spine Flashcards by Afnan Katlo

common causes of LBP

Muscular spasm, strain
Ligament sprain
Spondylosis
Herniated nucleus pulposus
Facet joint dysfunction
Spondylo-lysis or -listhesis
Seronegative spondyloarthropathies

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slipping or shifting of vertebrae out of their space is?

spondylolisthesis

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the diagnosis for LBP is divided into?

Specific spinal pathology
Non specific spinal pathology
Radicular pathology

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acute, subacute, and chronic
how can we differentiate them according to time?

acute up to 6 weeks
6-12 subacute
>12 chronic

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Corticosteroids for severe pain

true or false?

true

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increased level of c-reactive protein is indication of?

inflammation
ex, acute low back pain

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in acute LBP the pain is?

severe sudden onset

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Acute low back pain usually does have a specific cause
true or falsE?

false, does not have specific cause

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what are the red flags for rehabilitation?

Cauda equina, spinal fracture-infection, cancer, abdominal aortic aneurysm

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Degenerative joint disease affecting the vertebrae and intervertebral disc, arthiritis
is?

Spondylosis

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Fracture in pars interarticularis
is?

Spondylolysis

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Displacement of one vertebra on another
is?

Spondylolisthesis

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what are the stages of developing Ankylosing spondylitis?

1- formation of osteophytes of margins of vertebrae
2-then both osteophytes ossified into a joint as syndesmophytes
3- non-marginal syndesmophytes

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non radicular pain is caused by ?

referred pain facet joint or disc

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radicular pain is related to?

nerve compression

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radicular pain will effect the motor and sensory nerves of the same segment\true or false?

true

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which part of the disc is soft and movable and the other one is stable?

nucleus pulposus
annulus fibrosis

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what is the physiology of disc herniating?

1-Tears in the annulus fibrosis
2- Herniation of nucleus pulposus

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what are the stages of herniated disc?

bulging
protrusion
extrusion
sequestration

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there is only extension of the disc margin beyond the margins of the adjacent vertebral endplates without tearing of annuluses fibrosis
which one is this?

bulging

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the nuclear materials emerge through the annular fibers, but the posterior longitudinal ligament remains intact
which one is this pathology?

extrusion

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the nucleus pulposus impinges on the annulus fibrosis and the posterior longitudinal ligament remains intact
nucleus pulposus getting thicker
which one is this pathology?

protrusion

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the nuclear material emerges through the annulus fibrosis and the posterior longitudinal ligament is disrupted and a portion of nucleus fibrosis has protruded into the epidural space
which pathology is this?

sequestration

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radiculopathy happens in extrusion and sequestration in disc herniation
true or false?

true

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descending root can be impinged by ?

protrude posterolateral

for flexion based which compartment will affect?

Muscular Ligamentous Compression Fracture Discogenic

Stenosis Facet Spondylosis Central Disc will be affected by?

extension base

Transitional force will affect?

Spondylolisthesis Sacroiliac Facet

anterior compression of the disc will be cause by?

flexion force

extension force will lead to?

posterior compression

hyperflexion force will lead to posterior compression having posterior longitudinal ligament torn true or false?

true

anterior compression will affect posterior annulus and with the posterior compression will centralized annulus true or false?

true

what does it mean centralization?

the pain was peripheral but with the movement it centralizes

what are the pain characteristic of LBP?

sharp and burning relating to nerve and dull ach

pain with prone we will have?

Facet, Lat Herniated Nucleus Pulposus (HNP), systemic

pain with sitting we will have?

Paramedian HNP, annular tear

Lateral HNP, central stenosis, facet syndrome is related with ?

standing pain

central stenosis is for pain with walking true or false?

true

how radiation occurs?

Up back To sacrum To buttocks Down leg

what are the symptoms ?

radiation Cough/valsalva exacerbation Distal neuro symptoms - weakness/paresthesia Perianal paresthesia Bowel/bladder symptoms

length of stride arm swing trunk motion ?pelvic tilt related to?

walking

we have to assest what in LBP?

walking standing supine sitting

flexion of back is 90 exention of back is 15-20 side bending = 30 and trunk rotation are ROM for trunk true or false?

true

what should we assist for lower back pain in palpation?

Spinous processes Dorsal lumbar fascia/soft tissues

what is Stork Test for sacroiliac j ?

Single leg extension

Toe raises for?

Gastrocnemius strength

how can we asset LBP while the patient is standing?

by palpation ROM posture stroke test toe raises single leg raise

Distracted SLR DTR - patellar & Achilles Strength - EHL, TA, Peroneals, quads, hip flexors Sensation for?

sitting examination

how to Stretch the Spinal Cord or Sciatic Nerve in supine position?

Straight Leg Raise Cross Leg SLR Kering Test

what tests are applied in supine position?

straight Leg Raise Cross Leg SLR Kering Test Hamstring flexibility Leg lengths

how to measure leg length?

measured ASIS to Med Mal

l4 radicular pathy will cause?

Quads/Tibialis Anterior Patellar reflex decreased Sensory Great toe and medial leg loss

l5 radicular pathy will cause?

Strength of Ankle and great toe dorsiflexion Extensor Hallucis Longus Sensory to dorsum of foot loss

Ankle reflexes and sensation of posterior calf and lateral foot Peroneals/Gastroc Achilles reflex Sensory to lateral and plantar foot are lost by which innervation?

muscle relaxions are mostly used in acute management true or false?

true

what are the acute management?

NSAIDS muscle relaxers heating agent back exercises 'Stretching - HS, hip extensors, erector spinae Strengthening - abs, erector spinae'

prolonged sitting/standing recurrent bending twisting are avoid especially in?

subacute stage

what are the goals for chronic LBP?

Control pain Maintain function Prevent disability

what exercises we can do for chronic LBP?

standing hamstring stretch 15-30 sec quadruped arm/leg swing rep 10 times gluteal stretch 15-30 sec cat and camel 3 stets of 10 pelvic tilit 3 sets of 10 partial curl 3 sets of 10 extension exercise 4 sets 2 min rest side plank

muscle strain in 7 to 10 days, ligament sprain in 3 to 4 weeks disk herniation in 8 to 10 weeks true or false?

true

which exercises centralizes pain with trunk extension?

MCKenzie

centralizing the pain allows the source of the pain to be treated rather than the symptoms is done in which approach?

McKenzie approach

1.Double knee to chest in supine lying 2. Step standing trunk flexion with involved side on ground and uninvolved leg on bench, in this case right leg on ground 3.Quadruped stretch 4.Lumbar extension are for?

Mc Kenzie Stretching

In a derangement presentation, the direction of preference for treatment is lumbar flexion true or false?

false, extension

lumbar extension in lying would have decreased and centralized the pain trunk flexion, which would have increased and peripheralized the pain true or false?

true

what are lumbar extension exercises for derangement?

Prone press-ups without or with overpressure Standing lumbar extension Standing lumbar extension using wall to sag into

In any kind of derangement it is important to perform the exercise short enough for the fluid to alter its position anteriorly true or false?

false, long 5-10 min

In derangement, extension in standing is designed to reduce accumulation of nuclear material in the posterior compartment of the intervertebral joint true or false?

true

extension in standing mostly effective for?

after prolonged sitting

list the Meckenzie exercises

lying prone extension in lying extension in standing rotational mobilization exercises

SIJ pain causes?

TRAUMATIC (Fall, heavy weights) ATRAUMATIC (bulging[L4-5/L5-S1], scoliosis, postpartum, inflammatory arthropathy [AS])

Low back pain (BELOW L5) Pelvis/buttock pain Hip/groin pain Poor sleep habits Unilateral leg instability Sitting problems Lower extremity pain are for?

SIJ pain characteristics

Sit to stand Prolonged walking Unilateral weight bearing (stairs, putting on pants-socks) Prolonged standing are ?

aggravating factors for SIJ pain

what are the relieving factors for SIJ pain?

Weight bearing unaffected side Lying on unaffected Side Compression manually or with a belt to relieve hypermobility

Fortine's finger test is?

patient pointing to inferior-medially to posterior superior iliac spine

in SJ pain, patients point to ASIS true or false?

false, PSIS

what are Provocative Tests for SIJ?

distraction thigh thrust FABER GAEnslean compression 3 of 5 must be positive 1 of 3 positive results must be thigh thrust or compression

first aim for SIJ pain is to decrease its mobility true or false?

true

list three exercises for SIJ pain relief

push pull isometric push and pull modified dead bug

what are the EARLY INTERVENTION IN ACUTE CASES ?

ROM exercises in a pain-free range isometric activity of the injured muscles or the muscles around an injured joint, directional preference exercises

what are the AROM for cervical pain ?

rotation, chin retraction, and head nodding 6-10 repetitions

patients who have more than about 30 degrees of available pain free motion, isotonic exercises can be introduced within the pain free range true or false?

true

Isometric contractions holding for 6-10 sec and should be performed through ranges of motion at about 30 degree true or false?

false, 20 degrees

what is the strategy for cervical region pain?

1. Evaluate and train deep segmental stabilizers 2. Address postural factors and respiration 3. Address muscle imbalance of large torque producers Stretch short tight cervical muscles Evaluate/re-train scapula stabilizers Strengthen large torque producers of the neck 4. Re-train the sensory-motor response loop

weak flexor neck muscles compensated by increased activity in the superficial SCM and anterior scalene true or false?

true

Quadruped/prone series (Jull) for?

Treatment options for deep extensors

Combined treatment option for?

Quadruped track (Murphy

chin tucks Craniocervical flexion Isometric holds with chin tuck ball squeeze forehead ball roll with good AROM for?

Treatment options for inhibited deep stabilizers

Upper cervical spine 🡪 maximally extending Lower cervical spine 🡪 maximally flexing for chin tuck true or false?

false, opposite

acute phase, patient practice holding a supine chin retraction while holding the head off the edge of a mattress true or false?

false, post-acute the acute phase the head should be supported

how much isometric holds with chin tuck is done?

6 second holds, 6 repetitions

spine Flashcards

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