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MSK 2 > 3b - TBC DP traction and manip > Flashcards

3b - TBC DP traction and manip Flashcards

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1
Q

what is centralization

A

spinal pain and referred sx are progressively abolished in a distal-to-prox direction in response to therapeutic loading or mvmt strategies

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2
Q

what is peripheralization and what is this associated with

A

spinal pain and referred sx spread distally or further into limb as a result of loading strategies

associated w poorer prognosis

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3
Q

what is a directional preference

A

direction in which centralization (or sx alleviation) occurs

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4
Q

what does evidence say about the prevalence in centralization and what this indicates

A

low prevalence but was a pos prognostic indicator even if pain worsened

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5
Q

what predicts higher disability in radiating pain

A

baseline elevation in fear-avoidance beliefs about work and lack of centralization phenomenon
- lack of centralization also predicts higher pain intensity

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6
Q

what are the strongest predictive variables of chronicity in LBP

A

pain patter classification (noncentralization) and leg pain

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7
Q

what are the possible classifications under sx modulation

A

directional preference
- flex
- ext
- lateral shift

traction/active rest

manip/mobilization

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8
Q

ext preference: demographics

A

25-40yo

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9
Q

ext preference: MOI

A

*trauma (high load/lift and twist)
excessive repetitive motion
insidious

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10
Q

ext preference: aggravating factors

A

*flexion sensitivity *
prolonged flex activities
- sitting, driving, biking

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11
Q

ext preference: relieving factors

A

dec sleep in fowler position
walking short distances
standing
backwards/ext stretching

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12
Q

ext preference: functional ranking of pain in walking, standing, sitting

A

worst
1. sitting
2. standing
3. ext
best

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13
Q

if ext preference sx alleviated in fully supine position what can this indicate

A

mechanical stress

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14
Q

ext preference: ROM/quality of motion findings

A

limited & painful flex
end range ext may have pain
(+) repeated ext motions alleviates sx and may centralize sx

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15
Q

ext preference: joint play findings

A

hypomobile PA glide in lumbar spine

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16
Q

ext preference: ms function findings

A

strength, control, and endurance
- weak glut max/med
- poor pelvic control
- poor TrA, multifidi activation

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17
Q

ext preference: neuro exam findings

A

may have myotomal weakness
may have sensory deficits

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18
Q

ext preference: helpful special tests that may be positive and what could they indicate

A

possible signs of NRCS
(+) neuro exam
(+) SLR - herniated disc, neural tension
(+) slump - herniated disc (esp if crossed)

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19
Q

ext preference: interventions

A

start w preference
- end range ext exercises

mobilization to inc ext

functional training w short term task modifications
- ant pelvic tilt -> pelvic control
- esp in sitting w post tilt, ant tilt will provide relief

browder ext protocol

treat impairments!

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20
Q

what is a good strategy for interventions in ext preference pt who is highly volatile

A

browder ext protocol
- prone -> POE -> prone press up -> standing ext

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21
Q

flex preference: demographics

A

typically >50yo
younger (16-25) if after trauma

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22
Q

flex preference: MOI

A

insidious in older (>50yo)
- d/t degen changes over time
- spinal stenosis -> narrowing leads to more space in a flex position

trauma in younger, athletes
- spondylosis - articularis fx
- high load
- lift and twist
- excessive repetitive motion

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23
Q

flex preference: aggravating factors

A

ext based activity
- walking
- standing
- standing from a chair**

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24
Q

flex preference: relieving factors

A

sitting
- not always better, more in oldies
leaning forward on cane
leaning on grocery cart

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25
flex preference: ROM/quality of motion findings
limited/painful ext
26
flex preference: joint play findings
hypomobile LS/tspine in older hypermobile LS in younger hypomobile hip capsule
27
flex preference: ms function findings
strength, control, and endurance - weak glut max/med - poor pelvic control - poor TrA, multifidi activation flexibility, ms length - stiff psoas or rectus fem
28
what role do muscle function findings play in sx modulation w a flex preference and why is this important
if stiff psoas and hip capsule (common in sitting a lot), motion happens thru path of least resistance - if pt has stiff hip and thoracic, the lumbar spine has to take a majority of ext important bc we can't change bone structure but we can change mobility of hip and spine
29
flex preference: neuro exam findings
may have myotomal weakness may have sensory deficits
30
flex preference: special tests that may be important and what do they tell us
(+) 2 stage treadmill test possible signs of neurogenic claudication possible signs of NRCS
31
when does reclassification happen for those initially classified as sx modulation w a directional preference and what is a consideration of this
reclassify when no longer in sx modulation - may continue to have directional preference in movement control classification
32
flex preference: interventions and examples
flex biased exercise - post pelvic tilt - single/double knee to chest - dead bugs - child's pose mobilization - early stages: to LS to inc flex - mob hips and thoracic spine into ext functional training - post pelvic tilt -> pelvic control - teach them ant tilt after to connect to function and why feels worse when doing activities treat other impairments!
33
what will be your main directional preferences
flex and ext - lateral is less common
34
lateral shift: MOI
trauma - high load - lift and twist - excessive repetitive motion
35
lateral shift: aggravating factors
pain w most motions - worst SB in opposite direction of shift pain worst sitting > standing > walking - may be different, less consistent
36
lateral shift: relieving factors
laying flat (often w legs up)
37
lateral shift: posture findings
shoulders deviated from pelvis in frontal plane - shift named direction shoulders are moved in relation to lumbar spine
38
lateral shift: ROM and quality of motion findings
directional preference for pelvic translational mvmts asymmetrical SB
39
lateral shift: neuro exam findings
may have myotomal weakness may have sensory deficits
40
lateral shift: special tests that may be positive
possible signs of NRCS (+) neuro exam (+) SLR (+) slump test
41
lateral shift: 3 interventions
manual therapy to correct shift functional training w short term activity modifications graded loading exercises
42
what are types of graded loading exercises to do with a lateral shift
TrA -> pelvic tilting (mid range) -----> progressions of "core" activation
43
what is an important positioning consideration of traction in lateral shift and why
supine traction - when they stand up, will feel way worse
44
what does evidence say about the efficacy of direction preference specific interventions (ie flex, ext, lat)
people have tendency to get better in general but people will get better faster and more often w good treatment that is specific to directional preference - matching care matters in LBP
45
what pt pop in general fits in traction/active rest group for sx modulation
someone having difficulty w centralizing and peripheralizing - not clear what feels better and what is worse
46
traction/active rest: demographics
any age
47
traction/active rest: MOI
often an event such as bending, twisting, lifting
48
traction/active rest: aggravating factors
higher compressive activities
49
traction/active rest: relieving factors
mvmt (but not too much mvmt)
50
traction/active rest: ranking of walking, sitting, standing
best walking standing sitting worst *follows pattern of compressive activities
51
traction/active rest: key exam findings
s/sx of NRCS - (+) CSLR pain and numbness extending distal to buttock in previous 24hrs w/o ability to centralize thru repeated mvmts
52
what are 7 types of lumbar traction
mechanical sustained (static) intermittent manual autotraction positional inversion
53
what are 2 benefits to using harness traction
1. allows for manual adjustments based on directional preference 2. line of pull is from pelvis - if you apply traction via legs, creates slight ant pelvic tilt bc acetabulum is slightly ant to pelvis
54
what is Steve's issue w traction in PT
if can give someone self-traction techniques to do at home - you have improved person's self-efficacy --> sx are better --> improve px
55
what are 7 contraindications to manips in the LS
1. signs of NRCS, myelopathy, or cauda equina 2. OP or other bone dz 3. fx 4. acute inflammation 5. unstable med condition 6. progressing CNS disorder 7. demyelinating disorders (ie MS, ALS)
56
what is the evidence for lumbar manip in the LS
really good lol
57
what is the lumbar spine clinical prediction rule
classifying pts w LBP who, will respond favorably to HVT (4 of 5 signs) 1. duration of sx <16days 2. no sx distal to knee (aka no NRCS) 3. LB hypomobility 4. 1 hip >35deg IR 5. FABQ work subscale score <19 (aka low fear avoidance)
58
TBC manip category: MOI
typically inciting incident - bending, twisting, lifting - may be after repetitive motion
59
TBC manip category: aggravating factors
pain w most motions
60
TBC manip category: pain levels
high
61
TBC manip category: posture
guarded/stiff - walking carefully
62
TBC manip category: ROM and quality of motion
limited and painful stiff, guarding motions that are limited
63
TBC manip category: joint play
hypomobile
64
TBC manip category: neuro exam and special tests
no sx distal to knee (pain, sensation, weakness) (-) CSLR, aka neg for NCRS - if (+) must have neg reflexes, strength, sensation testing
65
what interventions should follow manips
mid range ROM - pelvic tilts - lower trunk rotation - cat camel
66
what are the 3 buckets we triage pts w LBP into based on appropriateness for therapy
med management rehab management self-care management
67
those who classify into sx modulation will be treated with one of what 4 subgroups
active rest traction directional preference manip

MSK 2 (20 decks)

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