treatment based classification Flashcards
(76 cards)
criteria for manipulation
no symptoms below the knee
recent onset of sym (<16 days)
low FABQW score
hypomobilty of the lumbar spine
hip internal rotation ROM (>35)
criteria for stablization
younger (<40)
greater flexibility
instability catch or aberrant movements during lumbar flexion and extension
positive prone instability test
postpatrum things
aberrant movements
deviate
from the typical or expected movement
pattern, are associated with low back dysfunction
criteria extension
symptoms distal to the buttock
sym centralize with lumbar extension
sym peri with lumbar flexion.
directional perference of extension
criteria flexion
older then 50
directional preference for flexion
imaging for lumbar spinal stenosis
stiff achy back
criteria lateral shift
visible frontal plane deviation of the shoulders relative to the pelvis
directional preference for lateral translation movements of the pelvis
traction criteria
signs and symptoms of nerve root compression
Symptoms of Radiculopathy
Tingling or numbness in the fingers or hand.
Weakness in arm, shoulder or hand.
Decreased motor skills.
Loss of sensation.
Pain associated with neck movement or straining.
Instability catch
any sudden acceleration or deceleration of trunk movement or movement occurring outside the primary plane of motion
Transversus Abdominis action
“Support & compress abdominal viscera; assist in forced expiration, decreases infrasternal angle
“
Rectus Abdominis action
Flexes vertebral column; can posteriorly rotate pelvis when thorax is fixed
Quadratus Lumborum
Fixes last rib so diaphragm acts more efficiently during inspiration;
hikes hip;
ipsilateral side bending when pelvis is fixed
Acting bilaterally forms guy wire support to stabilize lumbar spine in frontal plane”
Blocked Extension Principle
- Flexion worsens status
- Not able to test “Extension Hypothesis”
- Typically, not a “Mobilization Principle” candidate
- Pt: flex brought on their initial problem; we need to restore their ext to get them to centralize
- You cannot go into extension – this motion is blocked
Unstable Status (“Volatile”)
- Rapid worsening with any flexion movement or position
– Flexion – peripheralization - May or may not achieve a rapid improvement with extension
Pt: have inflammation that is interplaying with mech issues
Stable Status (“Mechanical”)
- Gradual improvement with sustained or repeated extension postures
– Clear extension bias - Status will worsen with sustained or repeated flexion
- Pt: have acute LBP and fall in line with textbook def
multifudus
Extension
Iliocostalis Lumborum, pars Lumborum
and
Longissimus Thoracis, pars Lumborum
Back extension, creates posterior shear forces to counteract anterior shear forces
External Abdominal Oblique action
“Support & compress abdominal viscera;
assist in forceful expiration
Acting bilaterally:
flexes spine
Lateral fibers: acting bilaterally, posteriorly rotates pelvis; acting unilaterally, laterally flexes spine
Anterior fibers: acting unilaterally, flex & contralaterally rotate spine”
malaise
geneally feeling unwell often accompanied by fatigue and diffused pain
what are myotomes testing for
you are looking for muscle weakness of a particular group of muscles.
Results may indicate lesion to the spinal cord nerve root, or intervertebral disc herniation pressing on the spinal nerve roots.
emergent medial red flags
extensive neurological involvement
non MSK conditions - red flags
fracture or something that need imaging work up
symptom modulation
preventing worsening status - moderating factors
signs of active inflammation
treatment:
- directional preference
- manipulation
- traction
- active rest
movement control - stage 2
impairment driven - improve dynamic movement control
improve basic functional movement patterns, break faulty compensatory patterns
the symptoms are now under control
treatment:
- flexibility exercises
- stabilization exercises
- sensorimotor exercises
functional optimization - stage 3
return to work or sport - increase functional capacity and tolerance
symptoms are low
treatment:
- strength and conditioning exercises
- work or sport specific tasks
- aerobic exercises
- general fitness exercises
