "closing" and "gapping" rule? Would this answer change if the pain was noted with L sidebend, in T7-T8? (Where sidebend and rotation occur in opposite directions). Which side would "open" and "close".

Thanks so much!

 

[jimmydicks101]

when you left side bend or L rotate, the L facet space is being "closed", while the R facet "gaps". If there is pain w L SB and rotation, the facet is having an issue with closing down for a variety of possible reasons. Therefore closing manipulation should assist with that and make the movement more fluid again. Kind of like when pts have pain going into lumbar extension, PAs may make them feel better as it is helping mobilize the joint into the deficient direction. It's late at night, so if that was a jumbled mess, my bad lol 😴

Thank you so much! May I ask a couple of follow-up questions to help nail this concept down?

1) Does rotation alone cause "closing" and "gapping" on the opposite side?

2) Will coupling motions affect the "closing" and "gapping" rule? Would this answer change if the pain was noted with L sidebend, in T7-T8? (Where sidebend and rotation occur in opposite directions). Which side would "open" and "close".

Thanks so much!

 

[starrsgirl]

Thank you so much! May I ask a couple of follow-up questions to help nail this concept down?

1) Does rotation alone cause "closing" and "gapping" on the opposite side?

2) Will coupling motions affect the "closing" and "gapping" rule? Would this answer change if the pain was noted with L sidebend, in T7-T8? (Where sidebend and rotation occur in opposite directions). Which side would "open" and "close".

Thanks so much!

1) Yes, in the case of the cervical vertebrae, rotation alone can cause closing and gapping. This is because of the angles of the facet joints. However, side flexion also does. The motions are coupled in the cervical spine so they don't really work in isolation anyway. I hope that makes sense.

2) I'm not sure about the rotation in the thoracic. We only focused on sagittal plane flexion (gapping) and extension (closing) in this region. We did look at rotated vertebral bodies but we did not use the terms gapping and closing when we were just doing veterbral rotation. Maybe someone else can shed some light here.

 

[jesspt]

Can someone please explain to me why choice #2 is the right answer? I've never quite understood the whole gapping and closing thing... Thanks so much!

"A 21 year old female patient presents with neck pain and stiffness that has gradually worsened over the last two weeks. Upon examination, the patient is noted to have left-sided pain with left side bending with left rotation and reports pain at the left C5-6 junction. Hypomobility is also noted with right side-gliding of C6. Which of the following techniques will be most appropriate to decrease pain?"

1. Closing technique for the mid-thoracic spine.
2. Closing manipulation in extension for C5-C6
3. Gapping manipulation in flexion for C5-C6.
4. Flexion/opening manipulation for mid-thoracic spine

I'm assuming this is for an exam in your PT school?

If it makes you feel any better, I wouldn't worry if you don't truly "grasp" this by graduation. You're probably better off to forget it once you start treating patients anyway.

 

[NewTestament]

It sounds like you have a really technical professor. The question assumes you can detect restrictions accurately. Jess is right. Forget it once you start treating patients.

 

[noyceguy]

Learn the material, then forget it. We treat people, not closing restrictions.