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MSK II > Class 3-4: LBP-IDD > Flashcards

Class 3-4: LBP-IDD Flashcards

(52 cards)

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1
Q

why is the general classification non specific LBP

A

nearly all cases have an unidentified nociceptive source

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2
Q

what does the STarT back tool do

A

determines risk of persistent diabling pain and matches treatment

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3
Q

prevalence of lumbar LBP

A

leading cause of worldwide disability and activity limitation/work absence

half of people over 65 will have it

80% of people will experience in their life

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4
Q

prevalence factors for LBP

A

women
older
lower edu status
higher physical work demands

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5
Q

risk factors for LBP

A

previous LBP
co-morbidities
poor mental health
smoking
obesity
low activity level
awkward posture
heavy lifting
fatigue
genetics with ARDC ONLY

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6
Q

functional lumbar flexion ROM for sit to stand

A

35-42 degrees lumbar flexion

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7
Q

functional lumbar flexion ROM for picking up objects on floor

A

60 degrees lumbar flexion

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8
Q

how many asymptomatic individuals will have positive findings on imaging

A

1/3

i.e. IDD, ARDC, N compression, or facet hypertrophy

2/3 had disc changes from 30-80 years old

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9
Q

how many symptomatic individuals had positive scan findings

A

1/2 had an abnormality

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10
Q

who should get imaging with LBP

A

over 50 years old AND hx of cancer
saddle paresthesias
bowel/bladder dysfunction
specific neuro deficits
progressive/disabling symptoms
NO improvement after 6 wks

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11
Q

problems that are presented with over-utilization of unsupported and ineffective PT Rx for LBP

A

higher costs
greater opioid addiction
greater imaging/radiation exposure
more likely to have invasive procedures/side effects
more absences from work

fear avoidance behaviors are promoted with passive interventions like modalities and even some manual therapies

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12
Q

things to keep in mind for the prevention component of LBP RX

A

inadequate research

most promoted preventions lack evidence

exercise is largely effective in adults

children = ergonomic furniture is effective but exercise is not evaluated

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13
Q

benefits of early PT with LBP

A

2% developed persistent LBP vs 15% with later PT

significant reduction in work absence

supported in many studies

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14
Q

what edu and advice should be given to LBP pts as a first line Rx

A

advise against bed rest and in-depth explanations of what is causing LBP

advise for:
-Spinal anatomical and structural strength
-neuroscience explanation
-overall good prognosis
-active P! coping mechanisms that decrease catastrophizing
-stay active and resume ADLs early
-emphasis on function

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15
Q

importance of edu in PT Rx for LBP

A

greater emotion = greater pain and persistence

improve emotions = less pain and persistence

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16
Q

validity of dry needling for any MSK condition

A

low/mod evidence of benefit on pain vs no treatment or placebo

no functional benefit

no support to use over exercise and manual therapy

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17
Q

effectiveness of modalities for LBP

A

generally ineffective/non reccomended

short term results at best; often no better than placebo

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18
Q

STM/massage effectiveness for LBP

A

only short term benefit

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19
Q

ways to overcome barriers to best practice in PT

A

increase consultation time and follow up

decrease lawsuits based on evidence

better incentives to return to work

public service announcements

reward quality and not quantity with reimbursement

increased provider knowledge of evidence and guidelines for use in clinical reasoning and decision makinh

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20
Q

what are the 4 LBP Rx subgroups

A

mechanical traction
directional preference
mobilization/manipulaiton
stabilization

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21
Q

effectiveness of intermittent traction with LBP

Study These Flashcards
A

preliminary support for LBP when symptoms peripheralize during repetitive ext and when there is a positive SLR special test

22
Q

intermittent traction is more supported in prone and when..

Study These Flashcards
A

18-60 yrs

paresthesias in last 24 hrs distal to knee

oswestry questionnaire > 30

+ n root compression, crossed SLR, and/or centralization

23
Q

there is moderate evidence against all types of tx when used alone in patients with…

Study These Flashcards
A

acute, subacute, and persistent LBP

non-radicular LBP

varying symptom pattern

24
Q

how can you tell if a patients LBP has directional preference

Study These Flashcards
A

pt centralizes with 2 or more movements in the same direction (i.e. flex or ext)

or

pt centralizes with movement in one direction and peripheralizes with an opposite movement

25
effectiveness of mckenzie exercises for acute LBP
nor superior to other treatments for pain/disability often utilized well with acute IDD in short term
26
effectiveness of mckenzie exercises for persistent LBP
no difference in pain/function vs no intervention at all
27
what classifies a LBP pt as a manipulation classification
recent onset of symptoms (<16 days) no symptoms distal to knee
28
least common IDD
acute herniations- nuclear migrations
29
most prevalent IDD
disc changes due to variables that allow herniations that gradually develop over time persistent IDD
30
what region are IDD injuries most common
most common in lumbar only 1-3% IDDs are symptomatic 95% at L4-S1
31
most common portion of the disc to tear
posterolateral weaker, thinner has more vertical and less oblique fibers just lateral to posterior longitudinal ligament
32
how does the acute disc injury usually happen
forward bending at waist with or without twisting/lifting
33
describe how the lumbar spine is not flexing like you think
b/c of pelvic tilt less circumferential disc compression/uneven annular tension with lumbar flattening and pelvic tilt less fixated end plate more anterior shearing and possible rotating stresses with additional influence of gravity increased and asymmetrical stress on weaker and thinner posterolateral annular and end plate fibers
34
best way to squat
not holding lordosis; avoid excessive arch let body move the way it wants let lumbar region curve and pelvic tilt allows symettrical compression
35
are outer or inner annulus tears more common
outer + end plate avulsion more common
36
once damaged how do disc structures act
immunoreactive
37
what happens as a result of the large inflammatory response of the disc when injured
excessive osmotic pressure OR increased static fluid pressure and around disc and spinal nerve static fluid has more inflammatory chemicals that sensitize nerves and cause pressure/tension no lymph drainage extended inflammatory phase
38
typical posterolateral IDD symptims
dull achy pain radiculopathy referred pain into glutes and groin decreased pain when unloading or lying/supported/walking increased pain with FB/sitting/coughing/lifting 24 hr behavior: increased pain in the morning
39
why does IDD cause dull/achy pain
annulus is highly innervated and very painful significantly more swelling than cervical disc due to higher number of gags
40
why might there be radiculopathy with IDD
possible segmental paresthesias within 24 hours worse situations = radiculopathy + coldness bc vv have rich routes and high degree of resistance to ischemia
41
observation of someone with posterolateral IDD
lateral shift of shoulders on pelvis common SB away from pain counter contralateral SB to levels rare = smaller calf growth -wasting likely at 4-6 wks of severe spinal n compression -more a sign of persistent radiculopathy
42
ROM findings for posterolateral IDD
all may cause pain flx + SB away from injured side = limit/P!; pushes swelling toward n and puts tension on area of injury ext + SB towards injury = less limited; often centralizes extremity pain BUT may increase spine pain from high osmotic pressure on disc (squeezing out swelling from pressure needed to relive leg pain)
43
scan findings for posterolateral IDD
resisted and MMT = variable possible + stress test with compression/distraction/PA pressures/torsion neuro = possibly + depending on severity/timing possibly + stability tests
44
rare central IDD signs
cord or cauda equina S&S depending on level immobilize and emergency referral
45
mckenzie method based on what
belief that most of the spinal pain comes from injuries to the disc classifies symptoms based on location of symptoms and positions/motions that decrease symptoms research says this is NOT the case
46
3 classification syndromes of the mckenzie method
postural = essential to correct posture dysfunctional = essentially stretches to improve end ROM derangement = essentially using end range motion to improve the theoretical nucleus migration in the disc
47
effectiveness of mckenzie method
evidence suggests NOT superior to the other treatments for pain/disability overall long term treatment effect is small; more needs to be done
48
strong evidence for mckenzie method when
benefit with LE symptoms and when centralization occurs with acute IDD
49
possible mechnisms of action for the mckenzie method
dynamic disc theory (nucleus repositions centrally) = unproven fluid dynamics with or without herniations (squeezing swelling away with repetitive motion)
50
PT Rx for acute IDD
POLICED directional preference = 10-20 reps every 1-2 hours intermittient traction if radiculopathy posture/ergonomic edu limited sitting neural mobilizations HEP for 1-2 weeks possible to avoid sitting while driving unweighted walking lessening over time
51
for acute IDD MET is ultimately for what purpose
tissue proliferation and stabilization
52
why should we squat "like a toddler"
more circumferential disc compression even annular tension with lumbar flexion/posterior pelvic tilt more fixated end plate less anterior segmental shearing and possible rotational stresses with additional influence of gravity

MSK II (18 decks)

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