Task 2/3

Question 1

The student is able to describe how pelvic stability develops and what it means.

Answer 1

Form and forced closed

Normally, the stability of the joint is provided by ligaments, the articular surfaces and the muscles. There is a form closure + force closure = the closing mechanism of the S-I joint. Pelvic girdle pain can arise as a result of motor control impairment.

Question 2

The student is able to name the movement directions and movement limitations of the SIJ.

Answer 2

Nutation, counter nutation

Question 3

The student knows the content of and evidence for the medical history data of the lumbar spine.

Answer 3

-

Question 4

The student knows the content of and evidence for the medical history data of the SI joints.

Answer 4

-

Question 5

The student knows the content of and evidence for the neurological tests and provocation tests of the lumbar spine.

Answer 5

• Straight leg raise test
• Crossed straight leg raise test (specific L4 S1)
• Prone knee bend test (Femoral nerve L2 L4)
• Slump test
• Kemps test (facet joint pain, stenosis)

Question 6

The student knows the content of and evidence for the the neurological tests and provocation tests of the SI joints.

Answer 6

Van der Wurf: minimal 3 out of 5
• Distraction
• Compression
• Thigh test
• Geanslen's
• Patrick sign

Laslett: 2 out of 4 
• Distraction test
• Thigh trust
• Compression test
• Sacral trust

Question 7

The student has an understanding of the screening process of the low back. He/she is aware of the general steps and specifically of the alarm signals of the low back.

Answer 7

Red flags are signs or symptoms that might, individually or collectively, indicate a possible (serious) specific cause of the low back pain, which would require supplementary diagnostics.

There is consensus about the following red flags:
• Onset of the low back pain after age 50 years, continuous pain regardless of posture or movement, nocturnal pain, general malaise, history of malignancy, unexplained weight loss, elevated erythrocyte sedimentation rate (ESR) → malignity?

• Recent fracture (< 2 years ago), previous vertebral fracture, age over 60 years, low body weight (< 60 kg/ BMI < 20 kg/m2), older person with hip fracture, prolonged use of corticosteroids, local percussion pain, tenderness and axial pressure pain in the spinal column, marked height reduction, increased thoracic kyphosis → osteoporotic vertebral fracture?
• Onset of low back pain before age 20 years, male sex, iridocyclitis, history of unexplained peripheral arthritis or inflammatory bowel disease, pain mostly nocturnal, morning stiffness > 1 hour, less pain when lying down or exercising, good response to NSAIDs, elevated ESR → ankylosing spondylitis?
• Severe low back pain after trauma → vertebral fracture?

• Onset of low back pain before age 20 years, palpable
misalignment of the processi spinosi at the L4-L5 level → severe spondylolisthesis?

Question 8

The student is able to explain the concepts of validity, sensitivity, specificity, responsiveness, negative and positive predictive value and likelihood ratio.

Answer 8

• Validity = the extent to which a test measures what it is supposed to measure.
• Sensitivity = Number of true positives of group with condition
• Specificity = Number of true negatives of group without condition

• Responsiveness = the extent to which a measurement instrument is capable of real changes
to measure.

• Positive predictive value = hindsight probability, ‘What is the probability that the condition’ is present?” (if test result is positive)
True positive / (true positive = false positive)

• Negative predictive value = ‘What is the probability that the condition is absent?’ (with a negative test result)
True negative / (true negative + false negative)

• The likelihood ratio is the strength with which the test results in a positive/negative result increases/decreases the risk of the condition (in retrospect).
LR + has to be > 10 (specific)
LR - has to be <0.1 (sensitive)

Question 9

The student knows the model by Meeuwisse (multifactorial development model for sports injuries).

Answer 9

Meeuwisse model (multifactorial origin model for sports injuries):
The multifactorial model takes into account the interaction of multiple risk factors, both internal (intrinsic) and external (extrinsic). 

Intrinsic factors may include:
• Age
• Gender
• Body composition
• Health
• Physical fitness
• Anatomy 
• Skill level
These intrinsic factors make a predisposed athlete.

Extrinsic factors can be:
• Human factors (teammates, opponents, referee)
• Protective equipment
• Sports equipment
• Environment (weather, floor)
These extrinsic factors make a susceptible athlete

If there is a inciting event:
• Joint motion (eg. kinematics, forces, moment)
• Playing situation
• Match schedule

this could lead to an injury.