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MSK Final > Thoracolumbar Spine III- LBP > Flashcards

Thoracolumbar Spine III- LBP Flashcards

1
Q

With LBP, it is ____-_______ and has an unidentified ________ source

A

non-specific; nociceptive

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2
Q

Which area is the smallest amount of related pathology?

A

thoracic

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3
Q

With LBP, it is the leading cause of …

worldwide _______
________ limitation and _____ absence

A

disability

activity

work

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4
Q

What percentage of people will experience LBP in their life?

A

80%

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5
Q

LBP is common in

Biological ______

Older or younger?

_______ educational status

________ physical work demands

A

women

older (half > 65 yrs.)

lower

higher

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6
Q

Imaging with MRI:

_______ of asymptomatic individuals had “abnormal” findings

A

1/3

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7
Q

What are some examples of abnormal findings on imaging with MRI?

A

IDD

Age-related disc changes

N. compression

Facet Hypertrophy

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8
Q

With Imaging w/ MRI:

______ of symptomatic individuals had an abnormality

A

1/2

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9
Q

With imaging with CT and MRI:

_____ of asymptomatic 30-80 yr. old individuals had disc changes

A

1/3

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10
Q

With imaging w/ CT and MRI:

Normal asymptomatic age-related changes MUCH ____ symptomatic structural changes

A. <
B. >

A

B.

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11
Q

Imaging changes significantly increase with ____

A

age

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12
Q

Who should get imaging with LBP?

> ____ years of age with a
hx of _____

_______ paresthesias

_______ and ______ dysfunction

Specific _______ deficits

Progressive/_______symptoms

NO improvement after ____ weeks of Rx

A

50; cancer

saddle

bowel; bladder

neurological

disabling

6

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13
Q

Imaging _____ ______ improve outcomes and guidelines; consistently recommended against routine imaging

A

does NOT

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14
Q

With LBP nearly all cases have an _________ _________ source

A

unidentified; nociceptive

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15
Q

With PT Rx, there is a SUBSTANTIAL gap between ______ and ________

A

evidence; practice

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16
Q

With PT Rx, there is ___________ of unsupported and ineffective Rx

A

overutilization

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17
Q

What are some examples of unsupported and ineffective Rx?

______ avoidance behaviors promoted with _______ interventions like modalities AND even some manual therapies

Leads to _____ costs

Contributes to greater _______ addiction

Greater imaging and _______ exposure

MORE likely to have ______ procedures, side effects and missed work

A

Fear; PASSIVE

higher

opioid

radiation

invasive

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18
Q

With PT Rx and prevention, it is:

_______ research

______ promoted preventions lack evidence

Exercise is ________ effective in adults

A

Inadequate

MOST

Largely

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19
Q

With PT Rx and prevention involving children, it is:

________ furniture effective

_______ is NOT evaluated

A

Ergonomic; Exercise

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20
Q

With PT Rx and early PT:

Only ___% developed persistent LBP

Significant reductions in lost ____ time

________ by numerous studies

A

2

work

Supported

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21
Q

With LBP involving education and advice: it is the _____ line of Rx with moderate to strong evidence

A

First

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22
Q

With LBP, PT Rx is AGAINST what two things?

A

Bed rest

In-depth explanations

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23
Q

With LBP, PT Rx is FOR what?

Spinal _______ and _______ strength

Overall ________ prognosis

Active P! ________ mechanisms that decrease fear catastrophizing

Stay _______ with early resumption of ADLs

__________ contributors and basics of nociplastic P!

Emphasis on _______ with back protetion techniques

A

structural; anatomical
favorable
coping
active
Biopsychosocial
function

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24
Q

Dry needling with LBP has what kind of evidence and benefit?

A

weak; short-term

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25
Q

Modalities with LBP is generally ________ and ____ recommended

A

ineffective; NOT

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26
Q

Modalities with LBP have what results?

A

short-term at best

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27
Q

With LBP, soft tissue mobilization/massage have what kind of evidence and benefit?

A

moderate; short-term

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28
Q

With PT Rx, what overcoming barriers are BEST to practice?

_________ consultation time and follow up

Better ______ to return to work

Reward _______ and NOT volume with reimbursement

________ service announcements

_________ provider knowledge of evidence and guidelines for use in clinical reasoning and decision making

A

Increase
incentives
quality
Public
Increased

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29
Q

LBP Rx Classifications:

There is ______ evidence with acute LBP

A

moderate

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30
Q

LBP Rx Classifications:

There is ______ evidence with chronic LBP

A

weaker

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31
Q

What are the 4 subgroups of LBP Rx Classifications?

A

Mechanical Traction
Directional Preference
Mobilization/Manipulation
Stabilization

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32
Q

With mechanical traction, there is NO ________ with static tx

A

benefit

33
Q

Intermittent tx for LBP with LE P! :

It is typically ______ and _______ LBP with LE P! that doesn’t centralize

A

acute; subacute

34
Q

With acute and subacute LBP with LE P! that doesn’t centralize, it needs _______ support

A

preliminary

35
Q

A pt. with LBP may need to be in a ______ position if they are…

____-____ years old

Paresthesia’s in last 24 hrs. distal to the _____

Owestry questionnaire score of > ____

+ _______ compression, crossed ______, and or centralization

A

prone

18; 60

knee

30

spinal n; SLR;

36
Q

You should NOT use mechanical traction with _______ LBP along with ____ p!

A

persistent; LE

37
Q

With mechanical traction:

There is moderate evidence AGAINST all types of tx used alone in patients with :

_____, _______,and _________ LBP

____-______ LBP

_______ symptom patterns

A

acute; subacute; persistent

non-radicular

varying

38
Q

Important to Review

A
39
Q

____ _____ is a position/motion that alleviates symptoms

A

directional preference

40
Q

What repeated motion MOST commonly centralizes LE symptoms to LBP?

A

extension/hyperextension

41
Q

________ is the abolition of distal and or/ spinal P! in a distal proximal direction in response to repetitive motion(s) or sustained position(s)

A

centralization

42
Q

_________ ________ can help choose positions and motions to avoid symptomsand promote exercise and activity

A

directional preference

43
Q

With mobilizations/ manipulation for LBP, there is strong patient preference/belief in ____ _____ effectiveness

A

short term

44
Q

With mobilizations/ manipulation for LBP, there is strong evidence for ______ and ___-____ mobilizations

A

thrust; non-thrust

45
Q

Manipulation is MOST effective for sub-groups with _____ and ____-______ LBP

A

acute; sub-acute

46
Q

Mobilizations have a added benefit when used with ________

A

exercise

47
Q

With mobilization/mnanipulation, there is strong evidence to improve ______ mobility with subacute and persistent LBP

A

hip

48
Q

With mobilizations/manipulations, there is _______ to _______ evidence to improve LBP and disability with back related LE P!

A

moderate; strong

49
Q

Mobilizations/manipulations:

______ quality evidence for a small effect

Manipulation effect larger than _________

_______ effect when combined with exercise

_____-______ effect is NOT well established

A

Moderate

mobilization

Greater

Long-term

50
Q

Stabilization for ______ LBP is safe and effective to do early

A

acute

51
Q

With stabilization for acute LBP, supervision is typically _________ unless it’s NOT progressing or risk factors for persistent LBP exist

A

uneccesary

52
Q

Stabilization is the first line Rx for ____-____ and _______ LBP

A

sub-acute; persistent

53
Q

The MOST effective treatments for sub-acute and persistent LBP

  1. ______ activation/coordination and _________
  2. _______ therapy, _______, and yoga
  3. mental health benefits with ______ and _______ training
A

motor;stabilization

aquatic; pilates

resistance; aerobic

54
Q

With sub-acute and persistent LBP, this should be graded activity and _______ (MET)

A

individualized

55
Q

______ muscle activation is effective for _____-____LBP and functions in isoation or with other ____-____

A

local

non-specific

ther ex

56
Q

Local muscle activation with LBP helps to improve _______ control and created ______ muscle activation

A

trunk; earlier

57
Q

With LBP, there was strong evidence for progressive ______ exercise for any intensity of aerobic activity

A

endurance

58
Q

With LBP there is moderate evidence of short-term benefit with chronic LBP with LE ________ mobilizations

A

neural

59
Q

William’s flexion exercises/ protocol

Theory: deforming the spine by forcing ourselves to _____

Goal: reduce ______

Exercises: involved _____ pelvic tilt and trunk and _____ flexion

What kind of evidence? ______

A

stand

lordosis

posterior

hip

weak

60
Q

With LBP PT Rx, _______ had NO difference in P! function vs. NO intervention at all with persistent LBP

A. Exercise
B. Mobilizations
C. Stretching

A

C. Stretching

61
Q

What kind of therapy is the FIRST line of Rx with LBP?

A

cogntive therapy

62
Q

______ ______ _______ helps patients understand and manage all biopsychosocial elements contributing to their symptoms

A

Cognitive Behavioral Therapy

63
Q

Cognitive behavioral therapy helps to understand things such as:

_______ pain

Innaccurate beliefs on ______ damage

unhelpful _______ behaviors

______ and ______ stress (related to symptoms)

Acivity and ______ avoidance

______ dysfunction

A

Nociplastic

tissue

lifestyle

mental; emotional

social

sleep

64
Q

Cognitive Functional Therapy is like behavior therapy plus addressing the _______ of movement

A

QUALITY

65
Q

With cognitive functional therapy, there is _____ and ______ improvements with persistent LBP at less than half the cost of usual care

A

large; sustained

66
Q

The 3 components of cognitive functional therapy:

  1. Making sense of P! from a _______ perspective
  2. Graded return to ______
    such as
    - _______
    - ________
    - _______
  3. _______ behavioral changes
A

biopsychosocial

activity (ADL) (MET) (p! control ad confidence to move)

lifestyle

67
Q

__________ _______ ______ is less effective than combining manual therapy and stabilization exercises

A. Cognitive Behavioral Therapy
B. Cognitive Functional Therapy

A

B.

68
Q

With LBP prognosis:

There are rapid improvements within ______ month

MOST improve substantially in ____ weeks

A

1; 6

69
Q

The typical patient with LBP:

Persistent LBP- _____% report P! at _____ and ______ months

There will be a ____-_____% reoccurrence, 33% have within one year

________ evidence that post- DC HEP prevented reoccurrences

A

66; 3; 12

24; 65

moderate

70
Q

With LBP prognosis: depression, anxiety, catastrophizing, and lack of self efficacy increases risk for _______

A

disability

71
Q

With LBP prognosis: Fear avoidance behaviors MORE influential than the ______ itself

A

pain

72
Q

________ education and income contributes to persistent LBP

A

LOW

73
Q

With LBP prognosis: there is higher _____ intensity and ______ painful areas that contribute to disability

A

pain; multiple

74
Q

With LBP and MD Rx (medications):

Many with ______ and uncertain influence and NOT recommended

Recommended ONLY with an ________ response to exercise and cognitive behavioral therapy

Any utilization should be limited and very ________ with the lowest effective dose

A

insufficient

inadequate

selective

75
Q

With LBP and MD Rx: there are invasive procedures that play a ______ role

A

limited

76
Q

What kind of injections are NOT recommended for non-specific LBP?

A

epidural and facet joint

77
Q

Epidural injections for LBP are only recommended if:

There is ______ pain

no benefit within _____ weeks

A

radicular

4

78
Q

With LBP, epidiral injections:

Don’t reduce the risk of _______

Create rare but _______ side effects

A

surgery

serious

MSK Final (30 decks)

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