Full Mckenzie Lumbar Flashcards
(46 cards)
1
Q
What percentage of adults experience back pain in their lifetime
A
- 50-80%
2
Q
Back can be episodic, recurrent, and persistent (True/False)
A
- True
3
Q
What are the risk factors for back pain
A
- PMH of prior back pain
- Heavy lifting or frequent lifting
- Whole body vibration (driving/machinery)
- Prolonged/frequent twisting
- Prolonged/frequent bending
- Awkward postural stresses
- Psychosocial factors
4
Q
The average person flexes how many times per day
A
- 3000-5000 times per day
5
Q
What posture causes increased and decreased disc pressure
A
- Kyphosis & flexion = increased disc pressure
- Lordosis & extension = decreased disc pressure
6
Q
Innervated structures of lumbar spine that can produce pain
A
- Facet joint capsule
- Out layer of annulus fibrosis of intervertebral disc
- Vertebral bodies, dura mater
- Nerve root sleeve & connective tissue of nerves
- Spinal musculature
7
Q
Describe chemical pain
A
- constant
- acute onset
- Signs of inflammation: swelling, rubor, calor, tenderness
- all movements are painful
- no movement reduces symptoms
8
Q
Describe mechanical pain
A
- intermittent but can also be constant
- certain repeated movements reduce or abolish/centralize symptoms
- movements in one direction may lessen symptoms whereas symptoms in another direction may increase symptoms
9
Q
Describe chronic pain
A
- may not be influenced by mechanics alone
- need to account for psychosocial factors
- length of time present does not mean mechanical assessment and treatment are not beneficial
- may take longer than patient’s that are not chronic
- chronic pain may not respond to treatment.
10
Q
What are the 3 tissue repair phases
A
- Inflammatory: 0-5 days
- Repair: 5-21 days
- Remodeling: 21+ days
11
Q
Describe the components of the intervertebral disc
A
- Concentric layers of annulus fibrosis surround nucleus pulposus
- Nucleus distributes forces evenly
- Outer annulus is innervated
- Posterolateral annulus is weakest
12
Q
Define the intervertebral disc terminology
A
- Displacement: intradiscal mass displacement within annulus
- Protrusion: intact annular wall (disc bulge); reducible condition
- Extrusion: annular wall breached by intradiscal mass that protrudes through but remains in contact with the disc
- Sequestration: annular wall breached by intradiscal mass that has separated from disc (irreducible)
13
Q
What are the cardinal features of MDT
A
- Classification of subgroups
- Focus on centralization
- Self treatment & patient education
- Progression of forces
14
Q
Describe lumbar dysfunction pain
A
- Pain caused by mechanical deformation of structurally impaired soft tissue
- Contracture, scarring, adherence, adaptive shortening of tissue
- Pain is intermittent
- Pain only occurs at end range of restricted movement
- Present at least 6-8 weeks
- Pain is localized (except in case of adherent nerve root)
- Symptoms do not persist after repeated movement testing
15
Q
Describe a lumbar extension dysfunction
A
- End range pain in extension that does not remain worse upon repeated movement
- Ext ROM will not progress with repeated movement
16
Q
Describe a lumbar flexion dysfunction
A
- End range pain in flexion that does not remain worse after repeated movement
- Flexion ROM will not progress with repeated movement
17
Q
Describe postural syndrome
A
- Intermittent pain brought on only by prolonged static position.
- Rarely seen in clinic
- Pain is localized
- No pain with movement
- No ROM deficits
- Posture correction decreases symptoms
18
Q
Define derangement
A
- Clinical presentation which demonstrates directional preference in response to loading strategies & is typically associated with the movement loss
19
Q
Describe a lumbar derangement
A
- Most common classification
- symptoms are variable, inconsistent and can change
- movements can increase/decrease symptoms
- sustained postures can increase/decrease symptoms
- temporary deformity may be present: lateral shift, lordosis or kyphosis
20
Q
Patterns in patient history for derangement
A
- Symptoms local, referred or radicular
onset can be gradual or sudden - Symptoms can change sides
- Symptoms can move proximal/distal
21
Q
Patterns in examination for derangement
A
- ROM Loss in one or more directions
- May have obstructed movement (movement loss that is temporary and changes rapidly with repeated movements
- Can have temporary deformity: Lordosis, kyphosis, lateral shift
- May have deviation with movement
- Repeated movements and sustained loading strategies
- Cause symptoms DURING and AFTER
- Can increase or decrease baseline ROM
- Range of motion can increase or decrease
22
Q
What is a hallmark of derangement
A
- Rapid change
23
Q
Define directional preference
A
- Clinical phenomenon where a specific direction of movement results in a clinically relevant improvement in symptoms
- There is not always a change in the location of the pain
24
Q
Define centralization
A
- Phenomenon by which distal pain originating from the spine is progressively abolished in a distal to proximal direction
- This is in response to a specific repeated movement and/or sustained position & this change in location is maintained over time
25
Describe Directional Preference and Centralization
- Only Present in Derangement Syndrome
- Occurs with repeated movement/sustained positions
- Most common with Extension
- Less common with lateral or flexion
- Will see improvement in symptoms
- May see improved function and/or mechanics
- If present this indicates a good prognosis
- Failure to find this indicated poor prognosis
26
Red flags/contraindications for MDT of the lumbar spine
- Serious spinal pathology
- Cancer
- Infections
- Fractures & osteoporosis
- Cauda Equina Syndrome
- Spinal cord signs
- Ankylosing spondylitis
- Recent surgery: fusion 3 mo to 1 year for good stabilization; discectomy no concerns
27
Red flag clues
- Age >55
- Hx of cancer
- Unexplained weight loss
- Constant, progressive, non-mechanical pain, worse at rest
- Systemically unwell
- Persisting severe restriction of lumbar flexion
- Widespread neurological deficit
- Prolonged steroid use
- Hx of intravenous drug use
- Hx of significant trauma enough to cause Fx or dislocation
- Hx of trivial trauma & severe pain in potential osteoporotic individual
- No movement or position centralizes, decreases, or abolishes pain
28
Describe a R versus L lateral shift
- R lateral shift: vertebra above has laterally flex to the right in relation to vertebra below. Shoulders to the right
- L lateral shift: vertebra above has laterally flexed in relation to the vertebra below. Shoulders to the left.
29
If during motion testing the pain abolishes or centralizes further testing of movements is not necessary (True/False)
- True
30
When is static testing indicated
- Severe pain or very acute pain
- When repeated movements do not effect symptoms
- If patient only reports symptoms with prolonged position
31
Lists the lumbar static tests
- Slouch sitting
- Long sitting
- Sitting erect
- Standing slouched
- Standing erect
- Lying Prone in extension
32
Terminology during movement
- Increase (↑) : Symptoms already present increase in intensity
- Decrease (↓): Symptoms already present decrease in intensity
- Produce (P): symptoms produced that were not present
- Abolish (A): Symptoms disappear during testing
- Centralising: Movement of pain from distal to proximal
- Peripheralising: Movement of pain from proximal to distal
- No Effect (NE): movement has no effect during testing
33
Terminology after testing
- Worse (W): Symptoms produced or increased with movement and remain aggravated after testing
- Not Worse (NW): Symptoms produced or increased with movement return to baseline after testing
- Better (B): Symptoms decreased or abolished during movement remain better after testing
- No Better (NB): Symptoms decreased or abolished during with movement or loading return to baseline after testing
- Centralised: Distal pain abolished by movement that remains abolished after testing
- Peripheralized: Distal pain produced during movement testing remains after testing
- No effect: Movement or loading has no effect on symptoms after testing
34
Describe a red light situation
- Produce worse
- Increase worse
- Peripheralize worse
35
Describe a yellow light situation
- Produce not worse
- Increase not worse
- Decrease not better
- Abolish not better
36
Describe a green light situation
- Decrease better
- Abolish better
- Centralizing better
37
Slide 61
38
What are the 4 stages of management of derangement
- Reduction
- Maintenance
- Recovery of function
- Prevention of recurrence
39
Clues for extension/posterior derangement for central symmetrical symptoms
- Hx: flexion injury/activity at onset
- Aggravating factors: sitting, b ending, rise from sitting
- Alleviating factors: lying with legs straight, standing, walking, sitting upright
- Exam: reduced lordosis
- Repeated motions: repeated flexion may increase or worsen
40
Clues for flexion/anterior derangement for central symmetrical symptoms
- Worse with walking and standing
- Have obstructed flexion ROM
- Improve with sitting
- May have excessive or fixed lordosis no reversal of curve in flexion
- Good response to flexion in lying
- Usually have a dramatic improvement in flexion ROM when rechecked in standing
- Test end range sustained extension prone lying on elevated plinth 2-3 mins: Pt will have obstructed flexion ROM
41
Clues for lateral component
- Unilateral or asymmetrical symptoms
- Activities of flexion and extension are aggravating factors
- Asymmetric ROM loss with side glides
- Centralizing or reduces symptoms with lateral movements
- Peripheralization or worsening with prone lying or extension in lying
- Symptoms unchanged after several days of extension exercises
- Is there a shift that needs to be corrected?
42
Extension with lateral component
- Position hips off center away from the painful leg
- Prone lying in extension with hips off center
- Extension in lying with hips off center
- Extension in lying with hips off center and clinician overpressure
- Side glides in standing
- Extension mobilization with hips off center
- Rotation mobilization in extension
- Consider return to sagittal plane extension once centralized.
43
Exercise prescription
- 10-15 repetitions, multiple sets if needed of appropriate principle.
- Exercise should be least force that decreases, abolish or centralize symptoms
- Have patient perform every 2 hours.
- Consideration for ability level (may need less frequency)
- Consideration for severity of symptoms (may need increased frequency)
- Avoid movements that exacerbate symptoms
44
Is derangement stable
- End range symptoms produce no worse
- No pain during movement
- Symptoms that produce do not remain worse
- Symptoms do not peripheralize
- Symptoms should not increase with repetitions
45
Describe recovery of function "5x5x5"
- Reintroduce flexion
- Begin with least force: flexion in lying
- Progression flexion force as tolerated ~ every 5 days
- 5-6 repetitions, 5-6 times per day
- Follow with 5 reps extension
- Avoid flexion in early AM
- Recovery of function not required with anterior derangements
- Don’t need to recover extension with anterior derangement
46
Prevention of recurrence
- Continue recovery of function program for 6 wks
- HEP: 2x/day, 10 reps flexion & 10 reps extension for life
- Continue use of lumbar support roll for life
