Acute

• 0-6 Weeks post injury
• No Medx testing initially, unless specified by doctor.
• Begin with warm-up weights, adjust weights at first session for a goal of “moderate” fatigue level
• Slow weight progression -- -- Goal is increased range of motion
• Caution with cervical rotation/ rotary torso MedX, may add at four weeks
• Transition to standard protocol with testing as tolerated

Fibromyalgia

• No Medx testing initially, unless specified by doctor.
• Begin with warm-up weights, adjust weights at first session for a goal of “mild-moderate” fatigue level at most
• Medx should be limited to 25-30 reps to avoid overly fatiguing patient and slowly increase weights each session.
• Maximum fatigue can flare up with condition, so patients should work to moderate volitional fatigue.
• Proper body mechanics/ posture/ energy conservation techniques should be stressed.
• Introduction of exercise should be limited to 3-5 per session depending on the patients’ tolerance.

Spondylolisthesis

• Limit extension in lumbar medx to 18 degrees (or 12-24 degrees)
• After testing, calculate torque deficit between 24 degrees and farthest standard point in flexion: comment on report
• Avoid extension/ hyperextension with home exercises with GR II-IV, cautious with GR I
• May increase extension AROM if not limited by pain and GR I spondy

Disc Pathology

Active radicular symptoms or increased L/E or U/E symptoms with forward flexion

• Limit flexion to 36 degrees lumbar and 90-108 degrees(or less if needed) cervical.
• Begin increasing flexion per Dr. orders
• If ROM limitation was initiated by therapist, increase flexion when L/E or U/E symptoms subside 1-2 wks
• If L/E or U/E sympt do not subside by 4 wks, slowly increase ROM and assess tolerance per therapist
• Caution with rotary torso machines or avoid altogether

No radicular symptoms

• Can limit flexion ROM 60 degrees lumbar, 108 cervical
• Limit ROM further if extremity pain presents, especially if it appears during or after MEDx
• Caution with rotary machines

General Considerations

• May want to assess for soft tissue work to piriformis/ SI area, or anterior/ rear shoulder to avoid unnecessarily limiting ROM in Medx
• Patient may benefit from drop-seat method in cervical rotation Medx
• Testing ROM per therapist judgment or Dr. orders
• If limiting flexion in Medx, will need to be cautious of flexion with home exercises as well.
• Remember to add flexion back into HEP once tolerated and symptoms controlled

Pregnancy

• No lumbar testing: cervical with Dr. orders from PDR doctor.
• Limit ROM 0-60 degrees (lumbar) during the 1 st trimester
• Limit ROM after that per size, or 0-36 degrees
• Allow 5 minute warm-up prior to Medx
• Heart rate not to exceed 140 bpm
• Suggest increased fluid intake during rehab session
• Proceed with caution with home exercises in supine
• Patient to consult with their ob/gyn regarding any abdominal exercises.

Accelerated Protocol

• Accelerated Medx protocol is utilized in treatment planning when patients test with a mild - moderate or less dysfunction and thus should not need a full 12 wk program. Pain factors should also be used to determine protocol.
• Patients will attend rehab 2-3 times per week depending on the doctor orders. Sessions will last 60-75 minutes in order to complete all instruction by discharge. The goal is for patients to complete their program in 4-8 weeks.
• Testing is completed every 4 weeks after the initial test.
• Medx weight increases should be a more accelerated pace or as patient tolerates.
• Standard Medx protocol home exercise program to be used, but will be incorporated sooner than standard protocol visits indicate.