Part C - Advanced Lumbar Spine & Extremities (Lower Limb)

Question 1

at the completion of the history you should have a hypothesis on?

Answer 1

location
classification
direction
force

Question 2

list 3 baselines you can identify in the physical exam

Answer 2

mechanics
symptoms
functional

Question 3

how can you determine that you are at end range?

Answer 3

feels like a strain

Question 4

terms used for recording during the repeated movements?

Answer 4

produce
centralizing
peripheralizing
increase
decrease
abolish

Question 5

terms used for recording after the repeated movements?

Answer 5

no worse
no better
worse
better
peripheralized
centralized

Question 6

words which indicate a “red” light?

Answer 6

worse

peripheralized

Question 7

words which indicate a “green” light?

Answer 7

better

centralized

Question 8

words which indicate an “amber”/”yellow” light?

Answer 8

no worse
no better
no effect

Question 9

list 3 things centralization determines

Answer 9

classification
direction
prognosis

Question 10

what criteria allow us to make the mechanically inconclusive classification?

Answer 10

no position or lasting improvement

Question 11

what does a mechanically inconclusive classification indicate regarding prognosis?

Answer 11

highly variable

Question 12

describe the worse section for a typical posterior derangement

Answer 12

flexion

prolonged sitting

Question 13

describe the better section for a typical posterior derangement

Answer 13

stand
walk
move

Question 14

describe the worse section for a typical anterior derangement

Answer 14

extension

prolonged standing

Question 15

describe the better section for a typical anterior derangement

Answer 15

flex

sit

Question 16

what is the typical pattern of movement loss in an anterior derangement?

Answer 16

flexion

Question 17

what is the “provocation test” for anterior derangement?

Answer 17

sustained extension

Question 18

what percentage of spinal patients are able to be classified as dysfunction?

Answer 18

~5%

Question 19

what factors contribute to the percentage of dysfunction patients?

Answer 19

surgery
previous derangements
trauma
men > women
>55 y/o

Question 20

what analogies might be effective when education patients?

Answer 20

disc model
jelly donut
knuckle papercut

Question 21

how can we achieve commitment by the patient?

Answer 21

non-invasive
demo change w/posture
involve patient in cause/effect

Question 22

an end-range response of decreased or abolish, but no better indicates what?

Answer 22

increase force

increase frequency

Question 23

an end-range response of increased, no worse indicates what?

Answer 23

apply over-pressure
increase reps
add sustained

Question 24

an end-range response of increase or produce, remains worse indicates what?

Answer 24

wrong direction

wrong classification

Question 25

what clues suggest more time is required for reduction to occur?

Answer 25

lack of motion

Question 26

what clues in the history and the physical exam suggest the presence of a relevant lateral component?

Answer 26

visual shift asymmetrical symptoms lateral movements affect pain deviation in sagittal plane

Question 27

if relevant lateral component is present how does it alter management?

Answer 27

avoid turning/twisting | sleep position

Question 28

how is maintenance of the reduction accomplished?

Answer 28

compliance good posture reincorporate provocative movement

Question 29

why is recovery of function important?

Answer 29

prevent dysfunction prevent future derangements ensure full reduction

Question 30

why is prophylaxis important?

Answer 30

minimize recurrences | self manage future recurrences

Question 31

when do we apply clinician procedures?

Answer 31

exhausted patient over-pressure sitting at "yellow" lights no better

Question 32

clinician procedures can be used to confirm?

Answer 32

direction | reduce derangement or expose dysfunction

Question 33

when would you consider a force alternative?

Answer 33

exhausted one plane of motion worse symptoms symptoms plateau

Question 34

aims of taking the history are?

Answer 34

``` provisional classification stage of the disorder functional limitations serious pathologies guide the physical exam baseline measurements ```

Question 35

what portion of the history section justifies need for PT to insurance companies?

Answer 35

functional disability from present episode

Question 36

what are the "yellow" flags to recovery barriers?

Answer 36

attitudes/beliefs reduced level of activity looking for a diagnosis emotions

Question 37

what are the "black" flags to recovery barriers?

Answer 37

family influences

Question 38

what are the "blue" flags to recovery barriers?

Answer 38

work influences

Question 39

what are the "orange" flags to recovery barriers?

Answer 39

psychosis - disconnect from reality

Question 40

serious spinal pathology

Answer 40

cancer | cauda equina syndrome

Question 41

tests may be used to detect a sacroiliac source of low back pain once a...?

Answer 41

McKenzie evaluation has ruled out the lumbar spine

Question 42

list 5 SIJ provocation tests

Answer 42

``` distraction or "gapping" posterior shear or "thigh thrust" compression sacral thrust pelvic torsion ```

Question 43

distraction or "gapping"

Answer 43

patient lying supine the therapist applies pressure to both ASIS's the force is directed posteriorly and laterally

Question 44

posterior shear or "thigh thrust"

Answer 44

patient lying supine the therapist applies a posterior shearing stress to the sacroiliac joint through the femur whilst the sacrum is stabilized excessive adduction of the hip is to be avoided as flex/add of the hip normally is uncomfortable or painful

Question 45

compression

Answer 45

patient lying on side the therapist applies pressure to the uppermost iliac crest the force is directed towards the opposite iliac crest

Question 46

sacral thrust

Answer 46

patient lying prone the therapist applies pressure directly to the sacrum whilst the ilia are fixed on the treatment table this causes an anterior force of sacrum on the ilia

Question 47

pelvic torsion or "Gaenslen's test"

Answer 47

posterior rotation of the left ilium on the sacrum is obtained by flexion of left hip and knee whilst simultaneously the right hip is extended overpressure is applied to force the sacroiliac joint to end range anterior rotation of the right ilium on sacrum is performed by forcing the right thigh towards the floor

Question 48

SI joint pain history

Answer 48

``` asymmetrical symptoms that do not cross midline female > men below L5 young (18-45 y/o) athletic MOI ```

Question 49

use what 2 movements to assess directional preference and for self-treatment of SI joint pain?

Answer 49

posterior rotation SIJ | anterior rotation SIJ

Question 50

articular dysfunction

Answer 50

intermittent pain consistently produced at a restricted end-range with no rapid change of symptoms or range

Question 51

contractile dysfunction

Answer 51

intermittent pain, consistently produced by loading the musculotendinous unit only during movement or loading remodeling process must affect both the tissue's ability to contract and stretch less predictable

Question 52

hip derangement percentage?

Answer 52

53% extension responders

Question 53

knee derangement percentage?

Answer 53

90% extension responders

Question 54

ankle derangement percentage?

Answer 54

75% dorsiflexion responders

Question 55

"target zone"

Answer 55

the point in the arc of movement that provokes pain or where pain is at its max (contractile dysfunction)

Question 56

what has been shown to be useful in the rehab of chronic tendon problems?

Answer 56

eccentric loading