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Flashcards in Review of year 1 material Deck (79):
1

Manipulation is a _______ velocity technique.

High

2

Mobilization is a _______ velocity technique

Low

3

Distraction is a form of ?

traction

4

Mobilization principles

- hands close to the joint line
- patient comfortable?
- therapist comfortable? (table height, joints in neutral)
- position joint (open packed, end range)
- keep arms in line with the direction of force
- stabilize (proximal bone usually)
- continually assess patient's tolerance/response
- if the patient isn't relaxing, ask yourself what you can do to make them relax more

5

Lumbar tests

- passive supine SLR
- crossed supine SLR
- slump (seated SLR)
- femoral nerve tension test
- spring test
- prone instability test

6

SIJ tests (4)

- SI distraction
- SI compression
- thigh thrust (posterior shear test)
- sacral thrust (spring test)

7

Screening: tests of function (4)

- chair stand
- squat
- single leg stance
- back bending

8

Screening: active motion testing (5)

- flexion/extension
- lateral flexion
- rotation
- repeated movements

9

Things to watch for when testing active motion

- symptoms
- deviations
- limitations of movement
- curve reversal
- rhythm
- compensatory movement

10

Contraction of what muscle facilitates pelvic floor contraction?

TR

11

What two muscles might atrophy post lumbar surgery?

Multifidi
TRA

12

When would you perform dynamic lumbar stabilization with a patient?

- hypermobile people who are symptomatic
- people with a fracture to promote stabilization

13

What is lumbar spinal stenosis?

Narrowing of the skeletal canal

14

Symptoms of lumbar spinal stenosis

- loss of sensation
- weakness
- reflex changes
- balance deficit from decreased nerve function
- pain with extension like reaching overhead
*- relief with flexion, sitting, recumbence*

15

Clinical picture of spinal stenosis patient

- 30's 40's: long history of low back pain
- 50's: generally asymptomatic
- 60's: slow onset, feels like leg pain but is actually compression. can't walk or stand long due to upright posture. numbness, paresthesia, weakness. LE symptoms predominate back pain, if any.

16

Symptoms of neurogenic claudication

- absent peripheral pulse (nerve compression affects blood circulation)
- ischemic signs in calves (pain, paresthesia, cramping)
- cauda equina symptoms (incontinence, saddle paresthesia, gait imbalance due to inability to coordinate muscle activity)

17

Spine diameter

C: 17-18mm
T: 12-14mm
L: 15-17mm

18

Interventions for stenosis

- flexion: knees to chest, drape over a swiss ball
- Neurontin: decreases nerve excitability
- laminectomy: cutting away bone and cleaning out

19

Spondylosis is...

spinal arthritis

20

Spondilolysis...

defect or fracture of vertebrae (typically pars, located between facets)

21

Spondylolysthesis...

vertebrae shifted out of normal position

Grades: fraction of body slipped
I: up to 1/4
II: 1/4 to 1/2
III: 1/2 to 3/4
IV: 3/4 to full
V: complete

22

Symptoms of spondylolisthesis

pain with palpation
flexion (midrange) feels good

23

Symptoms of clinical lumbar instability

- "catch in the back"
- Gower's sign
- reversal of LP rhythm
- pain moving into flexion
- pain returning from flexion
- clunking feeling or giving way

24

Treatment for clinical lumbar instability

core exercise in neutral spine
- NSAIDS
- lumbar fusion

25

Lateral shift is named for...

the direction the shoulders move

26

The upper body shifts _______ from pain in lateral shift.

away from the pain

27

Correction of lateral shift _______ intensity and causes _________.

increases intensity
centralization of symptoms

28

After correction of lateral shift, one should avoid...

flexion

29

Classifications of instability (5)

stabilization
manipulation
specific exercise (flexion or extension biased)
traction
lateral shift

30

Factors for stabilization

younger
+ prone instability test
aberrant motions
greater SLR ROM
Spring test hypermobility
increasing episode frequency
3+ episodes

31

Factors against stabilization

discrepancy in SLR ROM of >10 degrees
low FABQ scores

32

Factors for manipulation

onset of pain

33

Factors against manipulation

leg symptoms
no pain with spring test
increasing episode frequency
peripheralization with motion testing

34

Factors for specific exercise

strong preference for sitting/walking
centralization with motion testing
peripheralization in direction opposite to centralization

35

Factors against specific exercise

LBP only
no change with all movements

36

Red flags for referral

saddle anesthesia
urinary incontinence
history of cancer
abdominal pain that is non-musculoskeletal in nature
night pain
no response to treatment

37

What motion is C2 built for?

rotation

38

What are characteristics of the atlas?

no body
no spinous process
lateral masses

39

What are implications of DDD for movement?

loss of rom
fear of moving

40

What are functions of the disc?

shock absorption
structural stability
full mobility
protection of spinal cord and axial neural tissue

41

What disc is most likely to degenerate?

C5-6
followed by C6-7

42

Radicular

pertains to nerve root

43

Radiculitis

inflammation of spinal nerve
(pain, paresthesia but no signs of reflex, sensory or motor change)

44

Radiculopathy

disease of the nerve root
reflex, sensory and or motor changes!

45

What are classifications of disc disorders?

Bulge
Contained (protrusion- annulus disrupted, nucleus confined)
Extrusion (prolapse- nucleus attached to disc but outside annulus)
Sequestered (nuclear material in intervertebral canal)

46

Pain in the thoracic spine is...

poorly localized
A or P
may follow a rib

47

What ribs are true? false? floating?

true 1-7
false 8-12
floating 11-12

48

Describe the pump handle motion

upper ribs
up and forward motion of sternum
axis is the frontal plane

49

Describe the bucket handle motion

upper ribs
up and lateral motion
axis is frontal plane

50

How is scoliosis named?

apex of the convexity

51

What are tests to determine scoliosis?

Adam's sign (scoliosis persists with flexion and indicates structural curvature)
xray
Cobb angle

52

What are components of a T spine exam?

AROM
AROM with overpressure
neuroscreen
joint mobility assessment
PROM
special tests
palpation

53

What is thoracic outlet syndrome?

compression of neurovascular bundle between c spine and axilla

54

Typical symptoms of thoracic outlet syndrome?

swelling or arm/hand, fatigue in UE, pain, vein distention, weakness, problems with fine motor tasks, cramps, numbness, tingling

55

Potential causes of TOS?

congenital anomaly, postural, exostosis (cartilaginous tissue on bone), trauma, pregnancy

56

What could mimic thoracic outlet syndrome?

anterior scalene tightness
costoclavicular approximation
pec minor tightness
cervical rib

57

What is T4 syndrome?

like TOS plus a headache caused by thoracic hypomobility

vague complaints of back and arm pain

58

Why classify with McKenzie?

assess intensity and location of symptoms prior, during and after

59

What are the possible McKenzie classifications?

posture
dysfunction
derangement

60

McKenzie classifications: posture

intermittent pain
no pathology
not referred
soft tissue stress

61

McKenzie classifications: dysfunction

creeping onset
pain before end range
intermittent
only referred to adherent nerve root (ANR)
adaptive shortening

62

McKenzie classifications: derangement

affects joint surfaces ability to move
sudden onset
pain during movement
constant pain
may refer

63

Describe a McKenzie spine assessment

flexion
extension
lateral bending
loading and unloading
mobility

64

Peripheralization means symptoms move

midline to distal

65

Centralization means symptoms move

distal to prozimal

66

How does the facet orientation of the thoracic spine change from T1-T12?

angle of inclination increases
middle limits flexion, facilitates rotation

67

What is a potential negative consequence of the natural spinal curvatures?

shear forces at transitions between curves

68

Amount of spinal motion depends on what?

soft tissue extensibility
flexibility of ligaments
force of muscles
disc displacement
fear
pain

69

What region produces the most axial rotation?

C1-C2

70

What segments produce the most sagittal plane movement?

C4-5
C5-6
L5-S1

71

What 2 major motions are the facet joints capable of?

gliding up and down

72

What movements open the right facet?

Flexion
left side bend
left rotation

73

What movements open the left facet?

Flexion, right side bend, right rotation

74

What movements close the right facet?

extension, right side bend, right rotation

75

What movements close the left facet?

extension, left sidebend, left rotation

76

How do you know if it's fixed or static posture?

Does the posture changes with movement during mobility testing?
- if yes, it's static
- if no, it's fixed

77

What are possible impairments leading to poor posture?

proprioception
mobility
muscle impairment
body mechanics

78

What are some common faulty postures?

lordosis
flat back
kyphosis
forward head
scoliosis

79

Where should the line of gravity fall?

posterior to the hip
anterior S2, knee and ankle