M3/4 quizzes Flashcards
you finish your pt exam and your findings suggest your pt, Manuel,, belongs in the Mob/Manip classification. Before you begin Manuel’s treatment, explain what you believe is wrong and how you plan to treat it.
Have a back model
Your back is made out of a series of bone that look like this. Sometimes the joints get stiff and don’t move enough, which can lead to pain. We are going to work on loosing up those joints. Ben’s answer
Add to or alter your previous statement (about Maneul’s treatment/ being in the Mob/Manip classification) in a way that will maximize the placebo effect.
I have done this with other pts and the literature shows that this increase movement while decreasing the pain.
“Motion is lotion; rest is rust.”
Tell Manuel what he can do to assist in his recovery. (he is in the mob/manip classification.)
I will tell you some things to keep that movement by teaching you some exercises
*Ant/Post Tilts, etc
Manuel comes back to visit 2 and says that he read on the internet about some people had died or been paralyzed by manipulations and he is worried about letting you do that to him. Respond to his concerns with at least two type of reassurances.
~Manipulations are 37,000x safer than taking aspirin.
~We have a list of precautions (clues) and you do not have any of them.
Your pt, Libby, has limited painful flexion and hypomobility L>R at L4,5 and L5,S1. S/S indicate that she belongs in the mob/manip classification. Which of the following is the best approach for initial treatment?
A. L SI manip
B. L lumbar sidelying rotation manip
C. Central PA mob
D. Unilateral PA non-thrust
D. Unilateral PA non-thrust
SI manips are more for SI problems.
L lumbar sidelying rotation manip is for a R side problem.
Assuming you only have time to add one exercise (to be done in clinic initally, then will be her initial HEP) to Libby’s initial treatment, which of the following would be the best choice? (((Libby has limited painful flexion and hypomobility L>R at L4,5 and L5,S1 and just had unilateral PA non thrust)))
A. Muscle energy for flexion deficit
B. Pain-free Ant/Post tilts
C. Abdominal drawing in maneuver
D. Quadruped cat/cow to end range
B. Pain-free Ant/Post tilts
Which of the following pts (all of the following are IR ROM measurements) has the best chance of responding to mob/manip, assuming all other s/s are equal? (choice all that apply)
A. L 38* R 18*
B. L 38* R 41*
C. L 28* R 45*
D. L 28* R 28*
A. L 38* R 18AND C. L 28 R 45*
Shania’s S/S indicate she is appropriate for mob/manip but she seems anxious about some of the more vigorous exam techniques. She says she’s had relative joke with her about “pain and torture” being what PT stands for and she keeps asking how much things are going to hurt.
Does this affect your initial treatment plan? If so, how?
Start easy and educate!
Start with mobs, maybe G2 and ease into G3.
Eventually get to G4 if she is comfortable with it. While reassessing make sure the pt is ok.
Which of the following is one of the most serious adverse effects of spinal manipulation? A. CES- cauda equine syndrome B. CSS- cervical spinal stenosis C. cervical compression fracture D. CVA- cerebrovasclular accident
A. CES- cauda equine syndrome
*she says this- I think its mainly bc we are in the lumbar section
D. CVA- cerebrovasclular accident
*this is the most serious for cervical section
Your 53 year old pt has severe LBP which began insidiously and has worsened gradually over the past few months. Part of why he came as a direct self-referral to you was bc he doesn’t have a regular physician (he goes to the ER when he is sick). He has many agg factors and his AROM is equally limited in all directions. He doesn’t have any radicular s/s and the neuro screen is (-). His mobility is only limited by P (empty end-feel limits most special tests). What is the most appropriate action?
A. Trial SI mobilization since he can’t tolerate the SI manipulation yet
B. Refer for further diagnosis before treatment
C. Treat for P today and try manipulation when he can tolerate it
D. Try gentle mechanical lumbar traction since he can’t tolerate much else
B. Refer for further diagnosis before treatment
Which of the following is NOT a finding that would lead you to think the patient belong in the Mob/Manip category?
A. Lumbar jt mobility deficit(s)
B. Low FA behavior
C. Average SLR ROM >91*
D. Symptoms limited to lumbar, hip/buttocks, thigh
C. Average SLR ROM >91*
*this is a finding for stabilization
Which of the following is NOT a finding that would lead you to think the patient belongs in the stabilization category? A. overall hypermobility B. over 40 years old C. several prior episodes D. no centralization
B. over 40 years old
**being younger is a finding for stabilization
The ultimate goal of a stabilization program is
A. meeting the criteria of either prone or supine TrA contraction tests (pressure biofeedback)
B. being able to demonstrate a maximal abd brace >= 1 minute and still being able to breathe in supine
C. holding extensor and flexor endurance tests for the same amt of time without excessive effort
D. demonstrating spinal control during the functional movements, including agg factor activites
D. demonstrating spinal control during the functional movements, including agg factor activites
Which of the following is NOT one of the key treatments for a patient in the extension subgroup of DSE classification?
A. avoid sitting whenever possible
B. use lumbar support when sitting is necessary
C. perform passive extension several times a day
D. minimize excessive anterior pelvic tilts
D. minimize excessive anterior pelvic tilts
When should a patient in the extension subgroup of DSE classification resume flexion?
A. after several days without symptoms
B. never, in order to reduce the risk of recurrence
C. when leg P has centralized at least to buttocks
D. after several days of completely avoiding flexion
A. after several days without symptoms
Which of the following is NOT an appropriate way to address the hip extension mobility impairment in a patient with symptomatic LSS? (pick all that apply)
A. supine inferior glide joint mobilizations
B. standing resisted hip extension with theraband
C. prone lying with pillow under the LE
D. active hip extension with LE over the edge of table
C. prone lying with pillow under the LE
A. supine inferior glide joint mobilizations
also correct- it’s in book, but not correct here when talking about extension
Which of the following is NOT one of the three types of traction? A. Manual B. Mechanical C. Positional D. Oscillatory
D. Oscillatory
A pt with \_\_\_\_\_\_\_\_\_ should NOT do traction. A. severe P B. radicular P C. osteoarthritis D. hypermobility
D. hypermobility
Diana is being evaluated for intermittent LBP. She doesn’t have P in standing but does have it during flexion activities such as lifting her heavy backpack form the floor and putting groceries in the trunk. Early in the exam you notice Dianne has P during flexion that actually decreases as she approaches end range. What is the most appropriate predication based on this finding?
A. She will probability have a + prone instability test
B. She will probability have a + extension direction preference
C. She will probably need lumbar joint mobs
D. She will probably need to be referred to a physician
A. She will probability have a + prone instability test
Donald’s back P is reproduced when the PT does a CPA over L5>L4>L3. When the PT performs part 1 of the prone instability test at L5, his P is reproduced. When the PT performs part 2, his pain is abolished. What is the most appropriate assessment of this result?
A. His LBP generator is primarily muscular
B. there was no real need to do part 2 of the test
C. Muscle contraction exercises are likely to reduce his LBP
D. He probably needs lumbar mobilization in addition to stabilization
C. Muscle contraction exercises are likely to reduce his LBP
53 year old Mark is pretty active in martial arts and has never had back pain until this episode. This episode started with a bad fall a couple of months ago which caused a few weeks of back and R thigh P but 80% of this P which resolved without treatment. Kicking forward is his worst agg factor. Sitting and lying are pretty much pain free. Standing flexion is unremarkable though moderately limited by back and thigh P. Mark’s SLR is R 95, L 155 and his P increase with DF on the L. Which of the following is most true?
A. His SLR average is >91* so he belongs in the stabilization classification
B. his primarily classification is probably NOT stabilization
C. prone instability testing is contraindicated for Mark
D. Mark should be referred back to his MD bc this doesn’t make sense.
B. his primarily classification is probably NOT stabilization
*older and this is his first episode- not stabilization, even though SLR is >91
Which is most true about the more generalized approach to lumbar stabilization?
A. It relies on max contraction of all the abds whereas the specific approach asks only for a moderate contraction
B. It relies on brief but generalized contraction of all of the abds whereas the specific approach asks for a more sustained contraction
C. It activates the superficial and deep muscles initially whereas the specific approach only the deep muscles initially
D. once a pt learns the initial TrA contraction for the specific approach or the abd brace for the generalized approach, the generalized approach requires much less practice than the specific approach to integrate with other movements and activities.
C. It activates the superficial and deep muscles initially whereas the specific approach only the deep muscles initially
What is the best description of the role of the gluteals in spinal stabilization? (don’t think about role as much)
A. they are often overactive which allows the spinal stabilizers to get weak from underuse
B. they are attaché to the pelvis and provide significant pelvic stability which results in excessive lumbar lordosis
C. clam shells are performed for selectively activating and strengthening the gluteals while stabilizing lumbar spine
D. they are often underactive and generate somatic referred P in patients with poor stabilization
C. clam shells are performed for selectively activating and strengthening the gluteals while stabilizing lumbar spine
Davida’s physician has confirmed “B lumbar stenosis” but she is a poor surgical risk so her physician has sent her to therapy to see if anything can be done. Your subjective reveals that she ahs intermittent back and bilateral thigh and calf P but no B/B changes. Her sensation testing is normal but she reports that when her back hurts, she gets B tingling in her calves. DTR’s are 1+ B. Her agg factors, AROM, and repeated motions all indicate a directional preference for flexion. Which of the following is the best assessment of these finding?
A. She needs to be referred back to her physician bc of the B symptoms
B. She should be taught stabilization exercises in posterior tilted posture if neutral increase her back and LE pain
C. She should be issued a lumbar roll which will enable to sit with more muscle relaxation and better posture
D. She needs to be assessed carefully to determine whether pressure relief should focus on central canal or IVF
B. She should be taught stabilization exercises in posterior tilted posture if neutral increase her back and LE pain
A pt says that repeated flexion in standing increase his back P but decrease is thigh P. What is the best response?
A. “This is a positive change bc the thigh P is the most important symptom right now. We can address your back P more specifically once we figure out the thigh P.”
B. “This is a positive change because the back P isn’t really important right now until we get your thigh P resolved.”
C. “This suggests that your back and thigh P are really coming from 2 different problems. We’ll get the thigh problem fixed then figure out your back problem.”
D. “I’m only interested in the thigh pain right now but the fact that you also have back pain means that this problem will probably take longer to get better”
A. “This is a positive change bc the thigh P is the most important symptom right now. We can address your back P more specifically once we figure out the thigh P.”
Tai is seeing you for back and posterior thigh P and reports that FIS (flexion in standing) increases her back and thigh P, but double knee to check (flexion in lying) only increased her back pain. What is most likely the structure at fault? A. jt capsule B. posterior annulus C. sciatic nerve D. trunk extensor muscle
C. sciatic nerve
- in standing, the nerve is tightened; in lying, nerve is on slack
- *could be both posterior annulus or sciatic nerve causing the pain, but the sciatic nerve is the best answer
A lateral shift is NOT usually
A. voluntarily adopted by the pt to reduce P
B. associated with reduced lumbar mobility
C. contralateral to the side of pain
D. related to an annular defect
A. voluntarily adopted by the pt to reduce P
Active extension ROM causes local LBP at the end range but this P resolves when the pt returns to standing. Repeated extension causes pain with each repletion but no lasting P, and flexion ROM is unchanged after repeated extension. The pt is most likely to be in the \_\_\_\_\_\_ classification A. flexion-specific exercise B. extension-specific exercise C. mob/ manip D. movement/coordination
C. mob/ manip
*they are have P only at the end- problems with the tissue- shortened- need to be mob/manip
