lumbar Spine Segmental Assessment and Treatment of hypomobility

Question 1

Spine hypomobility etiology

Answer 1

Back injury

• unwillingness to move/fear, protection
• restriction in facet joint capsul, ligaments
• myofascial restriction, muscul tightness

Some folks are inherently tighter

• joint capsules, ligaments and muscles

Disease assoicated with hypomobility

• anklyosing spondlyitis, DM etc

Question 2

Hypomobility Signs and symptoms

Answer 2

• C/O stiffness, tightness, lack of ROM
• pain at end ranges/postures
• pain subsides when off end range
• no worsening of condition
• may have referred pain

Question 3

Complications of restricted motion

Answer 3

• adaptive shortening over time: muscles ligaments and capsules
• disuse of atrophy of musculature
• degeneration of synvoium
• reduced nutrition- disc articular cartilage
• loss of segmental mobility
• loss of function
• liability to further injury

Question 4

How can hypomobility be reversible

Answer 4

• mobilization/manipulation for joint stiffness
• soft tissue mobilization, myofascial release
• stretching of joints, assoicated muscles
• exercise to promote motion

Question 5

hypomobility observation

What are somethings to pay attention to

Answer 5

• posture: clues to what might be tight
• LS FB ROM limited = decreased L/S curve reversal, tight facet capsules, posterior ligaments and muscles
• one or multiple spine segments
• note where motion is occuring or not occuring
• note compensatory motion at hips, pelvis, T/S

Question 6

Hypomobility: dysfunction movement observation

Answer 6

• deviations from planar path; if resriction is unilateral, deviation to tight side
• L/S ROM capsular patterns
• patient may increase effort toward end range

Question 7

L/S ROM capsular pattern

Answer 7

• FB = deviation to tight side
• SB opposite tight side\ = limited
• Rotate to tight side = limited (less)

Question 8

Spine assessment

Answer 8

• spine palpation
• “pinch” SP to look at alignment
• reference is position or movement of superior segment

Question 9

Describe

LS spine segmental mobility testing

Answer 9

• apply PA force to SP
• Apply PA force on unilateral TP
• quantity: assess amount of motion compared to “normal” or different levels of spine

Question 10

Quality of LS motion

Answer 10

• spine joint play and end feel
• end feel: nature of restricition at end range
• normal capsular end feel with firm stop and some creep/give
• abnormal = stiff without creep or give

Question 11

LS segmental mobility testing reliability

Answer 11

• poor inter-tester reliability
• pain provocation (spring test) is more reliable

Question 12

Lumbarization

Answer 12

• abnormalities during palpation
• S1 is acting like a lumbar vertebrae and is not fused

Question 13

Sacralization

Answer 13

• abnormalities during palpation
• L5 is congenitally fused with S1
• motion does not occur

Question 14

Spina bifida occulta

Answer 14

• not a distinct palpable SP
• Osseous defect of vertebral arch and spinous process
• neural contents are OK
• may have hair or discoloration over the area

Question 15

Spine segmental mobility testing

Answer 15

• joint play = spring testing
• PPIVM = passive physiological intervertebral mobility testing
• perform mobility assessment at all levels of the LS before commencing mobilization

Question 16

Contraindications for mobilization/manipulation

Answer 16

grades 1 and 2 = none

grades 3-5 = likelihood of causing osseous and ligamentous damage

• disease states such as cancer and osteoporosis

Rotation grade 5 thrust

• LS - presence of annular disck weakness
• C/S vertebral artery

Question 17

Passive Physiologic intervertbral mobility testing

Answer 17

• PPIVM
• palpation between SP while moving patient LS into Flexion, extension, SB, rotation
• quantity = assesed compare to normal; compare different levels
• quality PPIVM end feel - restriction at end range
• graded = normal, hypomobile, hypermobile

Question 18

Red flags for low back pain

Answer 18

• significant trauma, pain, inflammation
• Hx Cancer
• patient over 50
• unexplained weight loss
• unrelenting night pain
• pain worse when lying down
• osteoporosis
• loss of bone or ligamentous integrity
• steriod use

Question 19

Criteria for L/S manipulation

Answer 19

• duration of LBP <16 days
• no symptoms distal to the knee
• FABWQ score <19
• spine mobility testing at least one hypomobile L/S segment
• at least one hip with 35ºof IR

Question 20

Spine and soft tissue assessment: condition and mobility

Answer 20

• is spine involved = common for soft tissue to be involved therefore examination of spine region includes assoicated soft tissue
• exam Soft tissue skin/fascia for swelling, edema, mobility, tenderness
• muscles specificially for decreased mobility/tightness
• hypertonicity - spasm/protective guarding
• hypotionicity: if NR involved = inhibition postinjury
• hypertrophy - muscles protecting instability acquired
• trigger points

Question 21

Soft tissue involvment

Answer 21

• soft tisse involvement may change what is going on at a segmental level
• soft tissue mobilization may allow you to better detect joint restrictions that are truly capsular restrictions
• joint mobilization may effect tone of soft tissue
• can use them in conjunction with on another

Question 22

treatment seqeuncing rule

Answer 22

• mobility before length before strength