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Clinical Medicine > Lumbar Spine > Flashcards

Lumbar Spine Flashcards

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1
Q

What are some criteria that a patient needs to meet to be put into the manipulation classification?

A

No sxm below knees
Recent sxm
Hypomobility
Low Fear avoidance
More Hip IR

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2
Q

If someone belongs in the manipulation treatment are performed?

A

Manipulation & exercise

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3
Q

What are some criteria someone must meet to be put into the specific exercise classification?

A

Centralization during movement exam

Postural/directional preference

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4
Q

If someone belongs in the specific exercise classification what treatment route is done?

A

Activities to promote centralization

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5
Q

If someone belongs in the stabilization classification what criteria must be met?

A

Prone instability test
Aberrant motions
Hypermobility
Younger age
Greater SLR ROM

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6
Q

If someone belongs in stabilization classification what treatment route is done?

A

Stabilization exercises

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7
Q

If someone belongs in the traction classification what criteria must be met?

A

Neurological signs
Leg Sxm
No centralization during movement testing

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8
Q

If you determine someone to be in the traction classification what treatment options?

A

Mechanical traction

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9
Q

For acute back pain what treatment should you use based on research?

A

Thrust or non thrust joint mobilization

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10
Q

For acute back pain what treatment may you use for the patient if they have leg pain?

A

Muscle strengthening & endurance
Specific trunk activation

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11
Q

What are some other treatments for acute back pain that you may use?

A

Soft tissue mobilization
Massage
Treatment based classification
Active education
Biopsychosocial contribute to pain
Self management techniques
Favorable natural history

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12
Q

In regards to patient education what should therapist not do?

A

Recommend or promote bed rest/activity avoidance
Give detailed anatomical explanation

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13
Q

In regards to patient education what should a therapist do?

A

Structural strength of spine
Pain perception
Favorable prognosis of LBP
Active approach (activity modification)
As activity level improve, pain goes away

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14
Q

What is a derangement syndrome?

A

Presence of directional preference with rapid change in sxm

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15
Q

Can the body repair disc derangements without surgery?

A

Yes they can get smaller over time, takes awhile 3-6 months

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16
Q

What is the treatment for a herniated disc/ lumbar radiculopathy?

A
  • Education
  • Specific Ex (likely ext)
  • May use targeted manual therapy (CVP)
  • Eventually prescribe stabilization ex (promote ext)
  • General fitness activity/ RTW
  • Traction
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17
Q

What are 3 ways that the canal of the vertebrae can narrow?

A
  • Ligamentum Flavum thicken
  • Facet joints thicken
  • Herniated disc
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18
Q

What is the treatment for lumbar stenosis?

A
  • Education
  • Specific ex (flexion)
  • May use targeted manual therapy to address lumbar & hip immobility (regain hip ext)
  • Address hip flexor tightness (stretching & mobs)
  • Ensure to prescribe stabilization ex
  • General fitness (cycling, treadmill on incline)
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19
Q

What is the clinical predication rule for manipulation of the lumbar spine?

A
  • Duration of Sxm < 16 days
  • Fear avoidance belief questionnaire work subscale score <19
  • At least one hip w/ >35° of IR
  • Hypomobility in lumbar spine
  • No sxm distal to knee
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20
Q

If 4 or more are present from the clinical predication rule what is percentage that manipulation will be successful?

21
Q

What is the amplitude/resistance & treatment goal of Grade I mobs?

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A

Small amplitude out of resistance
Pain reduction

22
Q

What is the amplitude/resistance & treatment goal of Grade 2 mobs?

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A

Large amplitude out of resistance
Pain reduction

23
Q

What is the amplitude/resistance & treatment goal of Grade 3 mobs?

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A

Large amplitude into resistance
Reduce joint stiffness

24
Q

What is the amplitude/resistance & treatment goal of Grade 4 mobs?

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A

Small amplitude into resistance
Reduce joint stiffness

25
What is the clinical prediction rule for success with stabilization?
- Prone instability test - Aberrant trunk motion - SLR > 90° - Age <40
26
What pathology causes the most amount of disability?
Fatty infiltration into muscles
27
What is avoidance behavior perceived as & associated with?
- Maladaptive response to LBP - Associated w/ chronic disability
28
What does avoidance behavior result in?
Physical disuse, reconditioning, & guarded movements
29
What is the gold standard questionnaire to look at function?
Revised Oswestry Disability Index
30
in regards to scoring the Oswestry, lower scores = what in regards to disability & high scores?
Lower Scores = lower disability Higher Scores = Higher disability
31
In regards to scoring the Oswestry, 0-20% indicates what?
minimal disability
32
What are some common patterns of herniated disc?
- Insidious onset or related to trauma - May start w/pain in lumbar region & progress to LE - Worse w/ flexion activités - Morning & evening worse - 95% occur at lower lumbar spine (L4/5 & L5/S1) - 30-50 y/o (men>women) - Result of (trauma, poor posture, rep trauma) - Smokers, sedentary life, obese
33
What are some common patterns of lumbar radiculopathy?
- Initially back pain presents as leg pain - Pain/parasthesia presents - SXM vary depending on activity & position but usually worse w/ flexion - Better with standing or walking - Pt may report weakness or difficulty w/ gait - Neuro exam mandatory
34
How are herniated disc/ lumbar radic diagnosis?
- MRI - Electrodiagnostic testing (EMG/NCV test) - Neuro Exam ( DTR, myotomes, dermatomes, SLR/slump) - Progressive neurologic decline noted, surgical consult indicated
35
What is an Adherent Nerve Root (ANR)?
- Episode of back pain w/radic or h/o of surgery - Leg sxm never completely go away - Sitting not an issue & walking may be painful at 1st but then improves - Reports episodes of burning & aching - Unable to bend forward or SB away - Neuro exam
36
What way will people with ANR deviate?
To side of DNR
37
What are some treatment options for chronic lumbar radiculopathy?
- Education - Carefully address neural tension - May use targeted manual therapy to address local lumbar impairments - Ensure to eventually prescribe stabilization ex - General fitness activity
38
What are some common patterns of lumbar stenosis?
- Complains of cramping, aching & or N/T in one or both legs cramping w/ walking - Worse with standing & walking - Intermittent sx in back (stiffness) - Older - Sitting always relieve leg pain - Standing tall or extending spine aggravates leg pain - Slouched position when sit or stand
39
What will the physical exam be of someone with lumbar stenosis?
- AROM may be decrease w or w/o pain - Hypomobilty with CVP/UVP - Limited hip ext - Normal neuro exam at rest but may have neurological signs after walking - Asess slump/SLR
40
What is the clinical prediction rule for lumbar stenosis?
- Bilateral sxm - Leg pain > back pain - Pain during walking/standing - Pain relief upon sitting - >48 y/o
41
What are some common patterns for spondylosis?
- Degeneration of IVD - Age > 50 - Symmetrial or asymetrical localized LBP - Episodic; usually time b/w episode decreases - C/o stiffness & pain - Normal neuro exam - Dx w/ radiographs/ CT/ MRI
42
What is the treatment for spondylosis?
- Education - Specific exercise from TBC if there is a directional preference - Acute assess mania CPR from TBC - May use targeted manual therapy to address lumbar & hip immobility - Address hip muscle tightness - Ensure to eventually prescribe stabilization ex - General fitness activity
43
What is the common patterns for spondylolysis?
- Defect in pars (L5) - Men> women - Common in athletes w/ lumbar ext dominant sports - Result of repeated micro trauma - Results in localized back pain - Ok with stationary task like sitting or standing - Extending or side- bending/ rotating to painful side is an issue - Decrease & painful extension (not flexion)
44
What is the common patterns for spondylolisthesis?
- Most common cause of LBP - Males > women - Common in kids w growth spurts - General back ache to increase stabbing - Catching or aberrant movements - Flex activates ok compared to ones involving ext - Transitioning in to and out of positions is painful - C/o difficulty with standing
45
What are the common patterns for sprain/ strains?
- Result of trauma/overuse - Local pain in lumbar spine (uni or bilateral) - Stiff & tentative ROM w/ pain - Decrease trunk rotation w/ ambulation - Pain w/ MMT of trunk - Passive ext usually not an issue - May see local muscle spasm & TTP
46
What is the treatment for sprain/ strains?
- Education - Assess manipulation CPR from TBC - Consider modalities - Ensure to eventually prescribe stabilization ex - RTW education/training - General fitness activity
47
What is the common patterns for facet joint arthropathy?
- Result of trauma/overuse - Local pain (unilateal) - Standing & walking more painful than sitting - Pain ext/SB/rot ROM - Passive ext will be painful - May see local muscle spasm & TTP over facet region - Normal neuro exam -
48
What is the treatment for facet jp

Clinical Medicine (12 decks)

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