MSK- Lumbar

Question 1

What is the purpose of the Slump test?

Answer 1

Detects adverse nerve root tension

Question 2

What is the purpose of the SLR (Lasegue) test?

Answer 2

It aims to assess for lumbosacral nerve root irritation.

Question 3

What are the ranges for a positive SLR test?

Answer 3

Less than 30• : not a positive test. Slack of sciatic.

Between 30-70• : considered a positive test with reproduction of symptoms

Above 70• : not considered a positive test ( due to other structures involved)

Question 4

What is the “crossover sign” for SLR?

Answer 4

Indicates a large disc bulge ( protrusion)

Occurs when performing a SLR, on the unaffected side, the pt experiences pain in the affected leg.

Question 5

What is the relief position for someone with spinal stenosis?

Answer 5

Flexion- bc it opens intervertebral foramen

Question 6

What is a worse position for someone with spinal stenosis?

Answer 6

Extension - bc it closes the intervertebral foramen

Question 7

What are the signs /symptoms for spinal stenosis?

Answer 7

Low back pain

Possible b/l numbness and tingling

Pain in b/l legs

Pain decreases as the morning progresses

Repetitive motion cause pain

Chronic pain w acute episodes

Question 8

What is the Bicycle test for?

Answer 8

For neurogenic claudication. Indicative of spinal stenosis

Question 9

What are some differences between neurogenic and intermittent claudication?

Answer 9

Neurogenic: nerves are getting compressed
Gets better w spine flexion
Onset: typically immediated
Pain characteristics: burning or tingling

Intermittent: caused due to ischemia ( decreased blood flow to the area)
Gets better w rest ( not position dependent)
Onset: gradually increases w activity
Pain characteristics: cramping

Question 10

What are some interventions for spinal stenosis?

Answer 10

Flexion based exercises and positioning
( cycling)

Traction

Aerobic exercs

Surgical: laminectomy

Question 11

What is laminectomy? What is a contraindication for position on the “protection phase ( 1week)?

Answer 11

Laminectomy: spinal decompression
Contraindication: pt is not supposed to rotate during transfers , on the protection phase.
Pt is encouraged to log roll.

Question 12

What is the mechanism of injury for Postero lateral disc herniation?

Answer 12

Flexion

Question 13

What are some interventions for Postero lateral disc herniation?

Answer 13

Typically prefer extension based exercise and mov such as repeated extensions in prone

Traction

Lumbar stabilization exercs : with core activation/ brace

Question 14

What are some interventions for anterior bulge disc herniation?

Answer 14

Flexion based exercs

Question 15

What is the main characteristic of pelvic crossed syndrome?

Answer 15

Imbalance patterns wich promotes increased lumbar lordosis

Question 16

What is Spondylosis?

Answer 16

Normal age related changes
“arthitis in the spine”

Question 17

What is Spondylolysis?

Answer 17

Stress type of fracture. It’s a repetitive stress injury

Question 18

What is spondylolisthesis?

Answer 18

Stress fracture and slinding of the vertebra (forward)

Question 19

What is retrolistheses?

Answer 19

Backward displacement of one vertebra on another

Question 20

How are the grades for spondylilisthesis?

Answer 20

Grade 1: less then 25% slippage

Grade 2: 25% -50% slippage

Grade 3: 50% -75% slippage

Grade 4: more then 75% slippage

Grade 5: 100% slippage

Question 21

What are the treatments for spondylolisthesis based on their grades?

Answer 21

Grades 1-2-3: core strengthening exercs
Grades 4-5: will need fixation

Question 22

What is a common sign on the x ray for spondylolisthesis?

Answer 22

Scotty dog with collar sign
Scotty dog with decapitation sign

Question 23

What is some
Interventions for spondylolisthesis?

Answer 23

Inner core stability exercises
Education regarding avoiding aggravating movements (extension)

Question 24

What is contraindicated on spondylilisthesis?

Answer 24

Manipulation

Question 25

What are some contraindications for laminectomy or fusion on the Maximum protection phase?

Answer 25

No heavy lifting more than 5-10 lbs for up to 3 months Extension exercs ( pt that had a laminectomy) Log roll for a week Do not sit for more than 20-30min continuously for 2ws Dont push,pull or lift

Question 26

What is Cauda equina syndrome? What are some signs/symptoms of Cauda equina syndrome?

Answer 26

Damage to cauda equina( nerve roots below L1) Loss of bowel and bladder control B/l leg pain Saddle paresthesia. (Numbness or different sensations in the backs of your legs, butt, hip and inner thighs (your saddle area, as in the parts of your body that would touch the saddle if you were on a saddled horse)

Question 27

What are some signs and symptoms for Malignancy?

Answer 27

Previous history of CA Unexplained weight loss Constant unrelenting pain Pain unrelieved by rest Pain worsens at night Night sweats Failure to improve w conservative therapy within one month

Question 28

To test patellar reflex…

Answer 28

L3-4

Question 29

To test achilles reflex…

Answer 29

S1-2

Question 30

Shopping cart sign

Answer 30

Relief from symptoms when leaning forward over the shopping cart, while shopping. often seen in a pt w lumbar spinal stenosis

Question 31

Which dermatome covers the great toe?

Answer 31

L4

Question 32

Laminectomy

Answer 32

Removal of lamina to make room to relieve compression on nerve roots and spinal cord

Question 33

Cause of neurogenic claudication

Answer 33

Nerve root compression due to lateral stenosis

Question 34

Slump test procedure

Answer 34

Therapist instructs the pt to place hands behind back, go into a slump posture( w rounded shoulders) and bring chin to their chest Therapist passively extends the uninvolved knee then repeats the test on the involved le. If symptoms have not been reproduced ankle df is added If symptoms of low back pain/radiating pain in post leg are recreated,ask pt to ext their neck while maintaining a rounded back

Question 35

Positive slump test findings

Answer 35

Relief of symptoms when pt extends neck indicates neural tension/restriction of lumbosacral roots

Question 36

Which dermatome goes over the patella?

Answer 36

L4

Question 37

You suspect the patient may be presenting with sign of the buttock. Which of the following correctly describes underlying pathologies associated with sign of the buttock? a. Rheumatic bursitis, osteomyelitis of the femur, neoplasm of the upper femur, ischiorectal abscess. b. Fractured sacrum, osteomyelitis of the tibia, neoplasm of the tibia, ischiorectal abscess. c. Septic sacroilitis, gluteal bursitis, rectal cancer. d. Ischiorectal abscess, rheumatic bursitis, rheumatoid arthritis or osteoarthritis, neoplasm of the upper femur.

Answer 37

A

Question 38

A physiotherapist is training a patient with spasticity of lumbar extensors, notices that the patient tends to extend the trunk quite often. The physiotherapist decides to rectify this by promoting excess anterior tilt at the pelvis. Which of the following can be done in order to do so? A) Pelvic positioner angled at 45° to the seat B) Decrease the seat width by 1 inch on both sides C) Pelvic positioner angled perpendicular to the seat D) Provide knee blocks anteriorly to free pelvis

Answer 38

C

Question 39

A middle aged man is referred to your clinic for persistent hip and buttock pain. The patient is acute and irritable. You perform a mobilization to increase hip flexion. Select the most appropriate treatment: a. Rest and ice as the patient is acuterand irritable. b. Oscillation or grade 1 posterior glide with hip in 30 degrees of flexion, 30 degrees of abduction and slight external rotation. c. Oscillation or grade 1 anterior glide with hip 30 degrees of flexion, 30 degrees of abduction and slight external rotation. d. Oscillation or grade 1 posterior glide with hip in 10 degrees of flexion, 10 degrees of abduction and neutral rotation.

Answer 39

B • When the joint is acute or irritable, oscillations or grade 1 mobilizations are appropriate. According to the convex/concave rule, to increase hip flexion, you would want to perform a posterior glide. You would perform the mobilization in the open pack position of the hip - 30 degrees of flexion, 30 degrees of abduction and slight external rotation.

Question 40

A fracture is a contraindication to all of the following except: a. Resistance exercises in the area. b. Grade 1 joint mobilizations. c.Flexion exercises in spondylolisthesis. d. Rib springing

Answer 40

C • Spondylolisthesis is a fracture of the pars leading to anterior slippage of one vertebrae on another. Without treatment, this can lead to cord compression. Extension is contraindicated NOT flexion when a spondylolisthesis is present.