case 1 - spondylolysis

Question 1

case 1

Answer 1

L5 Spondylosis

Question 2

l5 Spondylosis assesment

Answer 2

baseline functional task measures, confirm segment (palp and paivms) and idea of motor control)

Question 3

L5 spondylosis

• assessment
  1. Observation

Answer 3

a. Standing/standing on right leg/single leg (observe)
i. Observe for possibility of lat shift, pelvic tilt
ii. Observe for trendelenburg (pronounced more on R side)
iii. Looking for lumbar lordosis etc/ general posture
b. Jump/land on right foot if not too painful/irritable or squat
i. Indicates sides, bracing on take off and landing and look for too much ext, maladaptive patterns. Do because it is the task that brings on her pain - functionally relevant to goals
ii. Looking for pain and diff between sides

Question 4

L5 spondylosis

• assessment
  2. AROM+PROM

Answer 4

– reproduce symptoms of pain, provides baseline to be used for reassessment, see side difference, decreased range, reverse lumbar curve later in ROM of flexion, l5/s1 hinging ?

a. Flexion
b. Extension
c. LF

potentially
1. Combined mvmts
- only if no pain or mild symptoms
adding extra component to identify source of pain

Question 5

L5 spondylosis

3. - assessment MC

Answer 5

Motor control
. Prone hip extension (motor control)
- Progression to four point kneeling with raising arm/leg or hella progress to a deadlift (once the fracture has healed)
- Regression four point kneeling lumbopelvic dissociation (possibly also in sitting)
If can’t do prone maybe do a standing version or sitting version

Question 6

L5 spondylosis

- assessment other

Answer 6

3. Palpation
   - Find out the segment/area
   - How sensitive and irritable
   - Areas to palpate: QL, iliac crest, erector spinae and midline
   - Determine atrophy
4. PAIVMs → localise affected segments
   - ‘reactivity’ or pain associated
   - know The mobility of the segment
   - If they ask if it’s too painful then say you’d Start with small amount of mvnt to find level and start light
   - To find segment - good for educating patient and to know where to treat
   - Also sensitisation (central/peripheral), hyperalgesia
   - Builds patient trust/satisfaction
   - Inflammation / other nociceptive source

Question 7

Spondylolysis management 3 priorities

Answer 7

1. Advice and education
2. Motor control → hip extension
3. Pain reduction

Question 8

spondylolysis management advice and ed.

-

Answer 8

1. Advice and education
   - What the injury is and about sensitisation (alarm system and central because she is getting global area, but also peripheral)
   - - Reassures patient of what is happening, and why she is getting symptoms but also that the extent of area of pain does not reflect the amount of damaged tissue
   - Prognosis: 6-12 weeks recovery with conservative management meaning that you will need to take some time off from your gymnastics training for the first few weeks, but we can work together to find some activities you can still participate in to maintain your fitness.
   - Activity modification
   - What it means for her sport program?
   - Time off (discontinuing gymnastics for 8-12 weeks to heal)
   - Gentle graded exposure back to gymnastics
   - Avoiding extension and rotation (throwing ball)
   - Other forms of activies (swimming, deep water running cycling) to maintain fitness and
   - Do what they can do to maintain fitness and mental health - focusing on what she can do not what she can’t do only
   - Check understanding

• Bone scan (gold standard imaging)

Question 9

spondylolysis management

2. Motor control → hip extension

Answer 9

• 4 point kneel (bird-dog)
• Progressing motor control can include adding load, speed and complexity to the task and reducing feedback and base of support.
• Eventually motor control in standing that challenge extension – wood chop, throwing medicine ball or swiss ball overhead (eccentric control into extension).
  Jumping-landing – using trampoline if possible to start with (lower load). Gradually return to sport (depending on symptoms and time).

Question 10

spondylolysis management

3. Pain reduction

Answer 10

• Massage → R) QL and Iliac crest
• manual therapy: reverse lateral flexion or low grade rotation (not PA/unilateral PA high grade directly over joint)
• Say to patient: I’m doing this technique/movement to: Get your back to relax and become more comforttable with movements you are having difficulty with
• pain killers education – doc or pharmacist