Flashcards in Review of year 1 material Deck (79):
Manipulation is a _______ velocity technique.
Mobilization is a _______ velocity technique
Distraction is a form of ?
- 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
- passive supine SLR
- crossed supine SLR
- slump (seated SLR)
- femoral nerve tension test
- spring test
- prone instability test
SIJ tests (4)
- SI distraction
- SI compression
- thigh thrust (posterior shear test)
- sacral thrust (spring test)
Screening: tests of function (4)
- chair stand
- single leg stance
- back bending
Screening: active motion testing (5)
- lateral flexion
- repeated movements
Things to watch for when testing active motion
- limitations of movement
- curve reversal
- compensatory movement
Contraction of what muscle facilitates pelvic floor contraction?
What two muscles might atrophy post lumbar surgery?
When would you perform dynamic lumbar stabilization with a patient?
- hypermobile people who are symptomatic
- people with a fracture to promote stabilization
What is lumbar spinal stenosis?
Narrowing of the skeletal canal
Symptoms of lumbar spinal stenosis
- loss of sensation
- reflex changes
- balance deficit from decreased nerve function
- pain with extension like reaching overhead
*- relief with flexion, sitting, recumbence*
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.
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)
Interventions for stenosis
- flexion: knees to chest, drape over a swiss ball
- Neurontin: decreases nerve excitability
- laminectomy: cutting away bone and cleaning out
defect or fracture of vertebrae (typically pars, located between facets)
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
Symptoms of spondylolisthesis
pain with palpation
flexion (midrange) feels good
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
Treatment for clinical lumbar instability
core exercise in neutral spine
- lumbar fusion
Lateral shift is named for...
the direction the shoulders move
The upper body shifts _______ from pain in lateral shift.
away from the pain
Correction of lateral shift _______ intensity and causes _________.
centralization of symptoms
After correction of lateral shift, one should avoid...
Classifications of instability (5)
specific exercise (flexion or extension biased)
Factors for stabilization
+ prone instability test
greater SLR ROM
Spring test hypermobility
increasing episode frequency
Factors against stabilization
discrepancy in SLR ROM of >10 degrees
low FABQ scores
Factors for manipulation
onset of pain
Factors against manipulation
no pain with spring test
increasing episode frequency
peripheralization with motion testing
Factors for specific exercise
strong preference for sitting/walking
centralization with motion testing
peripheralization in direction opposite to centralization
Factors against specific exercise
no change with all movements
Red flags for referral
history of cancer
abdominal pain that is non-musculoskeletal in nature
no response to treatment
What motion is C2 built for?
What are characteristics of the atlas?
no spinous process
What are implications of DDD for movement?
loss of rom
fear of moving
What are functions of the disc?
protection of spinal cord and axial neural tissue
What disc is most likely to degenerate?
followed by C6-7
pertains to nerve root
inflammation of spinal nerve
(pain, paresthesia but no signs of reflex, sensory or motor change)
disease of the nerve root
reflex, sensory and or motor changes!
What are classifications of disc disorders?
Contained (protrusion- annulus disrupted, nucleus confined)
Extrusion (prolapse- nucleus attached to disc but outside annulus)
Sequestered (nuclear material in intervertebral canal)
Pain in the thoracic spine is...
A or P
may follow a rib
What ribs are true? false? floating?
Describe the pump handle motion
up and forward motion of sternum
axis is the frontal plane
Describe the bucket handle motion
up and lateral motion
axis is frontal plane
How is scoliosis named?
apex of the convexity
What are tests to determine scoliosis?
Adam's sign (scoliosis persists with flexion and indicates structural curvature)
What are components of a T spine exam?
AROM with overpressure
joint mobility assessment
What is thoracic outlet syndrome?
compression of neurovascular bundle between c spine and axilla
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
Potential causes of TOS?
congenital anomaly, postural, exostosis (cartilaginous tissue on bone), trauma, pregnancy
What could mimic thoracic outlet syndrome?
anterior scalene tightness
pec minor tightness
What is T4 syndrome?
like TOS plus a headache caused by thoracic hypomobility
vague complaints of back and arm pain
Why classify with McKenzie?
assess intensity and location of symptoms prior, during and after
What are the possible McKenzie classifications?
McKenzie classifications: posture
soft tissue stress
McKenzie classifications: dysfunction
pain before end range
only referred to adherent nerve root (ANR)
McKenzie classifications: derangement
affects joint surfaces ability to move
pain during movement
Describe a McKenzie spine assessment
loading and unloading
Peripheralization means symptoms move
midline to distal
Centralization means symptoms move
distal to prozimal
How does the facet orientation of the thoracic spine change from T1-T12?
angle of inclination increases
middle limits flexion, facilitates rotation
What is a potential negative consequence of the natural spinal curvatures?
shear forces at transitions between curves
Amount of spinal motion depends on what?
soft tissue extensibility
flexibility of ligaments
force of muscles
What region produces the most axial rotation?
What segments produce the most sagittal plane movement?
What 2 major motions are the facet joints capable of?
gliding up and down
What movements open the right facet?
left side bend
What movements open the left facet?
Flexion, right side bend, right rotation
What movements close the right facet?
extension, right side bend, right rotation
What movements close the left facet?
extension, left sidebend, left rotation
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
What are possible impairments leading to poor posture?
What are some common faulty postures?