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Flashcards in Final Exam Msk PART LBP Deck (66):
1

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

2

Simplified model to 4 interventions for signs and symptoms LBP according to treatment based classification?

 Specific Exercise
 Manipulation
 Stabilization
 Traction

3

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”

4

Manipulation Subgroup

 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

5

First contact provider triage what are 3 approaches to care?

1. Medical management
2. Self-management
3. Rehabilitation management

6

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

7

Örebro Musculoskeletal Pain Questionnaire

Scores grouped according to risk for developing persistent pain and disability

8

Lumbar Stability: 3 sub systems

Passive
Active
Neuromuscular Control

9

Passive Sub system consists of what?

Ligaments
thoracolumbar myofascia
Osseous structures

10

Active Sub system consists of what?

Global superficial stabilizers: rectus, obliques, QL, erector spinae

11

Active Sub-system: Global Stabilizers what is there function?

€ Function as guy wires to stabilize
spine
€ Transmit force across multiple segments
€ Respond to forces that shift center of mass
€ Control trunk movements

12

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

13

What is the neutral zone?

Minimal resistance to intervertebral motion from passive structures

14

What systems provide stability at the neutral zone?

Active and neuromuscular control

15

What is the elastic zone?

€ Significant resistance to intervertebral motion from passive structures

16

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

17

Lumbar Segmental Instability what zone will patients have less control in?

Neutral zone

18

If the following test are positive then you will test positive for LSI instability?

€ SLR
€ Prone instability test
€ Passive lumbar extension test

19

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

20

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

21

Directional Preference

is the direction in which posturing or repeated movements cause pain to decrease and/or abolish, or centralize and ROM increases

22

Centralized

indicates that all distal pain has abolished and that the pt has only central LBP.

23

Centralization of LE symptoms:

Foot to ankle to calve to thigh to buttock to back

24

Peripheralization

the phenomenon by which proximal symptoms originating from the spine are progressively produced in a proximal to distal direction

25

Peripheralized

Indicates application of inappropriate loading strategies that have caused distal symptoms that were produced to last

26

Disc model Flexion

Anterior disc compressed and posterior annulus stretched

27

Disc model extension

Posterior disc compressed and anterior annulus stretched

28

Postural Syndrome


 Pain remains local only to lumbar spine and is time-dependent
 No LE pain and no parasthesias
 Lumbar ROM is full and painfree

29

Dysfunction Syndrome

 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)

30

Derangement syndrome

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

31

Posterior derangement prefer what based movement ?

prefer extension based movement

32

Posterolateral derangement prefer what based movement ?

combined with extension and lateral based movements

33

Anterior derangement prefer what based movement ?

Flexion based movement

34

Anterolateral derangement prefer what based movement ?

combined flexion and laterally based movements

35

lateral shift

- named according to the side shoulders are deviated towards
- easily visible
- disappear at rest

36

Treatment principles force progression

self generated forces, SGF with self over pressure, RM with PT OP, mobilization, manipulation

37

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

38

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

39

Treatment of Derangment

1. reduce derangement
2. maintain reduction
3. recovery of function
4. prevent reoccurance

40

Hypomobile segments should be treated with?

Joint and soft tissue manipulation

41

Hypermobile segments should be treated with?

Stabilization

42

Identify the Arthrokinematic Motion at Each Facet flexion

Left and right facet upslide

43

Identify the Arthrokinematic Motion at Each Facet Extension

Left and right facet downslide

44

Identify the Arthrokinematic Motion at Each Facet Right sidebend

Left facet upslide

right facet downslide

45

Identify the Arthrokinematic Motion at Each Facet Left sidebend

Left facet downslide

right facet upslide

46

Identify the Arthrokinematic Motion at Each Facet Right Rotation

Left facet compress

Right facet gap

47

Identify the Arthrokinematic Motion at Each Facet Left Rotation

Left facet gap

Right facet compress

48

Facet capsular restrictions occur limit motion in what?

Upslides and gapping

49

What is capsular pattern restriction of the right L4/L5 facet?

Flexion, Left side bend, Right Rotation

50

When palpating for conditions what are the 3 Ts you are considering?

Temp, tenderness, tone

51

Define osteokinematics?

Palpation of motion such as flexion, SB, etc...

52

Define arthrokinematics?

Palpation of joint glides and spring testing

53

With PIVMs what are you palpating for?

Excursion, end feel , quantity if they are normal, hypomobile, hypermobile

54

With PAIVMs what are you testing for?

You are assessing for joint mobility, irritability, end feel, and if there is pain in the segment

55

Mechanical therapy does what to patients?

stretch the tight tissues

snap intra articular adhesions

increase arthrokinematics and osteokinematics

56

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

57

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

58

Contraindications to Manipulation

 Metastatic disease
 Congenital (i.e. dysplasia)
Iatrogenic (long-term use of corticosteroids)
Inflammatory (rheumatoid
arthritis)
Trauma/suspected or confirmed Fracture
Spondylolysis/spondylolisthesis
 Osteoporosis/osteopenia

59

Contraindications vascular

 Aortic aneurysm
 Blood disorder (hemophilia)
 Use of anticoagulants

60

What are the goals of neurodynamics?

 Goal is to increase nerve’s capability to slide
 Improve flow of axoplasm
 Decrease LE symptoms

61

If you have a facet restriction what is a sign or symptom

Decreased ROM in Facet capsular pattern

62

If you have a facet entrapment what are sign and symptoms?

Pain with movements requiring downslides

63

Muscle guarding voluntary caused by pain or fear of pain. what are signs and symptoms

Decreased AROM/PROM and pt apprehension

64

Muscle guarding involuntary caused by injury, trauma or dysfunction. what are signs and symptoms

 Hypertonicity
 Decreased ROM

65

What are signs and symptoms of Disc Dysfunction?

 Acute-rip or tear and sharp pain
 LE- symptoms
 Neurological signs

66

Lumbar Stenosis what are signs and symptoms?

 Central- bilateral LE, multi level
dermatomes/myotomes involved
 Foraminal- single level dermatome/myotome
 Neurogenic claudication with activity