lumbar spine

Question 1

what are red flags for lumbar spine?

Answer 1

fracture, cauda equina

Question 2

what categories do we try and put patients in when evaluating lumbar spine?

Answer 2

manipulation, specific exercise, stabilization, and traction

Question 3

what are predictors to indicate a patient belongs in the manipulation group?

Answer 3

no symptoms below the knee
recent symptoms
hypomobility
low fear-avoidance
more hip IR

Question 4

what intervention do we do with the manipulation group?

Answer 4

manipulation and exercise

Question 5

what are predictors to indicate a patient belongs in the specific exercise group?

Answer 5

centralization phenomenon during movement examination
postural/direction preference

Question 6

what intervention do we do with the specific exercise group?

Answer 6

activities to promote centralization

Question 7

what are predictors to indicate a patient belongs in the stabilization group?

Answer 7

prone instability test
aberrant motions
hypermobility
younger age
greater SLR ROM

Question 8

what intervention do we do with the stabilization group?

Answer 8

stabilization exercises

Question 9

what are predictors to indicate a patient belongs in the traction group?

Answer 9

neurological signs
leg symptoms
no centralization during movement testing

Question 10

what intervention do we do with the traction group?

Answer 10

mechanical traction

Question 11

for patient education of red flags what should the therapist not do?

Answer 11

recommend or promote bed rest/activity avoidance
give detailed pathoanatomical explanations for a specific cause of LBP

Question 12

what should therapists emphasize for patient education?

Answer 12

anatomical/structural strength of the spine
explain pain perception
overall favorable prognosis for LBP
stay active approach (active pain coping strategies, early resumption of activity)-activity modification
improvement in activity level, not just pain

Question 13

why do we start with the ROM exam?

Answer 13

to see if they are a candidate for repeated movements

Question 14

what is derangement syndrome?

Answer 14

a classification defined by the presence of directional preference with rapid change in symptoms and associated with the obstruction of a particular joint

Question 15

what are responses to movement during?

Answer 15

decrease, abolished, increase, produced, no effect, centralizing, peripheralizing

Question 16

what are response to movement after?

Answer 16

better, no better, worse, no worse, no effect, centralized, peripheralized

Question 17

what is the traffic light guide to movement selection?

Answer 17

red= worse, peripheralized: reconsider force, direction, and classification (change it)
yellow= no better, no worse, no effect: proceed with force progression with caution (check it)
green= better, centralized: continue with this loading strategy (crush it)

Question 18

what is the treatment for herniated disc/lumbar radiculopathy?

Answer 18

education
specific exercise (like extension)
may use targeted manual therapy (CVPs-facilitate extension)
ensure to eventually prescribe stabilization exercises (promoting extension)
general fitness activity/RTW
traction?

Question 19

what is the treatment for lumbar stenosis?

Answer 19

education
specific exercise (flexion)
may use targeted manual therapy to address lumbar and hip immobility (regain hip extension)
address hip flexor tightness
ensure to eventually prescribe stabilization exercises (core activation)
general fitness activity (stationary cycling, treadmill walking on an incline)
hip stretching and hip mobs

Question 20

what are the 5 variables that form the clinical prediction rule for manipulation?

Answer 20

duration of symptoms <16 days
fear avoidance belief questionnaire work subscale score <19
at least one hip with >35º of internal rotation ROM
hypomobility in the lumbar spine
no symptoms distal to the knee

Question 21

if 3 factors are present what is the predicting success with manipulation?

Answer 21

68%

Question 22

if 4 factors are present what is the predicting success with manipulation?

Answer 22

95%

Question 23

what is the prognosis for low back pain?

Answer 23

CPR for spinal stabilization exercises
criteria for “success” with stabilization: 3 or more present (prone instability test, aberrant trunk motion, SLR >90º, age <40)
the presence of 3 of the 4 variables increased the likelihood of success with spinal stabilization from 33% to 67%
success = at least 50% improvement in osw score

Question 24

what are the criteria for the lumbar stabilization rule?

Answer 24

age <40
average SLR > 91 degrees
presence of aberrant movements during Lx ROM
positive prone instability test

Question 25

if 3 or more are present in the lumbar stabilization rule what is the predicting success?

Answer 25

67%