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Flashcards in L-Spine classification systems Deck (61)
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1

What percentage of patients in primary care that have LBP cannot reliably be attributed to specific disease or spinal abnormality?

85 %

2

What are 7 specific disorders that CAN be a source of back pain?

Cancer = 0.7%
Compression fracture = 4%
Spinal infection = 0.01%
Ankylosing spondylitis = 0.3 – 5%
Spinal stenosis = 3%
Herniated disc = 4%
Cauda equina syndrome = 0.04%

3

What are 4 non-spinal sources of back pain?

- Pancreatitis
- Nephrolithiasis (kidney stones)
- Aortic aneurysm
- Viral syndromes

4

What is Level I of an exam?

- Are they appropriate for PT
- Yellow Flags: refer to psycho-social issues
- Red Flags: Refer for medical work-up

5

What is Level II of the exam?

- Determine the disability stage

6

What is Stage 1 disability? (4 aspects)

- Acute/ recent onset
- Pain dominates
- Function is significantly affected (mostly by pain)
- ODI > 25 %

7

What are the 3 factors of Stage 2 disability?

- ODI a little higher than 20 %
- Impairments dominate
- Function moderately affected

8

What are the 3 factors of Stage 3 disability?

- ODI < 20 %
- Only lacking high level function
- Chronic

9

What should be kept in mind when assessing stages?

- They are not distinct

10

What stage is the treatment based classification applied to?

Stage 1

11

What is the main goal of stage 2?

- Work on impairments and how they affect function

12

What is the main goal of stage 3?

- Return the patient to a high level of functional activity

13

What 2 stages are the most likely to blend?

1 and 2

14

Who were the 3 authors of the KEY article in treatment based classification acute LBP?

- Fritz JM
- Cleland JA
- Childs JD

15

Who came up with the first treatment based classification system?

- Delitto et al

16

What is the 3 step process of classification?

- Screen for red flags
- Confirm that the L-spine is the soruces of the problem, and not another musculoskeletal impairment (strain, bursitis, etc...)
- Categorize into: Manip, Spec Exercise, Stabilization, or Traction

17

What led to the development of the CPR for manipulation?

- Some studies showed it was superior to placebo, while others said it was not
- Wanted to determine what specific patients would benefit from the treatment

18

What 2 things can be determined by a CPR?

- Determines who is likely to benefit
- Determines who may require a different approach

19

What is the CPR for spinal manipulation?

4/5 of the following
- No symptoms distal to the knee
- Symptoms < 16 days
- FABQ score < 19
- L-spine hypomobility as determined by PA assessment
- IR of at least one hip > 35 degrees

20

How was success determined when creating the CPR for manipulation?

Symptoms 50 % better within 2 treatments

21

What are the 4 contraindications/ strong precautions for manipulation of the L-spine?

- > 60 years old
- Spondylolisthesis
- Osteoporosis or other bony abnormalities/ weakening
- Signs of nerve root compression

22

Have the lumbar CPR been validated?

Yes

23

Has non-thrust mobilization been proven be as effective as HVLAs?

No

24

Should the patient receive a lumbopelvic manip or a lumbar neutral gap manip?

It doesn't matter.

25

What 4 exercises made up the HEP following manipulations/ mobilizations in Cleland's study?

- Cat & Camel
- Crunch in neutral
- Side plank
- Quadriped arm and leg

26

What exercise typically directly follows a lumbar manipulation?

- Active ROM exercises

27

What are the 3 effects of a manipulation?

Window for:
- "Safe", pain free ROM
- Normalize muscle activity, and motor control
- Analgesia, and autonomic effects

28

According to Dr B, how many sessions are the manipulations typically performed?

< 3 - 4 sessions

29

What are the 2 most important indicators for lumbar manipulation?

- < 16 days
- No pain below the knee

30

What are the CPRs for stabilization classification?

3/4 of the following:
- < 40 years old
- R/L average SLR > 91 degrees
- Abberant movement during flexion/ extension
- (+) prone instability test