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MSK basics > lumbar back - 3 injuries > Flashcards

lumbar back - 3 injuries Flashcards

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1
Q

manipulation - class criteria

A

no symptoms below the knee

recent onset of symptoms (<16)

low FABQW score (<19)

hypomobility of the lumbar spine

hip IR (>35)

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2
Q

what does FABQW score mean

A

Fear Avoidance Belief Questionnaire

patients’ fear of pain and consequent avoidance of physical activity because of their fear[2][3].

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3
Q

stabilization - class criteria

A

younger age (<40)

general flexibility - greater SLR flex

instability catch or abberret movement during lumbar flex or ext

+ prone instability

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4
Q

extension - class criteria

A

symptoms distal to the buttock

sym centralize with lumbar extension

sym peri with lumbar flexion

directional preference for extension

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5
Q

flexion - class criteria

A

older age (<50)

directional preference for flexion

imaging evidence of lumbar spinal stenosis

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6
Q

lateral shift - class criteria

A

visible frontal plane deviation of the shoulder relative to the pelvis

directional perference for lateral translation movement of the pelvis

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7
Q

traction - class criteria

A

signs and symptoms of nerve root compression

no movement centralize sym

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8
Q

what does peri mean

A

paresthesia moves distally, away from the spine

a sym presents with increased intensity and remains increased for 30 secs after the completion of the movement

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9
Q

what is centralization

A

pain or paresthsia moves centrally, towards the spine

paresthesia that was present is abolished

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10
Q

what is status quo

A

neither centralization of peri is produced

trasient (not perminent) increase or decrease in pain is produced

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11
Q

extension bias - mech of onset

A

bending lifting twisting

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12
Q

extension bias - demographic

A

20-50

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13
Q

extension bias - presentation

A

Antalgic, muscular spasm, difficulty attaining erect upright postures

Extension will cause pain the centralize in these pt

Earlier in the day – have a hard time

Acute LBP – often seen with radiating features

flexion worsen the symptoms

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14
Q

what is the treatment for an extension bias

A

awakening ritual

extension exercises

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15
Q

what are some examples of extension exercises

A

prone lying flat

prone on elb

prone position propped on hands

Standing lumbar extension puts hands on the lower back while extending the spine)

End range loading

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16
Q

what is an example of a awakening principle

A
  • Lying prone
  • Prone on elbows
  • Prone press-ups
  • Get out of bed while maintaining extension
  • Restrict flexion
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17
Q

other things we can do for ext principle

A

maintain lordosis while sitting

limiting time in sitting

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18
Q

lateral shift - MOI

A

– Flexion mechanism

– Acute onset

– Visual deformity, worsens with weight bearing
* Both sitting and walking exacerbate symptoms

– Radicular signs/symptoms

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19
Q

lateral shift - Presentation

A

Frontal plane deviation of the shoulder in relation to the pelvis, accompanied by some degree of flexion.

– Possible signs of nerve root compression
– Positive side-bending test
– Restricted painful extension

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20
Q

lateral shift - pathomechanical

A

– Disc Herniation
– Protective muscle spasm
– Segmental instability

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21
Q

how to correct a lateral shift

A

NWB correction

WB correction

ext syndrome (avoid all flexion)

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22
Q

what are indication for traction

A

Pt with radicular signs and symptoms who are unable to centralize during ROM testing

Back and leg symptoms, resembling a flex/ext syndrome but who is unable to improve with any active movement

Patients with an acute deformity who are unable to self-correct

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23
Q

what are contraindication to traction

A

infection or spinal malignancy

Osteoporosis

Hiatal or abdominal hernia

Pregnancy

Acute Lumbago (Low Back Pain Only)

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24
Q

flexion principle - MOI

A
  • No specific mechanism, often gradual onset
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25
flexion principle - demographic
50s older individual - variable
26
flexion principle - presentation
* Stiff, Achy Back * May exhibit “Claudicant Behavior” – Flatback --Swayback – Hyperlordotic
27
what is Claudicant Behavior
P/N and sense of weakness when standing, walking (mechanical), they want to sit
28
flexion principle - movement control
look at pt’s balance, movement control, and where we can make changes to take stress off of their spine Flexion-oriented exercises De-weighted treadmill ambulation Exercises for individual impairments
29
what does stiff achy back mean
– Stenotic, Degenerative Spine – Often accompanied by radiating features
30
lumbar spinal stenosis is associated with what principle
flexion pattern
31
what is degenerative stenosis
facet joint arthrosis ligamentum flavum thickening intervert disc bulging spondylolesthesis
32
spinal stenosis presentation
pain with walking that is improved with sitting improved walking holding a shopping cart preferred position is sitting
33
pelvic component - pain pattern
rarely have symptoms below the knee, butt, lateral thigh status quo pain pain later in the day
34
pelvic component - neuro
no neuro component
35
pelvic component - pop
younger
36
what is included in cilbulkas criteria
standing flexion test seated landmark asymmetry long sit test prone knee flexion test ** frontin sign
37
what is included in pelvic component palpation examination
ASIS PSIS iliac crest
38
interpretation of pelvic component - all landmarks are level
normal
39
interpretation of pelvic component - all landmarks are high on one side
leg length difference (compared in sitting and standing )
40
interpretation of pelvic component - asymmetrical height difference
pelvic component (compared in sitting and standing)
41
cibulka criteria - what means positive
3/4 test = pelvic component
42
what is the long sitting test (LST)
patient in the supine lying position, feet off the table places the thumbs beneath the patient’s medial malleoli Patient assumes a seated position with the hips flexed as much as possible and the knees fully extended. Have to do 3 times
43
what is a positive long sitting test
change in length noticed Evaluation of the pelvic joint – short to long
44
what is the prone knee flexion test - procedure
positioned prone with shoes on, the relative leg lengths are assessed visually by looking at the heels of the shoes patient's knees are then flexed passively to approximately 90 degrees and the lower extremity lengths are again observed
45
what is a positive knee flexion test
change in relative lengths between the two positions - Short to long = pelvic - Short to shorter = sacral
46
what is the Seated/standing Flexion Test - procedure
- Places the tips of PT index fingers directly beneath the inferior shelves of PSIS – upward pressure - Examiner at eye level - pt bends forward as far as possible while the examiner observes for symmetry of cranial movement of these bony landmarks
47
what is a positive standing flexion test
one PSIS rises more in the superior direction while the patient is flexed
48
which flexion test is included in clibukas criteria
standing flexion test
49
what is Gillet test
* PSIS and S2 palpated in standing * S2 between the PSIS’s * Patient is asked to flex one hip towards the chest
50
what is a negative gillet test
PSIS moves inferiorly (below S2)
51
what is a positive gillet test
PSIS does not move or moves cranially
52
what are the treatment options for a pelvic component
Supine lumbo-pelvic roll Prone Position innominate anterior rotation thrust Long axis distraction Prone leg lift technique
53
what is the procedure for - Prone Position innominate anterior rotation thrust
- Side bend the patient’s trunk and legs away from you - Have pt rise on elbow opposite form you - Place two hand on below the furthest PSIS - Take up the slack and then drive the innominate posture to anterior o Push cranial and into the table
54
what is the procedure - Prone leg lift technique
- Bend pt’s leg that is closest to PT and tuck leg under arm (make sure foot is behind arm) - Lift pt’s leg while applying pressure at PSIS - Rock up and down
55
what do you after pelvic component manipulation
have the patient walk so that they are weight bearing on the pelvis heel rockers
56
what is the presentation of the sacral component
fortins sign ~vague, non-segmental radiating features decreased unilateral stance time Difficulty with transitional movements Difficulty actively extending the spine
57
what is fortin sign
patient twice identifies their most painful region within one centimeter of PSIS
58
sacral component - MOI
Slip and fall onto the buttock Asymmetrical loading mechanisms * Not on the last step on the stair Failure of “ilial” interventions Hypermobility of the Pelvis
59
what are some causes of – Hypermobility of the Pelvis
* Trauma – rear end motor vehicle accidents * Recent Pregnancy * Birth Control Medication
60
what is included in Laslett’s Criteria
Distraction thigh thrust Gaenslen's test Slide lying compression Sacral thrust
61
which two test in Laslett’s Criteria means that they have an SI pain
Thigh thrust Distraction
62
what are the sacral component correction
Active Mobilization Technique (SIJ) Prone sacral correction
63
when do we start to think about the thoraco-lumbar component
If it is not pelvic of sacral then it is thoracolumbar
64
thoraco-lumbar component is what level and higher
L4 and higher
65
what are the special test for the thoraco-lumbar component
This is more of a movement model does not have special tests
66
what is the treatment for the thoraco-lumbar component
Side lying lumbar roll
67
what testing can we do to discern a thoraco-lumbar component
1. AROM standing 2. Combo AROM testing 3. Seated thoracic rotation 4. PA spring testing
68
what is Combo AROM testing
a. SB + Ext b. Ext + SB
69
for spring testing what section are we looking at
L5 to L2
70
what is the procedure for Prone sacral correction
- Side bend the patient’s trunk and legs away from you - Have pt raise up on elbow Opposite from you - Place hand medially from the PSIS – apply pressure obliquely in the angle of the SI joint - Take up the slack and then drive thrust
71
what is the active mobilization of the pelvis - procedure
- Pt’s trunk brought towards PT and legs away - PT palpate pt’s segment and take uppermost leg o Move leg into flexion and ext, feeling the PSIS move o Hook uppermost leg on other leg (closing of segment) o Keep hand on segment of interest - Rotate pt’s trunk o Grab lowermost arm above elbow and rotate - After deep breath take up any slack and then apply a thrust
72
Classification of Lumbopelvic stabilization - demographic
<40 (+) Aberrant Motions (+) Prone Instability Test FABQ: > 8 (+) Spring test for hypermobility
73
what is included in the basic screening for stability
Unilateral Bridge with Leg Extended Bird dog - Quadruped with Alt. UE and LE Extended Side plank - Unilateral Side Support with Legs Extended
74
Unilateral Bridge with Leg Extended- bent leg
activation of the Hamstring
75
Unilateral Bridge with Leg Extended - straight leg
activation of the abdominal obliques, multifidus, other trunk extensors
76
Unilateral Bridge with Leg Extended - fall onto unsupported side
inadequate abdominal support
77
what is the function of the multifudus
stabilizes the vertebrae as the spine moves. Extension and contralateral rotation
78
what is the function of the abdominal obliques
contributes to a variety of trunk movements
79
bird dog - extended leg
hamstring, gluteus maximus, and multifidus
80
bird dog - Activation
external oblique
81
bird dog - Activation extended arm
upper trunk extensors
82
for the bird dog what do we want the patients to look like
curve of back (neutral)
83
side plank - down side
Unilateral involvement of the Gluteus Medius, Multifidus, External Oblique on the activated side Rectus Abdominis
84
what tests do we do for the posterior chain
Prone Instability Test bird dog Prone Unilateral Leg Lift
85
what movement are we looking at with the posterior chain
extension of the back
86
what is the procedure for the Prone Instability Test
pt lying prone at the end of the table , with the pt leg off of the table pos 1: Push on the lumber spine muscles with pt’s feet on the ground pos 2: Pt’s feet 2 inches off the ground Push on the lumbar spine muscles
87
what is a positive prone instability test
less pain when legs are off the ground
88
what is the prone instability test showing us
this is a test of muscle performance This showing how activating your muscles can ease the pain
89
what is the procedure for the Prone Unilateral Leg Lift
pt prone on mat table have the patient lift leg straight off the table, looking for activation of the contralateral multifudus
90
what is the function of the erector spinae
Back extension, side bending
91
what test do we look at for the anterior chain
Unilateral Bridge with Leg Extended Active Straight Leg Raising (An SLR) Abdominal Hollowing
92
Unilateral Bridge with Leg Extended - what muscle are being activated
activation of the abdominal obliques, multifidus, other trunk extensors hamstrings also looking at abdominal support
93
what is the procedure for the Active Straight Leg Raising (An SLR)
“keep your knee straight and pick your leg off the ground – do bilaterally” repeat procedure while placing force into the ASIS while pt is performing task
94
what does it mean if position 2 is easier in the active straight leg raise
they are not activating their abs
95
what does it mean if position 1 is painful in the active straight leg raise
pain - pain is worse when raising the leg that mean pt does not have great activation of the abdominals o No pain – activating the abdominals
96
what is the procedure for abdominal hollowing
1. have the pt prone and knees bent 2. ask them to take a deep breath
97
what muscle is abdominal hollowing looking at
the transverse abdominus
98
what is the function of the transverse abdominus
assist in forced expiration,
99
can abd hollowing be used as a intervention
yes, If the patient is having a hard time activating the TA then you can teach the patient
100
what are we looking for with abd hollowing
belly breathing activating the TA
101
with diaphramgic bretahing what do we want to move
the belly
102
what movements are we looking for in the lateral chain
Side plank Rose wall slide Trendelenburg test
103
what muscles are being activated with a side plank
downside: Unilateral involvement of the Gluteus Medius, Multifidus, External Oblique on the activated side
104
what is the procedure for the rose wall slide
pt side lying, bottom knee bent, and top leg straight - PT sees how high the pt can lift their top leg – this is the limit for their leg raises - Have the pt lift their leg to this height for multiple reps – sliding on a foam roller - Look for the change in pt strategies during exercise
105
what is the procedure for the trandelenburg test
- Pt standing - PT at eye level of the pelvis - PT place hands on pt’s iliac crest - Have pt do single leg stance - Positive: Look for drop on opposite side to the stance leg
106
look at my notes for the
stablization exercises
107
what does it mean when the patient says my LE has a influence on my back pain
think of the pelvic dysfunction
108
what is nutation
movement into the pelvis anterior and inf occurs in response to lumbar extension
108
to pt with sacral pain complain of pain with walking
yes
108
what is counter nutation
movement to return to neutral position
109
prone knee flexion - sacral component positive test
shorter to shorter

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