OrthoIII Midterm- Maitland Flashcards
(152 cards)
1
Q
Subjective exam goals: Obtain? (2)
A
Obtain a patient profile
Obtain a detailed description of all of the patients symptoms
2
Q
Subjective goals: Determine?(2)
A
Determine the patients problem from their perspective
Determine contraindications to physical exam and treatment
3
Q
Subjective exam goals- assess the following: _ and _ (_) of symptoms; baseline _ of _; patient _ _ _; PT _.
A
CAUSE and BEHAVIOR (SINS) of symptoms
Baseline LEVEL OF FUNCTION
Patient AS A PERSON
PT PROGNOSIS
4
Q
Subjective exam goals- provide a basis for _ the _: _ to examine; _ and _ of exam; need to examine _ _.
A
Provide a basis for the PLANNING OF THE PHYSICAL EXAM:
- STRUCTURES to examine
- EXTENT AND RIGOR of the exam
- need to examine ASSOCIATED STRUCTURES
5
Q
Subjective exam- body chart identifies: area of _ _; areas _ to the _ being examined; _, _, and _ of pain; _ sensation; are symptoms _ or _; _ of symptoms.
A
- Area of CURRENT SYMPTOMS
- Areas RELEVANT to the REGION being examined
- QUALITY, INTENSITY, and DEPTH of pain
- ABNORMAL sensation
- are symptoms CONSTANT OR INTERMITTANT
- RELATIONSHIP of symptoms
6
Q
What structure is thought to produce the type of pain described: sharp and burning pain*, distributed along specific nerves?
A
Nerves
7
Q
What structure is thought to produce the type of pain described: deep, boring, and poorly localized pain? 2 examples?
A
Bone
Examples: bone bruising and tumors
8
Q
What structure is thought to produce the type of pain described: localized, but referred pain to other areas as well?
A
Joints
9
Q
What structures are thought to produce the type of pain described: diffuse, aching, and poorly localized*, often referred to other areas?
A
Vascular structures
10
Q
What structures are thought to produce the type of pain described: Dull, aching, poorly localized and referred to other areas?
A
Muscle
11
Q
Which type of pain assessment is considered to be the most Objective? What is the best pain assessment tool to use for people for whom ESL and children?
A
Most objective: visual analog scale
Best for ESL patients and children: Wong-Baker Faces pain rating scale
12
Q
The modified oswestry disability questionnaire includes: _ sections, the score is expressed as a _, is used for patients with _ _; has minimal _ _ _; helps determine _ _; and is used most often in _.
A
Includes: 10 SECTIONS, the score is expressed as a PERCENTAGE, is used for patients with ACUTE LBP, has minimal CLINICAL IMPORTANT DIFFERENCE; helps determine SUCCESSFUL OUTCOME; and is used most often in RESEARCH
13
Q
The fear avoidance belief questionnaire: is a _ _ scale; is -; 2 different types include _ and _; is used in _ _ _ for lumbar spine. Abbreviations for each type?
A
Is a 16 POINT scale, is SELF-REPORTED; 2 different types include GENERAL PHYSICAL ACTIVITY (FABQP) and WORK ACTIVITY (FABQW); is used in CLINICAL PREDICTION RULE for the lumbar spine
14
Q
What are the possible structures implicated by central low back pain?
A
Lumbar spine
15
Q
What are the possible structures implicated with iliac crest pain?(3)
A
ILiac creSt Pain
- lumbar spine
- sacroiliac joint
- posterior primary rami T-12
16
Q
What are possible structures implicated with buttock and thigh pain? (4)
A
LMN’S
- lumbar spine
- muscle
- nervous tissue
- sacroiliac joint
17
Q
What 3 thing should you consider when identifying the behavior of symptoms?
A
FAE
- functional ability
- aggravating factors
- easing factors
18
Q
Common aggravating factors that affect the thoracic spine include? (2)
A
DR
- deep breathing
- reversing a car
19
Q
Common aggravating factors affecting the lumbar spine? (5)
A
SSS LoW
- sitting, standing, stooping
- lifting
- walking
20
Q
Common aggravating factors affecting the SI joint?
A
Single limb stance
21
Q
Common easing factors affecting the thoracic spine? (2)
A
SR
- shallow breathing
- rest
22
Q
Common easing factor that affect the lumbar spine? (5)
A
ChEWS Mnm’s
- changing position
- extending
- walking
- standing
- moving
23
Q
Common easing factor that can affect SI joint?
A
Sitting
24
Q
Determining _ _ _ is important for chronic pain patients. Why?
A
Determining NON-AGGRAVATING FACTORS is important for chronic pain patients
Helps keep them mobile!
25
What are 2 questions you should ask when looking at the severity of symptoms?
How much/ how bad is the pain?
Where is the pain?
26
What are 2 questions you should look at when determining the irritability of symptoms?
How easily is the pain provoked?
How quickly does it go away?
27
What are the 3 things you should look at/ and ask patient about with regards to the 24-hour behavior of symptoms?
Night, morning and evening symptoms
28
When looking at functional ability with regards to behavior of symptoms it is important to look for and ask about? (2)
Postures (both dynamic and static)
Work/ sports/ social activities (participation issues)
29
Determining the behavior of symptoms with regards to function is used to determine the _ of the _. What should you do with the most important functional limitations? (3)
Is used to determine the AIMS of the TREATMENT
Most important functional limitations:
- highlight/ asterisk
- reassess at subsequent treatment sessions
- use to evaluate the success of treatment interventions
30
When looking at the nature of symptoms you need to consider? (3)
Stability of the condition
Stage of the condition (acute, subacute, chronic)
Fear avoidance
31
What are special questions used for? Especially if?
To assess for comorbilities
Especially if you can't reproduce, increase or decrease pain symptoms during evaluation
32
General red flags for lumbar spine include a history of: _ (current or past), _ _ use, _ use and severe _ _.
History of:
- MALIGNANCY (current or past)
- IV DRUG use
- CORTICOSTEROID use*
- severe, ACUTE TRAUMA
33
Over 50 years of age, Fever, weight loss, adenopathy, blood in urine, signs and symptoms of systemic disease, sciatica, and neurological deficits are all considered?
General red flags
34
Major trauma, motor vehicle accident, fall from height, direct blow to lumbar spine are all red flags that could indicate presence of? (2 examples)
Spinal Fracture
Examples:
- compressive fx- trauma/ strenuous lifting in older person, prolonged steroid use
- pars interarticularis fx- persistent LBP in younger patients involved in repetitive hyperextension activities
35
What are red flags for possibility of Cauda Equine syndrome? (3)
- saddle anesthesia
- recent bladder dysfunction
- serious or progressive neurologic deficit in the LE
36
Red flags for which condition are being described: Age greater than 50, prior history of cancer, unexplained weight loss, no relief with bed rest
Possible presence of neoplastic conditions (cancer)
37
Red flags for which possible condition include: getting up and out of bed at night, morning stiffness, male gender, age of onset being less than 30 yo, no relief when lying down, and relief with activity and exercise?
Ankylosing spondylitis
38
Red flags for which possible condition include: recent fever and chills, recent bacterial infection, IV drug use, Immune suppression drugs (steroids, anti-rejection meds, AID/ HIV meds)?
Spinal infection
39
What does the following describe: recent significant trauma, milder trauma in an osteroportic/ elderly person, HX/ suspicion of CA, unexplained weight loss, UTI, IV drug use, prolonged steroid use, immunosuppression medication use, duration longer than 6 wks/, acute onset of urinary retention, fecal incontinence, saddle anesthesia, global/ progressive motor weakness in LE's?
Indications/ red flags for X-rays or imaging
40
Are positive films/ imaging results indicative of positive lumbar spine pain? Grade of evidence?
Not necessarily
Evidence grade for films: B
41
During subjective exam you should also look at history of _ _ (_), _ _ history (_), and _ and _ history.
history of PRESENT CONDITION (HPC)
PAST MEDICAL history (PMH)
SOCIAL AND FAMILY history
42
When planning the physical exam need to identify: _ that must be examined, _ _ that must be examined, and assessment of the _ _ (_).
STRUCTURES that must be examined
OTHER FACTORS that must be examined (posture at work/ ADL's, leg, length, biomechanics, etc)
Assessment of the PATIENTS' DISORDER (SINS)
43
During the PE you should develop?
Two hypotheses
44
Hyposthesis 1: if symptoms are _ when structure is _, the symptoms are?
If symptoms are REPRODUCED when structure is STRESSED, the symptoms are THOUGHT TO ARISE FROM THAT STRUCTURE
45
Hypothesis 2: if an _ is _ in a structure that could _ _ to the _ _, the structure is suspected to be? AKA?
If an ABNORMALITY IS DETECTED in a structure that could REFER SYMPTOMS to the SYMPTOMATIC AREA, the structure is suspected to be THE SOURCE OF SYMTPOMS
Aka: "comparable sign"
46
During the objective portion of the PE need to make _ and _ _
INFORMAL AND FORMAL OBSERVATIONS
47
What are 5 common syndromes/ postures that should be identified during the formal observation of the PE?
SYNDROMES:
- Layer syndrome
- Lower crossed syndrome
POSTURES:
- Sway back
- Flat back
- kyphosis- lordosis
48
With lower crossed syndrome what muscles are inhibited/ weak? (2) What muscles are facilitated/ tight? (3)
Inhibited/ Weak (GA):
- gluts (min/ med/ Max)
- abdominals
Facilitated/ tight (RIT):
- rectus femoris
- Iliopsoas
- thoraco-lumbar extensors
49
In the layer syndrome: muscles that are hypo-trophied include _ stabilizers of the _, lumbosacral _ _, and _ _.
LOWER stabilizers of the SCAPULA
Lumbosacral ERECTOR SPINAE
GLUTEUS MAXIMUS
50
With layer syndrome the hypertrophied muscles include: cervical and Thoracolumbar _ _, _ _, _ _, and _.
Cervical and thoracolumbar ERECTOR SPINAE
UPPER TRAPEZIUS
LEVATOR SCAPULAE
HAMSTRINGS
51
In patients with a flat back posture what is elongated and weak? Short and strong?
Elongated and weak: ONE-JOINT HIP FLEXORS
Short and strong: HAMSTRINGS
52
In patients with sway back posture _-_ _ _, _ _, _ _ _, and _ _ are elongated and weak.
ONE-U
ONE-JOINT HIP FLEXORS
NECK FLEXORS
EXTERNAL OBLIQUES
UPPER BACK EXTENSORS
53
In patients with sway back posture _, and upper fibers of _ _ are short and strong. The _ _ _ are strong but NOT short.
Short and strong:
- HAMSTRINGS
- upper fibers of INTERNAL OBLIQUES
Strong (not short):
-LOW BACK MUSCLES
54
In patients with kyphosis- lordosis posture _ _, upper back _ _, and _ _ are elongated and weak.
- NECK FLEXORS
- upper back ERECTOR SPINAE
- EXTERNAL OBLIQUES
55
In patients with kyphosis- lordosis posture _ _ and _ _ are short and strong. _ _ _ are strong and may/ may not develop shortness.
Short and strong:
- NECK EXTENSORS
- HIP FLEXORS
Strong and may/ may not be short:
-LOW BACK MUSCLES
56
When performing the formal observation you need to observe _ _ (including _, _, and _ comparison), _ _, _, and the patients _ and _.
Observe MUSCLE FORM (including BULK, TONE, BILATERAL comparison), SOFT TISSUE, GAIT, and the patients ATTITUDES and FEELINGS.
57
_ _ should be performed if they have peripheral symptoms or signs of neuropathy, and if there is a change in the _ _ once the PE begins. These tests should be performed _. 3 examples?
NEUROLOGICAL TESTS should be performed if they have peripheral symptoms or signs of neuropathy, and if there is a change in the NERVOUS SYSTEM once the PE begins.
These tests should be performed FIRST
Examples: myotome so, dermatomes, reflexes
58
The standardized palpation of tenderness was developed by _ et al in _, using _ _ of pressure (enough to blanch the tip of the thumb if pressed on a table). Scale?
Was developed by WOLFE et al in 1990, using 4 KILOGRAMS of pressure
Scale is from 0-IV
59
Palpation of tenderness grade 0? Grade I?
Grade 0: NO tenderness
Grade I: tenderness with NO physical response
60
Palpation of tenderness grade II? III?
Grade II: tenderness with GRIMACE/ FLINCH
Grade III: tenderness with WITHDRAWAL (+ jump sign)
61
Palpation of tenderness grade IV?
Grade IV: withdrawal to non-noxious stimuli or pull away before palpation
62
With a clearing test when should over pressure be applied?
If no pain is produced
63
Joint tests (4) in sequence to reproduce/ change symptoms?
JAAM
- joint integrity tests
- active and passive physiological movements
- active and passive physiological movements with OVER PRESSURE
- modifications of active movements
64
Repeated movements, combined movements, speed of movements, addition of compression/ distraction, sustained movements, testing of injuring movement, and differentiation tests are all examples of?
Modifications of active movements
65
What are the 4 active physiological movements that are tested in the lumbar spine? Which one is not measured?
Active Flexion
Active Extension
Active Lateral Flexion
Active Rotation (NOT MEASURED)
66
When measuring active physiological movements which two landmarks are used to assess movement with the inclinometer?
1- thoracolumbar junction
2- sacrum
67
Normal ROM for lumbar spine: flexion? Extension? Side/ lateral flexion? Rotation?
Flexion: 40-60 degrees
Extension: 20-35 degrees
Side/ lateral flexion: 15-20 degrees
Rotation: 3-18 degrees
68
Lumbar spine anatomy: _ lumbar vertebrae, _ articulating facets per vertebral body (_ and _). Lumbar _ _ are the _ for _ _.
5 lumbar vertebrae
4 articulating facets per vertebral body (UPPER AND LOWER)
Lumbar VERTEBRAL BODIES are the WIDEST for LOAD BEARING
69
When looking at a paired segment (L4-L5), during flexion the upper vertebrae (L4) moves _ to the segment below (L5)
Upper vertebrae moves ANTERIOR to the segment below during FLEXION
70
Looking at a paired segment during extension the upper vertebrae moves _ to the one below.
Upper vertebrae moves POSTERIOR to the one below during EXTENSION
71
If there is limited flexion on one side (L/R) when held in extension vertebrae/ body will deviate? If there is limited extension on one side when held in flexion?
Both will cause DEVIATION TOWARDS THE SIDE OF RESTRICTION
72
If treating a patient in side lying for a flexion problem you want the painful side _. If treating a patient in side lying for an extension problem you want the painful side _.
Flexion problem: painful side DOWN
Extension problem: painful side UP
73
Fryette's first law of physiologic motion: when the thoracic and lumbar spine are in _ position, the coupled motion of _ and _ for a _ of vertebrae occur to _ sides.
When the thoracic and lumbar spine in a NEUTRAL position, the coupled motion of SIDEBENDING and ROTATION for a GROUP of vertebrae occur to OPPOSITE sides.
-Group- Neutral- opposite sides
74
Fryette's second law of spinal motion: when the thoracic and lumbar spine is sufficiently _ or _ (_-_) the coupled motions of _ and _ in a _ vertebrae occur to the _ side.
Is sufficiently FLEXED OR EXTENDED (NON-NEUTRAL) the coupled motions of SIDEBENDING and ROTATION in a SINGLE vertebrae occur to the SAME side.
Single- non-neutral- same side
75
Fryette's second law of spinal motion: when the spine is sufficiently flexed or extending the _ _ are engaged and they _ _ which _ the _ of the _ _.
. . . The FACET JOINTS are engaged and they NOW DICTATE which DIRECTION the BODY of the VERTEBRAE MOVES
76
Fryette's Third law of spinal motion: _ _ of a vertebral segment in _ _ of _ will _ the _ of that segment in _ _ of motion.
INITIATING MOTION of a vertebral segment in ANY PLANE OF MOTION will MODIFY THE MOVEMENT of that segment in OTHER PLANES of motion.
77
Fryette's laws were based on _ _ studies in the _ _.
Laws were based on CADAVER MOVEMENT studies in the EARLY 1900'S
78
According to Gibbons et al study _ _ _ (_ _ )is inconsistent, are more appropriately applied to the _ _.
LUMBAR SPINE COUPLING (FRYETTE'S LAW) is inconsistent, are more appropriately applied to the CERVICAL SPINE.
79
What is the sequence of ramping up the testing to reproduce a patients pain through combined movements? (3) When are they used?
1: place the patient in a position that more closely resembles aggravating factors
2: any combination of movements is acceptable
3: add over pressure if necessary
They are used when Cardinal movements + OP do not reproduce the patients pain.
80
Lumbar quadrant testing: passive combined movements of _, _ _ (_ side), and _ (_ side) with _ _. Use same hand placement as _ _ _, and then return the patient to _ _.
Passive combined movements of EXTENSION, LATERAL FLEXION (SAME side) and ROTATION (SAME side) with OVER PRESSURE.
Use the same hand placement as LUMBAR CLEARING TEST, and then return the patient to ERECT STANDING POSITION
81
What are the 3 types of passive accessory intervertebral motions (PAIVM's)? Which one is usually used for treatment and not assessment?
3 PAIVM's:
- Central PA
- Unilateral PA
- Transverse pressures (usually used for TREATMENT not assessment)
82
4 types of muscle tests?
MMM I
- muscle strength
- muscle control
- muscle length
- isometric muscle testing
83
What are the 5 stages of abdominal testing?
Normal (5): hands behind neck, 20-30 seconds*
Good (4): Arms crossed over chest, 15-20 seconds*
Fair (3): arms straight, 10-15 seconds*
Poor: arms extended toward knees, 1-10 seconds*
Trace: unable to raise more than head off table
*= scapulae off of table
84
What are the 5 stages of extensor (back) testing?
Normal (5): hands behind head, 20-30 seconds*
Good (4): hands at side, 15-20 seconds*
Fair (3): hands at side, sternum off table, 10-15 seconds
Poor (2): hands at side, head off table, 1-10 seconds
Trace (1): only slight contraction of muscle with no movement
*= head, chest and ribs off the table
85
4 cyriax type of isometric muscle/ resisted testing?
Painful and strong
Painful and weak
Painless and weak
Painless and strong
86
Which cyriax level is described: minor lesion of a muscle or tendon? Major lesion of a muscle or tendon?
Painful and strong
-minor lesion
Painful and weak
-major lesion
87
Which cyriax is described as: neurological lesion, complete rupture of a muscle or tendon?
Painless and weak
88
Painless and strong is described as _ _
As NORMAL TISSUE
89
When performing the lumbar extension test: hip should be in _ _ of _, and legs should be approximately _-_ _ off of the table.
Hip should be in 25 DEGREES OF EXTENSION
And legs should be approximately 30-45 degrees off of the table
90
What are the 4 subgroups of diagnostic/ classification groups in the lumbar spine? Grade?
ITEM
- immobilization/ stabilization
- traction
- exercise
- mobilization
Grade: I
91
What are the 5 lumbopelvic classification system- intervention based (evidence based)?
D MINT
- directional preference group (disc dsyfunction- Mckenzie)
- Mobilization and manipulation group
- immobilization/ stabilization group
- neurodynamics group (Klingman)
- Traction group
92
Lumbopelvic classification system- pathology based (NAIOMT)? (5)
IS LIZ?
- Instability
- stenosis (lateral or central)
- lumbar disc (acute posteromedial, posterolateral, central disc protrusion)
- Iliolumbar ligament
- z-joint arthritis
93
Which lumbopelvic classification system is being described: lumbar spine mobility, power and movement/ coordination deficits, lumbar spine and related LE radiating pain (sciatica), lumbar spine and related LE pain (disc), and pelvic girdle mobility deficits? According to?
Lumbopelvic classification systems- impairment based (WHO-ICF)
94
All of the varying classification systems are _ with _ _.
All are SIMILAR with DIFFERENT NAMES.
95
What are the 5 lumbar spine evaluation and treatment methods?
MS To ND
- mobilization/ manipulation
- stabilization
- traction
- neurodynamics
- directional preference (Mckenzie)
96
_% of chronic LBP patients (greater than _ _) present with at least one psychiatric diagnosis
60% of chronic LBP patients (greater then 6 MONTHS) present with at least one psychiatric diagnosis
97
LBP (with or without radiculopathy) is the _ _ of years lived with a _. Is the _ _ cause of _ adjusted for life years.
LBP (with or without radiculopathy) is the LEADING CAUSE of years lived with a DISABILITY
Is the THIRD RANKING cause of DISABILITY adjusted for life years.
98
LBP is the _ _ _ reason for a physicians visit. _ to _ of people are affected by LBP over their lifetime.
LBP is the SECOND MOST COMMON reason for a physicians visit.
80% to 85% of people are affected by LBP over their lifetime.
99
_ _ is a simple screening tool using nonorganic signs to assist in identifying patients who might require a more critical psychological assessment.
WADDELL SIGNS is a simple screening tool . . .
100
Waddell signs: Any individual sign counts as a positive sign for that type: a finding of _ or _ of the _ _ is clinically significant. _ _ signs are ignored.
A finding of THREE OR MORE of the FIVE TYPES is clinically significant
ISOLATED POSITIVE signs are ignored
101
What are the 5 types of Waddell signs?
D SORT
- distraction
- simulation tests
- overreaction
- regional disturbances
- tenderness
102
Waddell signs: _ is usually localized to a particular structure. Two types?
TENDERNESS is usually localized to a particular structure
2 types:
- superficial (skin tender to touch over wide surface of lumbar skin)
- nonanotomic (felt over a wide area, not localized to 1 structure, often extends to T/S and sacrum)
103
Waddell signs: _ _ that give the patient the impression that a particular exam is being carried out when in fact it is not. 2 types?
SIMULATION TESTS that give the patient the impression that a particular exam is being carried out when in fact it is not
2 types:
- axial loading (LBP "reproduced" with Cephalad to caudal vertical loading over a standing patients skull)
- Rotation (LBP reported when the shoulders and the pelvis are passively rotated at the same time in the same plane)
104
Waddell signs: _ + physical finding is elicited in the routine manner, + finding is then compared with the same test when the patient is _. 2 parts?
DISTRACTION . . . When patient is DISTRACTED
2 parts:
- measure L/S flexion and then observing patient picking up pencil off the floor (any increase in ROM?)
- SLR (sitting v. Supine)
105
Waddell signs: _ _ involves a widespread region of neighboring parts. The key factor is _ from accepted _.
REGIONAL DISTURBANCES involves a widespread region of neighboring parts.
The key factor is DIVERGENCE from accepted NEUROANATOMY
106
Waddell signs: _ is a disproportionate verbalization, facial expression, muscle tension or swelling. Caution?
OVERREACTION is a disproportionate . . .
Caution: very easy to introduce tester bias or provoke this type of response unconsciously
107
Waddell signs: to optimize the homogeneity and variability of the Waddell score, it is recommended to _ _ the _ signs instead of _ _ the _.
It is recommended to SUM UP the INDIVIDUAL signs instead of SUMMING UP the CATEGORIES.
108
The study titled Physical therapy or advanced imaging as instead management strategy following a new consultation for low back pain in primary care: associations with future health care utilization and charges found that? (2)
- charges were higher with advanced imaging by an average $4,793
- PT is more cost effective
109
Study "movement impairment during functional tasks in LBP: what is the "core" of the problem": clinical reasoning hypothesis- excessive _ motion is used as a compensatory technique for _ _ weakness. _ _ weakness and _/__ _ muscle overuse.
Excessive SPINAL motion is used as compensatory technique for HIP ABDUCTOR weakness
HIP ABDUCTOR weakness and PARASPINAL/ QUADRATUS LUMBORUM muscle overuse
110
Study "movement impairment during functional tasks in LBP: what is the "core" of the problem": clinical reasoning hypothesis- excessive _ motion is a compensatory technique for _ _ tightness. Low back pain with _ and _.
Excessive PELVIC motions is a compensatory technique for HIP FLEXOR tightness.
Low back pain with SQUATTING AND LIFTING
111
What does the acronym F.A.S.T stand for?
Flexibility
Activate Muscles
Strengthen
Training movement
112
"UK back pain exercise and manipulation randomized trial: effectiveness of physical treatment for back pain in primary care" study's objective was to estimate the effect of adding _, _ _, or _ + _ to "best care" in general practice
Was to estimate the effect of adding EXERCISE, SPINAL MANIPULATION, OR MANIPULATION + EXERCISE to 'best care' in general practice.
113
Results of "UK back pain exercise and manipulation randomized trial": all groups _ _ _. But the _ _ _ group was _ _ at the _ and _ month follow up.
All groups IMPROVED OVER TIME
But the MANIPULATION + EXERCISE group was MOST IMPROVED at the THREE and TWELVE month follow ups.
114
What grade of evidence does the mobilization or manipulation techniques targeted to the SI or lumbar region and active ROM exercises?
Grade A
115
Success rates for using CPR to determine if mobilization/ manipulation would be beneficial: 4 out 5 CPR's? 3 out of 5? 2 out of 5? 1 out of 5? How was success measured?
4 out of 5: 95%
3 out of 5: 68%
2 out of 5: 49%
1 out of 5: 46%
Success: considered as a 50% reduction in their self report disability score
116
A prescriptively selected non-thrust manipulation versus a therapist selected non thrust manipulation for treatment of individuals with LBP, by Donaldson et al: what type of study? What two things did it compare?
It was a randomized clinical trial
2 comparisons:
- Prescriptive treatment (using the CPR)
- Therapist selected (what the therapist wanted to do/ more specific)
117
Results of Donaldson study: Therapist selected treatment resulted in _ _ in _ and _ as those resulting from the prescriptively selected treatment of nonthrust manipulation in patients with chronic mechanically reproducible LBP at the short term and long term follow up.
Therapist selected treatment resulted in SIMILAR CHANGES in PAIN AND DISABILITY as those resulting . .. .
118
Results of Donaldson study: Patients who received therapist selected non-thrust techniques had a _ _-_ global rating of _ than those who received the prescriptively selected techniques.
Patients who received selected non-thrust techniques has GREATER LONG-TERM global rating of IMPROVEMENT than those who received the prescriptively selected techniques.
119
The study 'Effects of thoracic mobilization and manipulation of function and mental state in chronic LBP', by Sung et al: _ subjects were randomly divided into what 3 groups?
36 SUBJECTS were randomly divided into:
- group A: mobilization group
- group B: manipulation group
- group C: control group
120
In sung study: the _ _ _ (_) was used to measure the functional impairment of patients with LBP. _ _ _ was used to measure the ROM of vertebral segments. _. _ _ was used to investigate the mental state of LBP patients
OSWESTRY DISABILITY INDEX (ODI) was used to measure the function impairment of patients with LBP
MULTIPLE SPINAL DIAGNOSIS was used to measure a ROM of vertebral segments.
FEAR AVOIDANCE BELIEFS QUESTIONNAIRE was used to investigate the mental state of LBP patients
121
Results of Sung study: group A and B were significantly different from C in terms of? (2) The _ of group B was significantly different than group A. Between groups there was no difference in _ during _ _.
A and B were significantly different than C:
- in terms of the ODI, and extension ROM
The FABQ of group B was significantly different than group A.
Between groups there was no difference in ROM with TRUNK FLEXION
122
Sung et al study conclusions: application of _ or _ to the thoracic/ lumbar vertebrae has a positive effect on _, _ _, and _ in patients with LBP.
Application of MOBILIZATION OR MANIPULATION to the thoracic/ lumbar vertebrae has a positive effect on FUNCTION, MENTAL STATE, and ROM.
123
What are key examination findings for initiating stabilization exercise as treatment for LBP? (5)
- frequent prior episodes of LBP
- Increasing frequency of episodes of LBP
- instability catch or painful arcs during lumbar flexion and extension
- hypermobility of the lumbar spine
- positive prone instability test
124
Stabilization exercise are used to promote _ _ and _ of the _ _ muscles; _ of the large spinal _ _.
Promote ISOLATED CONTRACTION AND CO CONTRACTION of the DEEP STABILIZING muscles
STRENGTHENING of the large spinal STABILIZING MUSCLES
125
Grade of evidence for use of stabilization exercises?
Grade A
126
With the clinical prediction rules for stabilization _ out of _ must be present to be considered _.
4 out of 4 must be present to be considered UNSTABLE
127
What 2 stabilizing muscles are targeted with stabilization exercise techniques? Function of each?
MULTIFIDUS: extends and rotates the spine
TRANSVERSE ABDOMINUS: flexes, assists in respiration, and decreases shear and torque forces
128
Study 'Multifidus and paraspinal muscle group cross-sectional areas of patients with LBP and control patients' by Macedo et al: what type of study was it? With focus on?
A systematic review with a focus on blinding
129
Conclusion of Macedo et al study: results of most studies suggest that Multifidus and paraspinal muscle groups are _ in patients with _ than those that are healthy.
Multifidus and paraspinal muscle groups are SMALLER in patients with LBP than those that are healthy
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Conclusion of Macedo et al study: patients with chronic LBP appear to have more Multifidus muscle atrophy at _ than _ because the pooled effect estimates were _ for the _ Multifidus muscle in cross-sectional area comparison.
More Multifidus muscle atrophy at L5 THAN L4 because the pooled effect estimates were GREATER FOR THE L5 Multifidus muscle in cross-sectional area comparison.
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Study on 'the relationship between hip abductor muscle strength and IT band tightness in individuals with LBP', by Arab and Nourbakhsh: what type of study was it? Subjects were categorized in what 3 groups?
Cross sectional study
Subjects were categorized into:
- LBP with ITB tightness
- LBP without ITB tightness
- No LBP
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What was measured in Arab study?
Hip abductor strength was measure in all subjects
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Results of Arab study: No significant difference in hip abductor muscle strength was found between?(2)
Between LBP patients WITH AND WITHOUT ITB tightness
134
Results of Arab study: Subjects with _ _ had significantly _ hip abductor muscle strength when compared with?
Subjects with NO LBP had significantly STRONGER hip abductor muscle strength when compared with subjects with LBP (with and without ITB tightness)
135
Study 'muscle assessment in healthy teenagers, comparison with teenagers with LBP' by Bernard et al: compared results of 4 static tests assessing _ _, _ _, _ _ and _ _. Which 3 were lower in the LBP group?
4 static tests assessing:
Trunk FLEXORS, trunk extensors*, hip extensors*, and quadriceps endurance*
*= those which were lower in the LBP group
136
Study of 'systematic review of the literature on the correlation between hip weakness and LBP in athletes and non-athletes, by Breese et al: where was the study done? Showed that current evidence _ _ relationship between hip weakness and LBP, therefore _ the _ _ muscles primarily _ _ and _ _ should be the next logical step in treatment.
Study was done at Loma Linda
Showed that current evidence CLEARLY SHOWS relationship between hip weakness and LBP, therefore STRENGTHENING the WEAK HIP muscles primarily GLUTEUS MAXIMUS AND GLUTEUS MEDIUS should be the next . . . .
137
Study on 'changes in lateral abdominal muscle thickness during the abdominal drawing-in maneuver in those with lumbopelvic pain' by Teyhan et al.: study design? Were divided into 2 groups based on? How was the outcome measured?
CLINICAL TRIAL- NON-RANDOM
2 groups: patients with lumbopelvic pain and those without during abdominal drawing in maneuver
Outcome was measured by muscle thickness using US
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Results of Teyhen study: % change of thickness of _ _ muscle was _ _ in subjects with LBP. _ _ _ between groups for IO. Both muscle groups were _ during the drawing in procedure. No significant difference between _ and _ _ of the LBP group.
- % change of thickness of TRANSVERSE ABDOMINUS muscle was SIGNIFICANTLY LOWER in subjects with LBP
- NO SIGNIFICANT DIFFERENCE between groups for internal obliques
- Both muscle groups were SYMMETRICAL during . . .
- No significant difference between SYMPTOMATIC AND ASYMPTOMATIC SIDES of the LBP group
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What is the grade of evidence for Extension specific exercise? Flexion specific? (Mckenzie)
Extension: grade A
Flexion: grade C
140
The study ' recent advances in lumbar spinal mechanics and their clinical significance' by Adams, et al: upheld McKenzie's theory of _ _ _ to the lumbar _. Validated McKenzie's hypothesis of _ _ within the _.
Upheld McKenzie's theory of REPETITIVE MOTION INJURIES to the lumbar DISC.
Validate McKenzie's hypothesis of NUCLEOID MOVEMENT within the DISC.
141
Study on 'Efficacy of spinal mobilization in the treatment of patients with lumbar radiculopathy due to disc herniation' by Kumar and Cherian: study design? 2 groups assessed? Outcome measure- Pain using _, ROM using _ and pain disability using _.
Randomized clinical trial
Control group and experimental treatment group
Outcome measure- pain using VAS, ROM using SLR, and pain disability using QBPDI (Quebec back pain disability index)
142
Kumar study: control group recieved conventional PT treatment of _ _ _ in Fowlers position, application of _ to LB in prone, and _ _ (including back care, postural control and ergonomic _ _)
Conventional PT treatment of INTERMITTANT LUMBAR TRACTION in Fowler's position, application of HEAT to LB in prone, and HOME PROGRAM (including back care, postural control and ergonomic INFORMATIONAL HANDOUT)
143
Study by Kumar: Experimental treatment group received _ _ as _ and _ _ and _ _ _ _ _ on the _ _ under consideration for 5 reps and 2 sets.
Group received SAME TREATMENT as CONTROL and GRADE I and GRADE II TRANSVERSE VERTEBRAL PRESSURES on the SPINOUS PROCESS under consideration for 5 reps and 2 sets.
144
Conclusion on Kumar study: _ _ group showed significant improvement in the _, _, and _ when compared to the control group in the post treatment comparison. Long term results?
MAITLAND MOBILIZATION group showed significant improvement in the PAIN, SLR, and QBPDI in the post treatment comparison.
Long term results compared to the immediate post treatment improvement, but was NOT significant
145
Mechanical traction key examination findings include: signs and symptoms of _ _ _, no movements _ _, and acute LBP for _ than _ _. Grade of evidence?
Signs and symptoms of NERVE ROOT COMPRESSION, no movements CENTRALIZE SYMPTOMS, and acute LBP for LESS THAN 6 WEEKS
146
Study 'A clinical prediction rule for classifying patients with LBP who demonstrate short term improvement with mechanical lumbar traction' by Congcong Cai: CPR rules being evaluated are no _ _; FABQW score of _ than _, no _ _, and _ than _ years old.
CPR rules being evaluated are no MANUAL WORK, FABQW score of LESS THAN 21, no NEUROLOGICAL DEFICITS, and GREATER than 30 years old.
147
Study by Congcong Cai: The study is _ _ _, based on what prediction model (how many indicators must be present?)?
This study is NOT YET VALIDATED, based on prediction model of 4 out of 4 PREDICTORS MUST BE PRESENT.
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Neural tissue/ Neurodynamics key examination findings: signs and symptoms of _ _ _, no movement _ _, and _ trial treatment fails. Grade of Evidence?
Signs and symptoms of NERVE ROOT COMPRESSION, no movements CENTRALIZE SYMPTOMS, and trial TRACTION treatment fails.
Grade of evidence: C
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Study 'Slump stretching in the management of non-radicular LBP' by Cleland and Childs: study design? Data suggests patients with _ _ who are unable to _ may benefit from slump stretching.
Pilot clinical trial
Data suggests that patients with DISTAL SYMPTOMS who are unable to CENTRALIZE may benefit from. . .
150
Cleland/ Child's study results: Slump stretching is useful for decreasing _ _ _ and decreasing _. Slump stretching caused a _ of symptoms from the _ _ _ to the _ _.
Slump stretching is useful for decreasing SHORT TERM DISABILITY and decreasing PAIN.
Slump stretching caused a CENTRALIZATION of symptoms from the PERIPHERAL LOWER EXTREMITY to the LOWER BACK.
151
Grade of Evidence for patient education? Strategies NOT to use include promoting _ _ and providing _ _ explanations.
Grade of evidence: B
Strategies NOT to use:
- promoting BED REST
- providing IN-DEPTH PATHOANATOMICAL explanations.
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Strategies you should emphasize to help educate your patients: promotion of _ of the _/_ _ of the spine, _ of pain, favorable _, use of _ _ strategies,_ _ of normal _, and the importance of _ in activity levels and specific movements.
You should emphasize:
- promotion of UNDERSTANDING of the ANATOMICAL/ STRUCTURAL STRENGTH of the spine
- NEUROSCIENCE of pain
- favorable PROGNOSIS
- use of PAIN COPING strategies
- EARLY RESUMPTION of normal ACTIVITY
- importance of IMPROVEMENT in activity levels and specific movements. (Highlight progress made)
