Lecture 2 Flashcards
disc pain patient presentation
- muscle guarding
slightly flexed posture and - deviate away from the symptomatic side
- neuro (derm and myo) but that’s severe.
- more symptoms with sitting, flexed posture, transition from STS, cough, strain
- SLR at 30-60 degrees
- “peripheralization” of sx with repeated forward bending
disc pain vs facet pain?
disc- first- “on and off”
facet- “used to be on and off but now it’s just on”
facet pain patient presentaion
- acute: mm guarding
- subacute and chronic: immobility or excessive activity
- posture impaired
- impaired extension
- any prolonged flexibility exercises or rep of trunk motion may exacerbate sx
- pain worse in am/pm
2015 TBC update
medical management: for red flags, med comorbidities, neurologic deficits
rehab management: med to high psychosocial and minor/controlled medical
self-car management: low psychosocial; predominately axial LBP
patient with nerve root impairment
early on, SLR = SLUMP ; pain increasing with flexed posture
later: stenosis
stabilitiy is visualized as a three-legged stool
- active mm function
- passive osteoligamentous structures
- neural control from CNS
NEED ALL 3 FOR STABILITY
factors favoring manipulation
acute (< 16 days)
no peripheralizaiton
hypomobile
low FABQ (< 19)
Hip medial rotation >35
factors against manipulation
Sx below knee
more episodes
peripheralization with motion
no pain w spring testing
factors favoring stabilization
- hypermobile
- younger
- SLR > 90
- Aberrant motion (catches)
- post partum
- tender over long dorsal lig
- pubic symph tender
- increased episode 3 or more
factors favoring traction
S&S of nerve root compressing;
NO MOVEMENT HELPS CENTRALIZE. always peripheralized
flexion preference exercises
Supine with knees flexed
Single knee to chest
Double knee to chest
Posterior pelvic tilt
Quadruped Cat/camel
Quadruped rocking backward
Hamstring stretching
Trunk curls
Progression: restore extension in prone or prone over
pillows
Prone knee bends to stretch hip flexors and quads
Stabilization exercises in neutral spine
Flexion preference
ADL/Education
Avoid overhead activities & extension
Standing with one leg on stool/shopping cart
Sitting with knees above hips
Endurance/CV training – bike, water aerobics
Lumbar corset for acute phase?
“flattened spine” =
flexion prefernce
(and lordosis/kyphosis posture)
Extension Preference
exercises: Acute
Prone lying
Over pillows
Lie flat
Pillow under chest
Lateral shift correction Prone
Standing
Prone on elbows Prone press up Watch
closely! Lumbar ext or posterior pelvic tilt? Decrease
range or stabilize pelvis as needed.
Standing extension
ideas to increase rotation
sidelying thoracic rotaiton (open books)
supine with knees flexed then legs side to side for rotation
exercises to increase SB
prone reaches
quadruped SB
sidelying over bolster
stand sidebends
respond to external loads and controls orientation
global muscle function
dynamic support of individual segements
deep, segmental muscles
name the global muscles
Rectus abdominis, EO, ES
name the deep muscles
TA
IO
Multifidus
Volitional Pre-emptive Abdominal
Contraction (VPAC) Strategies
Abdominal Draw In Maneuver (ADIM)
Multifidus Activation (MF)
Pelvic Floor Muscle Activation (PFM)
Abdominal Bracing Maneuver (ABM)
turning on the “core”
POOR activaiton signs
Posterior pelvic tilt
Pull upper abdominals under ribs
Quick contraction
Pulling ribs down (this activates EO; not what we want)
multifidus poor activation signs
posterior pelvic tilt
erector spinae activation
fundamaental 6 pack
Transversus Abdominis/Internal Oblique
Multifidus
Pelvic Floor
Gluteus Maximus
Latissimus Dorsi
Diaphragm
