Flashcards in Final Exam Msk PART LBP Deck (66):
What are the three stages for treatment-based classification?
1. Determine appropriateness for PT vs referral or consultation
2. Determine severity and stability of pt’s symptoms
3. Match pt with most appropriate intervention
Simplified model to 4 interventions for signs and symptoms LBP according to treatment based classification?
What is Centralization
in response to therapeutic loading strategies, pain is progressively abolished in a distal-to-proximal direction with each progressive abolition being retained over time until all symptoms are abolished”
Symptom duration <16 days
No symptoms distal to knee
FABQ-Work subscale score <19/42
At least 1 hypomobile segment with prone PA spring test
Prone Hip IR >35 on at least one side
First contact provider triage what are 3 approaches to care?
1. Medical management
3. Rehabilitation management
STarT Back Screening Tool
Score determines categorization of pts into Low, Medium, or High-risk for persistent pain and disability and subsequent management strategies based on category
Örebro Musculoskeletal Pain Questionnaire
Scores grouped according to risk for developing persistent pain and disability
Lumbar Stability: 3 sub systems
Passive Sub system consists of what?
Active Sub system consists of what?
Global superficial stabilizers: rectus, obliques, QL, erector spinae
Active Sub-system: Global Stabilizers what is there function?
€ Function as guy wires to stabilize
€ Transmit force across multiple segments
€ Respond to forces that shift center of mass
€ Control trunk movements
Active Sub-system: Segmental Stabilizers do what for the lumbar spine?
have direct attachment to vertebrae
control motion at segmental level
rotators and intertransversarri may play a role
What is the neutral zone?
Minimal resistance to intervertebral motion from passive structures
What systems provide stability at the neutral zone?
Active and neuromuscular control
What is the elastic zone?
€ Significant resistance to intervertebral motion from passive structures
What is the definition of instability ?
loss of motion stiffness such that forces applied to a given segment produce greater displacement than would occur normally
Lumbar Segmental Instability what zone will patients have less control in?
If the following test are positive then you will test positive for LSI instability?
€ Prone instability test
€ Passive lumbar extension test
Principles of treatment for lumbar spine instability?
- Begin with activation and motor control
- incorporate other muscle groups
- Increase challenge
- progress to strengthening and resistance
- activity specific training
Principles of MDT?
Primarily uses symptom response and mechanical change to develop diagnosis and guide treatment
Emphasizes patient self-management with decreased reliance on therapist
Utilizes progression of forces in treatment approach from least to most force
is the direction in which posturing or repeated movements cause pain to decrease and/or abolish, or centralize and ROM increases
indicates that all distal pain has abolished and that the pt has only central LBP.
Centralization of LE symptoms:
Foot to ankle to calve to thigh to buttock to back
the phenomenon by which proximal symptoms originating from the spine are progressively produced in a proximal to distal direction
Indicates application of inappropriate loading strategies that have caused distal symptoms that were produced to last
Disc model Flexion
Anterior disc compressed and posterior annulus stretched
Disc model extension
Posterior disc compressed and anterior annulus stretched
Pain remains local only to lumbar spine and is time-dependent
No LE pain and no parasthesias
Lumbar ROM is full and painfree
Named according to direction of movement loss
Similar to tissue shortening, scar tissue, etc.
Pain is local to lumbar spine. No LE pain and/or parasthesias
Pain present >8 weeks
No pain at rest, only at end-range ROM
Will likely see loss of ROM in 1 direction (i.e. full lumbar ROM except for extension)
Hallmark is rapid change in symptom severity and location with repeated motions
Patient can have pain at rest, during movement, and at end-range of movement
Pain onset can be acute or chronic
Pain &/or paresthesias can be in spine or LE
Disc or other tissue is obstructing motion. Utilize repeated movements to “clear the obstruction”
Utilizing disc model and patient’s history allows for hypothesis of best treatment approach
Posterior derangement prefer what based movement ?
prefer extension based movement
Posterolateral derangement prefer what based movement ?
combined with extension and lateral based movements
Anterior derangement prefer what based movement ?
Flexion based movement
Anterolateral derangement prefer what based movement ?
combined flexion and laterally based movements
- named according to the side shoulders are deviated towards
- easily visible
- disappear at rest
Treatment principles force progression
self generated forces, SGF with self over pressure, RM with PT OP, mobilization, manipulation
Treatment of Dysfunction Syndrome
- repeated at end range loading direction of movement loss
- pain should be abolished once load removed from end range
- movement has to produce pain/discomfort in order to be effective
Treatment of Derangement Syndrome
Repeated end-range movements or sustained posturing in direction that causes patient’s symptoms to centralize
Disc model can serve as useful guide to treatment based upon pt’s pain location & response to repeated movements
Treatment of Derangment
1. reduce derangement
2. maintain reduction
3. recovery of function
4. prevent reoccurance
Hypomobile segments should be treated with?
Joint and soft tissue manipulation
Hypermobile segments should be treated with?
Identify the Arthrokinematic Motion at Each Facet flexion
Left and right facet upslide
Identify the Arthrokinematic Motion at Each Facet Extension
Left and right facet downslide
Identify the Arthrokinematic Motion at Each Facet Right sidebend
Left facet upslide
right facet downslide
Identify the Arthrokinematic Motion at Each Facet Left sidebend
Left facet downslide
right facet upslide
Identify the Arthrokinematic Motion at Each Facet Right Rotation
Left facet compress
Right facet gap
Identify the Arthrokinematic Motion at Each Facet Left Rotation
Left facet gap
Right facet compress
Facet capsular restrictions occur limit motion in what?
Upslides and gapping
What is capsular pattern restriction of the right L4/L5 facet?
Flexion, Left side bend, Right Rotation
When palpating for conditions what are the 3 Ts you are considering?
Temp, tenderness, tone
Palpation of motion such as flexion, SB, etc...
Palpation of joint glides and spring testing
With PIVMs what are you palpating for?
Excursion, end feel , quantity if they are normal, hypomobile, hypermobile
With PAIVMs what are you testing for?
You are assessing for joint mobility, irritability, end feel, and if there is pain in the segment
Mechanical therapy does what to patients?
stretch the tight tissues
snap intra articular adhesions
increase arthrokinematics and osteokinematics
Rules for manipulation
Symptoms < 16 days
No symptoms distal to knee
At least 1 hip IR >35˚
FABQ work subscale <19
At least 1 hypomobile lumbar segment
According to CPR of lumbar manipulation what are the 2 variables shown to be predictive of success of spinal manipulation in the fritz article?
Symptom duration < 16 days
No symptoms extending distal to the knee
Contraindications to Manipulation
Congenital (i.e. dysplasia)
Iatrogenic (long-term use of corticosteroids)
Trauma/suspected or confirmed Fracture
Blood disorder (hemophilia)
Use of anticoagulants
What are the goals of neurodynamics?
Goal is to increase nerve’s capability to slide
Improve flow of axoplasm
Decrease LE symptoms
If you have a facet restriction what is a sign or symptom
Decreased ROM in Facet capsular pattern
If you have a facet entrapment what are sign and symptoms?
Pain with movements requiring downslides
Muscle guarding voluntary caused by pain or fear of pain. what are signs and symptoms
Decreased AROM/PROM and pt apprehension
Muscle guarding involuntary caused by injury, trauma or dysfunction. what are signs and symptoms
What are signs and symptoms of Disc Dysfunction?
Acute-rip or tear and sharp pain