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3d - MDT & SI Joint Flashcards

(108 cards)

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1
Q

what is the McKenzie Classification (MDT) system

A

system of assessment and classification of MSK disorders
- mechanical dx
- mechanical treatment based on mechanical dx
- prevention of recurrence

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2
Q

what does MDT place a strong emphasis on

A

patient ed and self treatment

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3
Q

what is the philosophical basis of MDT in the spine

A

the majority of LBP comes from the disc
- nucleus pulposis (disc itself)
- centralization
- peripheralization

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4
Q

what are the 2 main pain response subgroups? subgroups within these?

A
  1. centralized/directional preference
  2. non-centralization
    - directional preference (sx feel better)
    - no directional preference
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5
Q

what are components to a MDT exam

A

posture
mvmt in relation topain
repeated mvmts to reproduce
repeat mvmt 10-15xs then reassess sx
start in sagittal plane -> frontal –> transverse
- progress for what will be most provocative

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6
Q

MDT treatments

A

active and passive exercises
- trunk flex, ext, side gliding

NWB -> WBing based on centralization
- introduce mvmts opposite to preference

correction of lateral shift

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7
Q

how are pts classified per MDT and what are the classifications

A

uses pain behavior and its relationship to mvmts and positions

  1. postural syndrome
  2. dysfunction syndrome
  3. derangement syndrome
  4. other (no serious path, not severe sciatica w neuro deficits)
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8
Q

MDT postural syndrome: MOI

A

prolonged / sustained positioning
–> prolonged static loading of normal tissues

pain from mechanical deformation and sustained positioning

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9
Q

MDT postural syndrome: pain pattern

A

intermittent, midline & dull, never referred
gradual onset

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10
Q

MDT postural syndrome: aggravating and relieving factors

A

aggravating: standing, sitting, static positions
relieving: movement

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11
Q

MDT postural syndrome: clinical findings

A

no loss of motion

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12
Q

MDT postural syndrome: treatment

A

posture correction
interruption of end range stress at freq intervals
- get up and move!

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13
Q

MDT dysfunction syndrome: MOI

A

pain resulting from mechanical deformation of abnormal tissues
- contracted, fibrosed, adaptively shorted tissues, adherent nerve root (ANR)

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14
Q

MDT dysfunction syndrome: pain pattern

A

intermittent pain
local adjacent to midline
usually not referred, repeated mvmts don’t alter sx

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15
Q

MDT dysfunction syndrome: exam findings

A

restriction of end range motion

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16
Q

MDT dysfunction syndrome: emphasis of intervention

A

exercises at end range to remodel affected structures

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17
Q

MDT derangement syndrome: MOI

A

pain caused by internal disruption and displacement of tissue (primarily disc)

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18
Q

MDT derangement syndrome: pain pattern

A

sudden onset
constant, paresthesia or numbness down into leg
- peripheralization/centralization
central, unilateral, symmetric, or asymmetric

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19
Q

MDT derangement syndrome: aggravating factors

A

posterior derangement: flexion
anterior derangement: ext

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20
Q

MDT derangement syndrome: exam findings

A

lateral shift
loss of motion and function

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21
Q

MDT derangement syndrome: emphasis of intervention

A

perform mvmts to dec internal derangements and maintain stability

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22
Q

what is the guiding principle for treatment progressions in derangement syndrome and what are resulting categories

A

pt- controlled and generated mvmts that are assisted by clinician only when necessary
- static pt- generated force
- dynamic pt generated force
- clinician-generated forces

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23
Q

MDT category for pain during mvmt

A

derangement

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24
Q

MDT category for centralization of sx

A

derangement

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25
MDT category for end range pain
dysfunction
26
MDT category for pain on prolonged static loading
postural syndrome
27
main intervention for postural syndrome
re-ed thru posture retraining
28
main intervention for dysfunction syndrome
remodel and stretch
29
main intervention for derangement syndrome
dec derangement
30
what does evidence say about the reliability and effectiveness of the MDT
good interrater reliability w/i therapists who are certified not better than other rehab for dec pain and disability in acute LBP however depending on comparative, better in dec pain and disability in chronic LBP
31
when can the dx of pelvic girdle pain be reached
AFTER EXCLUSION OF LUMBAR CAUSES and reproducible by specific clinical tests
32
what is pelvic girdle pain and common culprits
pain experienced between post iliac crest and gluteal fold pregnancy, trauma, arthritis, OA
33
what is the function of the SIJ
multidirectional force transducer
34
what is controversial about the SIJ
some don't agree that an injured SIJ can be cause of LBP
35
what composes the sacrum
5 fused vertebrae
36
interosseous ligs: location and main function
anterior major SI stabilizer, creates pelvic ring
37
sacrotuberous ligs: location and main function
posterior stabilize in sacral flex and taut in WB
38
long sacroiliac: location and main function
posterior multifidi has some fibers which insert on the lig
39
sacral nutation vs counter nutation and their corresponding relative motions
nutation - ant mvmt of base, post mvmt of apex - post pelvic tilt counter nutation - post mvmt of base, ant mvmt of apex - ant pelvic tilt
40
sacral nutation/flexion: motion resisted by ____, bilateral vs unilateral motion
resisted by sacrotuberous and interosseous ligs (B) in initial stages of forward bending unilateral during flex of LE
41
what position of the sacrum is more stable
nutation/flexion
42
sacral counter nutation/ext: motion resisted by ____, unilateral motion
resisted by long sacroiliac lig (B) initial stage of backwards bending
43
what are the functional biomechanics of a forward bend
1. ant pelvic tilt 2. PSIS travel equally superiorly 3. sacral nut inc relative to innominates for first 45-60deg of FB 4. extensibility of tissues of sacrum reached so sacral counter nut w continued FB as pelvis cont to move forward
44
how and in what way specifically is torsion produced at pelvis
during climbing or walking R innominate post rotates L ant rotates R sacrum nutated (relative to innominates) L counter nutated (relative to innominates) and vice versa
45
when is stability of pelvis achieved and what are contributing components
when active, passive, and NM controls work together to transfer loads dynamic stability (intrinsic, extrinsic) form closure force closure
46
form vs force closure in the pelvis
form: passive stability - ligs and bony attachments force: active stability - ms system, co-contraction
47
what are the 2 components to force closure and what specific structures are involved in each
inner unit = local/stabilizing ms - levator ani, multifidi = control sacral position - TrA, pelvic floor = inc intra-abdominal pressure outer unit = gross/mvmt ms (adds compression) - glut max, contralateral lats - glut med and min, contralateral ADDs
48
what paths have a common pain referral over the SIJ
L3-4 facet L4-5 nerve root piriformis / sciatic nerve
49
why is SIJ path a dx of exclusion
most common sources of SI region pain are lumbar and hip dysfunction
50
SIJ pain: MOI
any trauma/fall/misstep fall on glutes quick upward force
51
SIJ pain: PMH
EDS (connective tissue disorder), RA, AS hypermobility, pregnancy, PMS med dx and hypermobility --> excessive mobility --> less form closure
52
SIJ pain: pain patterns
somatic pain referral rarely below knee
53
SIJ pain: goal of clinical exam
reproduce pain at SIJ w provocative tests
54
what is the order of the clinical exam for SIJ pain
palpation - static and dynamic kinetics tests - type of dysfunction ms length - confounding factors leg length measurements provocative tests - helps confirm SIJ dx joint mobs
55
what is obliquity at the pelvis
rotation of 1 innominate vs the other
56
what is a significant finding of PSIS standing/supine alignment
~2.5cm difference
57
what are some dynamic/kinetic mvmt tests to do at the pelvis
forward bend gillets prone press up/ knee bend long sitting active SLR
58
what is a consideration before conducting a static palpatory non-WBing test
have them do a bridge up first to neutralize leg length
59
how would a R upslip present in palpatory testing
R ASIS/iliac crest higher in supine R PSIS higher in prone
60
how would a R innominate ant rotation present in palpatory testing
R ASIS/iliac crest lower in supine R PSIS higher in prone
61
how will a true innominate rotation present in static palpatory tests
in both NWB and WB
62
how will an upslip present in long sitting
leg length should change - rotation will have femur pulled superior so malleoli won't line up
63
what is a consideration of any objective measures used in the pelvis
lack a gold standard
64
what are the cluster of provocation tests used in the SIJ and how
1. distraction 2. post shear/thigh thrust 3. Gaenslen L 4. Gaenslen R 5. compression 3/5 (+) indicates SIJ path
65
what are all the possible provocation tests that can be used at the SIJ
distraction* post shear/thigh thrust* FABER gaenslen L* and R* compression* sacral thrust/spring test cranial shear
66
when can a dx be achieved relating to an SIJ path
hx r/o LBP and hip 3/5 provocative tests
67
once SIJ dysfunction dx, what guides treatment directions
positional tests dynamic tests confounding variables - posture ms - balance - leg length
68
what are 6 classifications of pelvic girdle dysfunction
hypomobile hypermobile pain w normal mobility pelvic girdle fx coccyxadynia ankylosing spondylitis
69
hypomobile: onset
trauma/lift/twist insidious positional stressors compressive force
70
hypomobile: pain pattern and aggravating factors
pain over SIJ/into buttocks or post thigh inc walking/stairs/rolling/STS
71
hypomobile: normal exam findings
neg LB scan hip ROM WNL
72
hypomobile: abnormal exam findings
fixed palpatory obliquity dec/fixed mobility w kinetic testing dec arthrokinematics/mobs (+) provocation tests leg length discrepancy may be present
73
what are the 3 main possible obliquities
ant rotated innominate post rotated innominate up slip (inferior translation)
74
what are 3 ways to restore alignment when an obliquity is present
mobs manips MET
75
what are the 5 CPRs for mob or manip the SIJ (show banana manip as what would be done)
FABQ <19 sx <16days no sx below knee hyposegment LB hip IR >35deg
76
acute hypomobile treatment
dec pain, inflammation, and MS spasm
77
sub acute hypomobile treatment
inc ROM and strength promote good posture and body mechanics
78
chronic hypomobile treatment
ergonomics dynamic stability self management
79
hypermobile dysfunction: onset
repetitive micro trauma / major trauma hormonal changes / pregnancy
80
hypermobile dysfunction: painpattern
pain location switches sides - buttocks, thigh, pubic symphysis, groin +/- clicking popping
81
hypermobile dysfunction: aggravating and relieving factors
aggravating: - unilateral WB - wt shift relieving: - rest - positions that don't stress joint
82
hypermobile dysfunction: exam findings
+/- positional faults +/- gower sign poor control (w wt shift) poor isolation and endurance of stabilizing ms antalgic gait (inc wt on one side) change in dynamic/static palpatory tests - difference in supine vs standing inc joint glides (+) active SLR
83
hypermobile dysfunction: medical intervention
if systemic - sclerosing/prolotherapy/ pharm fusion (after failed Rx)
84
hypermobile dysfunction: acute PT intervention
dec pain inflammation and ms spasm stabilization SI belt
85
hypermobile dysfunction: sub acute PT intervention
correct obliquity inc pain free ROM strength promote good posture & body mechanics stabilization exercise
86
hypermobile dysfunction: chronic intervention
ergonomics dynamic stabilization exercise self-management (SI belt)
87
pain w normal mobility: onset
overuse articular and myofascial structures dysfunction somewhere else - biomechanical (ie LBP)
88
pain w normal mobility: pain pattern and factors
same as hypo/hyper pain over SIJ/buttocks/post thigh inc w walking/stairs/STS
89
pain w normal mobility: exam findings
leg length/trendelenburg - ms imbalance b/w gluts and lats, gluts and ADDs - look down kinetic chain
90
pain w normal mobility: treatment
control aggravating factors - ie running, walking, etc. dec irritability stability based exercise - ie strengthen what is weak
91
sacrum dysfunction: onset
trauma / lift / twist
92
sacrum dysfunction: pain pattern and factors
same as hyper/hypo, normal mobility pain over SIJ/buttocks/post thigh inc w walking/stairs/STS
93
sacrum dysfunction: exam findings
positional fault - upslip - nutation, counternutation ---> when test flex/ext, not getting equal mvmt (B)
94
sacrum dysfunction: treatment
restore alignment - MT - METs - repeated motions
95
pelvic girdle fx: onset
trauma (+) radiographs
96
pelvic girdle fx: pain pattern and why
unable to WB - fx anywhere on pelvic ring, WBing w any mvmt will cause pain bc of ligs that surround the ring and creates tension
97
pelvic girdle fx: exam findings
point tenderness over bony prominence
98
pelvic girdle fx: acute vs outpatient treatment
acute: external fixator - compensate/mobility/fxn outpatient: assess hypo/hyper mobility - address impairements
99
coccyxadynia fx/sublux: onset
fall on buttocks - missed chair/toilet seat - fell down stairs
100
coccyxadynia fx/sublux: pain pattern and aggravating factors
localized over coccyx strong/sharp pain w contact on coccyx sitting worse than standing/walking
101
coccyxadynia fx/sublux: exam findings
sitting posture pain palpation/mobs
102
coccyxadynia fx/sublux: treatment
mob or protect function/strength
103
ankylosing spondylitis active vs late phase
active - inflammatory process affecting ligs causing progressive fibrosis and low-grade fever late - bony ankyloses, bamboo spine risk for multiple stress fx
104
ankylosing spondylitis: demographics
young men 17-35yo
105
ankylosing spondylitis: sx
pain worse in AM, >3mo - AM stiffness >3mo, >30min LBP/ stiffness --> loss of motion stiffness onset in SI region often --> followed by progressive limit in mvmt aggravated by inactivity better w mvmt
106
ankylosing spondylitis: exam findings
dec ROM, general hypomobility imaging late stages: - mobility - gait - breathing (rib cage) - morbidity
107
ankylosing spondylitis: active stage interventions
medically managed - NSAIDS - corticosteroid injections - PT not indicated**
108
ankylosing spondylitis: remission stage interventions
this is when they go to PT posture - promote ext sleeping ext exercise joint mob only in early non active stage - contraindicated in late stages aerobic education

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