Lumbar Spine Evaluation

Question 1

AHCPR Red Flags

Answer 1

• age >65 or 10 year post menopause
• trauma
• immunosppression
• rest/night pain
• LE neurological deficit
• history of cancer
• saddle anesthesia
• bladder dysfunction
• fever, chills, night sweats
• weight loss
• recent infection

Question 2

Self assessments for lumbar spine

Answer 2

• Oswestry Disability Index (ODI)
• Roland-Morris Disability Questionnaire
• Patient Specific Functional Scale
• Fear Avoidance Beliefs Questionnaire (FABQ)
• Pain Catastrophizing Scale (PCS)

Question 3

Neurodynamic testing

Answer 3

• SLR
• slump
• femoral nerve test

Question 4

Neuro screen for diagnosing lumbosacral radiculopathy

Answer 4

• reflexes
• weakness
• sensory
• +SLR

Question 5

Repeated movement testing

Answer 5

• Flexion 10 reps
• Extension 10 reps
  Sideglides if lateral shift is present 10 reps
• assess for centralization or peripheralization of symptoms

Question 6

Muscle testing

Answer 6

• Multifidi: swelling, arm movement, weight shift
• Transverse Abdominus: drawing in maneuver
• Myotomal testing

Question 7

Describe the prone instability test

Answer 7

• patient lies on table with hips hanging off and feet on the ground
• PT provides PA pressure to the lumbar spine looking for provocation of pain
• patient lifts legs off of floor
• PT provides PA pressure to lumbar spine looking for provocation of pain
• Positive if pain is reduced in 2nd movement

Question 8

What are the 6 low back pain classifications

Answer 8

• LBP w/mobility deficits
• LBP w/movement coordination impairments
• LBP w/referred LE pain
• LBP w/radiating pain
• LBP w/cognitive or affective disorders
• LBP generalized

Question 9

Mobility deficits impairments

Answer 9

• reduced ROM
• reduced segmental mobility
• low back & referred pain reproduced with segment provocations

Question 10

Mobility deficits interventions

Answer 10

• thrust/non-thrust mobilizations
• exercises for spine mobility
• patient education for return to activity

Question 11

Manipulation test item cluster

Answer 11

• duration of symptoms <16 days
• no symptoms distal to knee
• lumbar hypomobility
• at least one hip with greater than 35 degrees IR
• FABQ-W less than 19
• 4/5 predictors and no contraindications = manipulate

Question 12

When to use the neutral gap manipulation technique

Answer 12

• for patients that prefer flexion

Question 13

Movement coordination deficits impairments

Answer 13

• acute: pain with initial to middle AROM or PROM
• chronic: pain at sustained end range
• referred pain reproduced with lumbar motion or segment provocations
• aberrant movements
• hypermobility may be present
• diminished core muscle activation & endurance

Question 14

Movement coordination deficits interventions

Answer 14

• neuromuscular re-education dynamically
• consider external stability
• self care home training
• manual therapy
• exercises to address core muscle activation & endurance
• community or work integration training

Question 15

Coordination impairment/stabilization test item cluster

Answer 15

• age<40
• positive prone instability test
• aberrant movement with ROM
• SLR greater than 90 degrees

Question 16

Transverse abdominus training

Answer 16

• patient supine in hook lying position
• palpate TA
• have patient lower stomach
• hold for 10 seconds for 10 reps with minimal effort

Question 17

Multifidus training

Answer 17

• palpate patients multifidus
• have patient either lift contralateral arm or perform a weight shift

Question 18

Referred LE pain impairments

Answer 18

• symptoms centralize with specific positions or repeated motions
• may present with lateral shift
• reduced lumbar lordosis & ROM
• may present with movement coordination impairments also

Question 19

Referred LE pain interventions

Answer 19

• exercises, manual procedures, or traction to centralize symptoms
• patient education on positioning
• exercises to address core muscle activation & endurance
• community or work integration training

Question 20

Radiating pain impairments

Answer 20

• pain with initial to mid ROM
• aggravated with neurodymanic testing
• may present with LE sensory, strength, & reflex impairments

Question 21

Radiating pain interventions

Answer 21

• patient education to reduce stress to nerve root
• manual based treatment to reduced stress to surrounding tissues
• manual traction
• nerve mobility exercises

Question 22

Direction specific exercise flexion category

Answer 22

• mainly older patients with spinal stenosis
• LE symptoms come on after standing or walking for certain amount of time
• sitting improves symptoms
• flexion activités improve symptoms
• occasionally a younger patient without stenosis will fit this category

Question 23

Exercises for flexion preference

Answer 23

• SKTC
• DKTC
• sitting flexion
• standing flexion

Question 24

Interventions for stenosis

Answer 24

• flexion exercises
• manual stretching (hip flexors)
• strengthening
• supported treadmill walking

Question 25

Direction specific exercise extension category

Answer 25

• symptoms distal to the buttock
• symptoms centralize with lumbar extension
• symptoms peripheralize with lumbar flexion

Question 26

Exercises for extension preference

Answer 26

• prone
• prone on elbows
• prone press up
• standing extension
• sideglide against wall
• bridging
• prone leg raise

Question 27

Cognitive or affective tendencies impairments

Answer 27

• one or more
• 2 positive responses to the primary care evaluation of mental disorders (depression)
• high FABQ scores
• High PCS scores

Question 28

Cognitive or affective tendencies interventions

Answer 28

• patient education & counseling to address specific issues exhibited by the patient
• exercise according to pain science research

Question 29

Describe generalized low back pain

Answer 29

• LBP >3 months
• high fear avoidance
• does not meet other classifications
• education (acute injury is healed)
• movement into fearful positions
• fitness

Question 30

Describe symptom modulation stage

Answer 30

• high disability
• volatile symptoms
• high to moderate pain

Question 31

Patient characteristics for symptom modulation stage

Answer 31

• recent or recurrent episodes of LBP that is currently causing significant symptomatic features
• tend to avoid certain postures
• AROM is limited & painful
• increased sensitivity with neurological examination

Question 32

Treatment for symptom modulation stage

Answer 32

• manual therapy (mobilizations/manipulations/soft tissue massage)
• directional preference exercises
• neural mobilization

Question 33

What classifications fall under symptom modulation stage

Answer 33

• LBP with mobility deficits
• LBP with radiating pain
• LBP with referred LE pain

Question 34

Describe movement control stage

Answer 34

• moderate disability
• stable symptoms
• moderate to low pain

Question 35

Patient characteristics for movement control stage

Answer 35

• poor ability to activate individual muscles (TA, multifidus, diaphragm)
• impaired ability to coordinate thoracolumbar & lumbopelvic movements
• poor ability to perform loaded multiplayer movements (squat, lunge, rotation)

Question 36

Treatment for movement control stage

Answer 36

• motor control exercises
• flexibility exercises
• stability exercises

Question 37

What classifications fall under movement control stage

Answer 37

• stabilization/movement coordination deficits

Question 38

Describe functional optimization stage

Answer 38

• low disability
• low to no pain
• symptoms stable

Question 39

Treatment for functional optimization stage

Answer 39

• strength & conditioning
• work tasks
• aerobic exercise
• general fitness