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MSK basics > lumbar back - 3 injuries > Flashcards

lumbar back - 3 injuries Flashcards

1
Q

manipulation - class criteria

A

no symptoms below the knee

recent onset of symptoms (<16)

low FABQW score (<19)

hypomobility of the lumbar spine

hip IR (>35)

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2
Q

what does FABQW score mean

A

Fear Avoidance Belief Questionnaire

patients’ fear of pain and consequent avoidance of physical activity because of their fear[2][3].

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3
Q

stabilization - class criteria

A

younger age (<40)

general flexibility - greater SLR flex

instability catch or abberret movement during lumbar flex or ext

+ prone instability

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4
Q

extension - class criteria

A

symptoms distal to the buttock

sym centralize with lumbar extension

sym peri with lumbar flexion

directional preference for extension

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5
Q

flexion - class criteria

A

older age (<50)

directional preference for flexion

imaging evidence of lumbar spinal stenosis

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6
Q

lateral shift - class criteria

A

visible frontal plane deviation of the shoulder relative to the pelvis

directional perference for lateral translation movement of the pelvis

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7
Q

traction - class criteria

A

signs and symptoms of nerve root compression

no movement centralize sym

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8
Q

what does peri mean

A

paresthesia moves distally, away from the spine

a sym presents with increased intensity and remains increased for 30 secs after the completion of the movement

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9
Q

what is centralization

A

pain or paresthsia moves centrally, towards the spine

paresthesia that was present is abolished

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10
Q

what is status quo

A

neither centralization of peri is produced

trasient (not perminent) increase or decrease in pain is produced

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11
Q

extension bias - mech of onset

A

bending lifting twisting

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12
Q

extension bias - demographic

A

20-50

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13
Q

extension bias - presentation

A

Antalgic, muscular spasm, difficulty attaining erect upright postures

Extension will cause pain the centralize in these pt

Earlier in the day – have a hard time

Acute LBP – often seen with radiating features

flexion worsen the symptoms

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14
Q

what is the treatment for an extension bias

A

awakening ritual

extension exercises

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15
Q

what are some examples of extension exercises

A

prone lying flat

prone on elb

prone position propped on hands

Standing lumbar extension puts hands on the lower back while extending the spine)

End range loading

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16
Q

what is an example of a awakening principle

A
  • Lying prone
  • Prone on elbows
  • Prone press-ups
  • Get out of bed while maintaining extension
  • Restrict flexion
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17
Q

other things we can do for ext principle

A

maintain lordosis while sitting

limiting time in sitting

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18
Q

lateral shift - MOI

A

– Flexion mechanism

– Acute onset

– Visual deformity, worsens with weight bearing
* Both sitting and walking exacerbate symptoms

– Radicular signs/symptoms

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19
Q

lateral shift - Presentation

A

Frontal plane deviation of the shoulder in relation to the pelvis, accompanied by some degree of flexion.

– Possible signs of nerve root compression
– Positive side-bending test
– Restricted painful extension

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20
Q

lateral shift - pathomechanical

A

– Disc Herniation
– Protective muscle spasm
– Segmental instability

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21
Q

how to correct a lateral shift

A

NWB correction

WB correction

ext syndrome (avoid all flexion)

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22
Q

what are indication for traction

A

Pt with radicular signs and symptoms who are unable to centralize during ROM testing

Back and leg symptoms, resembling a flex/ext syndrome but who is unable to improve with any active movement

Patients with an acute deformity who are unable to self-correct

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23
Q

what are contraindication to traction

A

infection or spinal malignancy

Osteoporosis

Hiatal or abdominal hernia

Pregnancy

Acute Lumbago (Low Back Pain Only)

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24
Q

flexion principle - MOI

A
  • No specific mechanism, often gradual onset
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25
Q

flexion principle - demographic

A

50s older individual - variable

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26
Q

flexion principle - presentation

A
  • Stiff, Achy Back
  • May exhibit “Claudicant Behavior”

– Flatback –Swayback
– Hyperlordotic

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27
Q

what is Claudicant Behavior

A

P/N and sense of weakness when standing, walking (mechanical), they want to sit

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28
Q

flexion principle - movement control

A

look at pt’s balance, movement control, and where we can make changes to take stress off of their spine

Flexion-oriented exercises

De-weighted treadmill ambulation

Exercises for individual impairments

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29
Q

what does stiff achy back mean

A

– Stenotic, Degenerative Spine

– Often accompanied by radiating features

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30
Q

lumbar spinal stenosis is associated with what principle

A

flexion pattern

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31
Q

what is degenerative stenosis

A

facet joint arthrosis

ligamentum flavum thickening

intervert disc bulging

spondylolesthesis

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32
Q

spinal stenosis presentation

A

pain with walking that is improved with sitting

improved walking holding a shopping cart

preferred position is sitting

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33
Q

pelvic component - pain pattern

A

rarely have symptoms below the knee, butt, lateral thigh

status quo pain

pain later in the day

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34
Q

pelvic component - neuro

A

no neuro component

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35
Q

pelvic component - pop

A

younger

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36
Q

what is included in cilbulkas criteria

A

standing flexion test

seated landmark asymmetry

long sit test

prone knee flexion test

** frontin sign

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37
Q

what is included in pelvic component palpation examination

A

ASIS

PSIS

iliac crest

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38
Q

interpretation of pelvic component - all landmarks are level

A

normal

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39
Q

interpretation of pelvic component - all landmarks are high on one side

A

leg length difference

(compared in sitting and standing )

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40
Q

interpretation of pelvic component - asymmetrical height difference

A

pelvic component

(compared in sitting and standing)

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41
Q

cibulka criteria - what means positive

A

3/4 test = pelvic component

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42
Q

what is the long sitting test (LST)

A

patient in the supine lying position, feet off the table

places the thumbs beneath the patient’s medial malleoli

Patient assumes a seated position with the hips flexed as much as possible and the knees fully extended.

Have to do 3 times

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43
Q

what is a positive long sitting test

A

change in length noticed

Evaluation of the pelvic joint – short to long

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44
Q

what is the prone knee flexion test - procedure

A

positioned prone with shoes on, the relative leg lengths are assessed visually by looking at the heels of the shoes

patient’s knees are then flexed passively to approximately 90 degrees and the lower extremity lengths are again observed

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45
Q

what is a positive knee flexion test

A

change in relative lengths between the two positions

  • Short to long = pelvic
  • Short to shorter = sacral
46
Q

what is the Seated/standing Flexion Test - procedure

A
  • Places the tips of PT index fingers directly beneath the inferior shelves of PSIS – upward pressure
  • Examiner at eye level
  • pt bends forward as far as possible while the examiner observes for symmetry of cranial movement of these bony landmarks
47
Q

what is a positive standing flexion test

A

one PSIS rises more in the superior direction while the patient is flexed

48
Q

which flexion test is included in clibukas criteria

A

standing flexion test

49
Q

what is Gillet test

A
  • PSIS and S2 palpated in standing
  • S2 between the PSIS’s
  • Patient is asked to flex one hip towards the chest
50
Q

what is a negative gillet test

A

PSIS moves inferiorly (below S2)

51
Q

what is a positive gillet test

A

PSIS does not move or moves cranially

52
Q

what are the treatment options for a pelvic component

A

Supine lumbo-pelvic roll

Prone Position innominate anterior rotation thrust

Long axis distraction

Prone leg lift technique

53
Q

what is the procedure for - Prone Position innominate anterior rotation thrust

A
  • Side bend the patient’s trunk and legs away from you
  • Have pt rise on elbow opposite form you
  • Place two hand on below the furthest PSIS
  • Take up the slack and then drive the innominate posture to anterior
    o Push cranial and into the table
54
Q

what is the procedure - Prone leg lift technique

A
  • Bend pt’s leg that is closest to PT and tuck leg under arm (make sure foot is behind arm)
  • Lift pt’s leg while applying pressure at PSIS
  • Rock up and down
55
Q

what do you after pelvic component manipulation

A

have the patient walk so that they are weight bearing on the pelvis

heel rockers

56
Q

what is the presentation of the sacral component

A

fortins sign

~vague, non-segmental radiating features

decreased unilateral stance time

Difficulty with transitional movements

Difficulty actively extending the spine

57
Q

what is fortin sign

A

patient twice identifies their most painful region within one centimeter of PSIS

58
Q

sacral component - MOI

A

Slip and fall onto the buttock

Asymmetrical loading mechanisms
* Not on the last step on the stair

Failure of “ilial” interventions

Hypermobility of the Pelvis

59
Q

what are some causes of – Hypermobility of the Pelvis

A
  • Trauma – rear end motor vehicle accidents
  • Recent Pregnancy
  • Birth Control Medication
60
Q

what is included in Laslett’s Criteria

A

Distraction

thigh thrust

Gaenslen’s test

Slide lying compression

Sacral thrust

61
Q

which two test in Laslett’s Criteria means that they have an SI pain

A

Thigh thrust

Distraction

Gaenslen’s test

Slide lying compression

Sacral thrust

62
Q

what are the sacral component correction

A

Active Mobilization Technique (SIJ)

Prone sacral correction

63
Q

when do we start to think about the thoraco-lumbar component

A

If it is not pelvic of sacral then it is thoracolumbar

64
Q

thoraco-lumbar component is what level and higher

A

L4 and higher

65
Q

what are the special test for the thoraco-lumbar component

A

This is more of a movement model does not have special tests

66
Q

what is the treatment for the thoraco-lumbar component

A

Side lying lumbar roll

67
Q

what testing can we do to discern a thoraco-lumbar component

A
  1. AROM standing
  2. Combo AROM testing
  3. Seated thoracic rotation
  4. PA spring testing
68
Q

what is Combo AROM testing

A

a. SB + Ext
b. Ext + SB

69
Q

for spring testing what section are we looking at

A

L5 to L2

70
Q

what is the procedure for Prone sacral correction

A
  • Side bend the patient’s trunk and legs away from you
  • Have pt raise up on elbow Opposite from you
  • Place hand medially from the PSIS – apply pressure obliquely in the angle of the SI joint
  • Take up the slack and then drive thrust
71
Q

what is the active mobilization of the pelvis - procedure

A
  • Pt’s trunk brought towards PT and legs away
  • PT palpate pt’s segment and take uppermost leg
    o Move leg into flexion and ext, feeling the PSIS move
    o Hook uppermost leg on other leg (closing of segment)
    o Keep hand on segment of interest
  • Rotate pt’s trunk
    o Grab lowermost arm above elbow and rotate
  • After deep breath take up any slack and then apply a thrust
72
Q

Classification of Lumbopelvic stabilization - demographic

A

<40

(+) Aberrant Motions

(+) Prone Instability Test

FABQ: > 8

(+) Spring test for hypermobility

73
Q

what is included in the basic screening for stability

A

Unilateral Bridge with Leg Extended

Bird dog - Quadruped with Alt. UE and LE Extended

Side plank - Unilateral Side Support with Legs Extended

74
Q

Unilateral Bridge with Leg Extended- bent leg

A

activation of the Hamstring

75
Q

Unilateral Bridge with Leg Extended - straight leg

A

activation of the abdominal obliques, multifidus, other trunk extensors

76
Q

Unilateral Bridge with Leg Extended - fall onto unsupported side

A

inadequate abdominal support

77
Q

what is the function of the multifudus

A

stabilizes the vertebrae as the spine moves.

Extension and contralateral rotation

78
Q

what is the function of the abdominal obliques

A

contributes to a variety of trunk movements

79
Q

bird dog - extended leg

A

hamstring, gluteus maximus, and multifidus

80
Q

bird dog - Activation

A

external oblique

81
Q

bird dog - Activation extended arm

A

upper trunk extensors

82
Q

for the bird dog what do we want the patients to look like

A

curve of back (neutral)

83
Q

side plank - down side

A

Unilateral involvement of the Gluteus Medius, Multifidus, External Oblique on the activated side

Rectus Abdominis

84
Q

what tests do we do for the posterior chain

A

Prone Instability Test

bird dog

Prone Unilateral Leg Lift

85
Q

what movement are we looking at with the posterior chain

A

extension of the back

86
Q

what is the procedure for the Prone Instability Test

A

pt lying prone at the end of the table , with the pt leg off of the table

pos 1: Push on the lumber spine muscles with pt’s feet on the ground

pos 2: Pt’s feet 2 inches off the ground Push on the lumbar spine muscles

87
Q

what is a positive prone instability test

A

less pain when legs are off the ground

88
Q

what is the prone instability test showing us

A

this is a test of muscle performance

This showing how activating your muscles can ease the pain

89
Q

what is the procedure for the Prone Unilateral Leg Lift

A

pt prone on mat table

have the patient lift leg straight off the table, looking for activation of the contralateral multifudus

90
Q

what is the function of the erector spinae

A

Back extension, side bending

91
Q

what test do we look at for the anterior chain

A

Unilateral Bridge with Leg Extended

Active Straight Leg Raising (An SLR)

Abdominal Hollowing

92
Q

Unilateral Bridge with Leg Extended - what muscle are being activated

A

activation of the abdominal obliques, multifidus, other trunk extensors

hamstrings

also looking at abdominal support

93
Q

what is the procedure for the Active Straight Leg Raising (An SLR)

A

“keep your knee straight and pick your leg off the ground – do bilaterally”

repeat procedure while placing force into the ASIS while pt is performing task

94
Q

what does it mean if position 2 is easier in the active straight leg raise

A

they are not activating their abs

95
Q

what does it mean if position 1 is painful in the active straight leg raise

A

pain - pain is worse when raising the leg that mean pt does not have great activation of the abdominals

o No pain – activating the abdominals

96
Q

what is the procedure for abdominal hollowing

A
  1. have the pt prone and knees bent
  2. ask them to take a deep breath
97
Q

what muscle is abdominal hollowing looking at

A

the transverse abdominus

98
Q

what is the function of the transverse abdominus

A

assist in forced expiration,

99
Q

can abd hollowing be used as a intervention

A

yes, If the patient is having a hard time activating the TA then you can teach the patient

100
Q

what are we looking for with abd hollowing

A

belly breathing

activating the TA

101
Q

with diaphramgic bretahing what do we want to move

A

the belly

102
Q

what movements are we looking for in the lateral chain

A

Side plank

Rose wall slide

Trendelenburg test

103
Q

what muscles are being activated with a side plank

A

downside: Unilateral involvement of the Gluteus Medius, Multifidus, External Oblique on the activated side

104
Q

what is the procedure for the rose wall slide

A

pt side lying, bottom knee bent, and top leg straight

  • PT sees how high the pt can lift their top leg – this is the limit for their leg raises
  • Have the pt lift their leg to this height for multiple reps – sliding on a foam roller
  • Look for the change in pt strategies during exercise
105
Q

what is the procedure for the trandelenburg test

A
  • Pt standing
  • PT at eye level of the pelvis
  • PT place hands on pt’s iliac crest
  • Have pt do single leg stance
  • Positive: Look for drop on opposite side to the stance leg
106
Q

look at my notes for the

A

stablization exercises

107
Q

what does it mean when the patient says my LE has a influence on my back pain

A

think of the pelvic dysfunction

108
Q

what is nutation

A

movement into the pelvis

anterior and inf

occurs in response to lumbar extension

108
Q

to pt with sacral pain complain of pain with walking

A

yes

108
Q

what is counter nutation

A

movement to return to neutral position

109
Q

prone knee flexion - sacral component positive test

A

shorter to shorter

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