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OPP II > Winter Midterm Lab > Flashcards

Winter Midterm Lab Flashcards

1
Q

What are the steps in any facilitated positional release

A
  1. Dx
  2. Flatten spinal curve (pillow for lumbar)
  3. Take tissue indirectly (away from barrier)
  4. Add facilitating force
  5. Hold 3-5 sec
  6. Recheck
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2
Q

Name some landmarks to use on spine: Spine of scapula, iliac crests, inferior angle of scapula, floating 12th rib

A

Spine of scapula- T3 Spinous process
Iliac crests- b/w spinous process of L4/L5
inferior angle of scapula- T7 spinous process
12th rib- T12 spinous process

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3
Q

What can you use lumbar facilitated positional release for?

A

Treat hypertonic paraspinal muscles, also for extension and flexion lumbar dysfunctions

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4
Q

Perform lumbar faciliatated positional release for tight paraspinal muscles

A
  1. Dx
  2. With pt prone and pillow under to flatten spine, stand at side of tx.
  3. Monitor tissue tension with finger and place your knee above iliac crest to stabilize and move both pt’s legs toward you inducing sidebending, then remove our knee and cross their opp leg over leg closest to you
  4. Reach around and grab patients upper thigh/ASIS and slowly rotate it toward you into adduction by leaning back still monitoring
  5. Hold 3-5 seconds and slowly return hip then recheck soft tissue
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5
Q

Perform lumbar facilitated positional release for extension dysfunction EX DX: L4ERlSl

A

EX DX: L4ERlSl (tx towards same side as dx)
Pt prone with pillows under stomach and you stand at side opp dysfunction (stand R of pt)
1. Monitor posterior TP with finger of R hand
2. Push pts legs away inducing L sidebending until movement felt at L4
3. Reach across grab pts thight/ASIS and lift towards you inducing extension and R rotation
4. Hold 3-5 sec, return to rest position and recheck

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6
Q

Perform lumbar facilitated positional release for flexion dysfunction EX DX: L4FRlSl

A

EX DX: L4FRlSl (tx towards same side as dx)
Pt prone with pillows under stomach and you stand/SIT at side of dysfunction (stand L of pt)
1. Monitor post TP with finger of R hand
2. Bring pts closest leg off table and flex and hip and knee using your L hand until motion felt at monitoring finger
3. Adduct pts leg under table until motion felt (rotates hip to right which rotates lumbar to Left)
4. Internally rotate lower leg until motion felt which inducing sidebending to left
5. Hold 3-5 seconds, return to rest position and recheck

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7
Q

Perform muscle energy for the lumbar spine with neutral dsyfunction. Ex: L3-L5 NRlSr

A

EX DX: L3-L5NRlSr (tx towards opp side dx)

  1. Pt seated (can straddle table at end) with arms crossed and you standing to side opposite posterior TP (opp rotation side).
  2. Treat middle segment so put monitor L4 with L thumb at interspace below
  3. Reach around and grab pts L shoulder and rotates torso away from side of most posterior TP unless motion felt in monitoring thumb
  4. Then sidebend pt to opposite side (opp to dx sidebending)
  5. Ask pt to attempt to sit up while providing isometric resistance for 3-5 sec then we both relax
  6. Take to new barrier increasing rotation and sidebending further
  7. Repeat contraction and relaxation cycle 3-5 times or no further progress made and ending with new barrier …. recheck
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8
Q

What is the difference in treatment of lumbar spine with flexion or extension dysfunction as compared to neutral dysfunction?

A

Only difference is you add that one extra motion to treatment: take them to extension if flexed and flexion if extended.

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9
Q

Perform the Straight Leg Raising Test. What types of pain could indicate tight hamsrings vs. lumbar dysfunction vs. lumbar radiculopathy?

A
  1. Place hand on ipsilateral ASIS to monitor motion and raise pts leg off table (keep it straight) until pain felt OR motion felt at ASIS…stop. (note angle)
  2. Ask the pt where pain is felt.
  3. Decrease the angle b/w leg and table a little bit until pain disappears and dorsiflex foot..note if pain returns.
  4. Repeat with other leg.

Pain in posterior thigh (also didn’t return when foot was dorsiflexed)= tight hamstrings
Pain in lumbar spine=lumbar dysfunction **unless pain felt on opposite side to raised leg then =radiculopathy
Pain down into leg=lumbar radiculopathy

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10
Q

What is the Hoover’s test for and demonstrate it.

A

Test of malingering for low back pain.

With pt supine stand at foot of table and put pts heels in palms of your hands and lift few inches off table. Ask pt to lift the affected leg and you should feel opp leg press down into your hand.
-If no downward effort felt (+) Hoover test=FAKER!

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11
Q

What is the Seated Knee Extension (Tripod Test) for and demonstrate it.

A

Test of malingering for low back pain.

With patient seated you kneel in front at their feet while talking to distract them. While conversing, examine the foot on affecting then casually extend the knee while still observing foot (as if you are checking bottom of foot).

  • If pain returns = not malingering
  • If no pain= FAKER!!
  • you would expect to see pt put their hands behind back/lean back and arch it to avoid pain.
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12
Q

Demonstrate the hip drop test…what is it for…is it Fryette’s 1st or 2nd principle of motion? What if:

Equal distance dropped?
Right iliac crest drops farther than left?
Left iliac crest drops farther than right?

A

Assesses restriction of lumbar sidebending..to move under Fryette’s 1st Principle (in neutral position so sidebending and rotation should be opposite).
-Ask pt to remove shoes and stand w/feet 4-6 inches apart, relaxed equal weight on both feet. You should be in squat to observe hips.
Ask them to flex right knee (keep left extended) and observe right iliac crest drop and degree of lumbar curve formed on left. Do same for other side. Compare distance of drop of right iliac crest vs. left.

-Equal distance dropped? - no restriction to sidebending
-Right iliac crest drops farther than left? restriction on right sidebending
Left iliac crest drops farther than right? restriction on left sidebending
**the side that doesn’t drop as much is one with restriction/side bending

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13
Q

Where are the Anterior lumbar tenderpoints and how can we treat them?

A 
AL1- medial to ASIS
AL2- Medial to AIIS (AIIS is about 1 inch directely below ASIS)
AL3- just lateral to AIIS
AL4-just inferior to AIIS
AL5-just lateral to pubic symphisis

*Treat with counterstrain technique

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14
Q

Demonstrate counterstrain treatment of AL1, AL3 and AL4 tenderpoints

A

-Patient supine and you stand on same side of TP
(AL1- medial to ASIS, AL2- Medial to AIIS (AIIS is about 1 inch directely below ASIS), AL3- just lateral to AIIS)
-With finger(s) on TP estabilish 10/10 pain scale
-Place your leg on table and place pts legs on top
-Flex pts knees and hips and rotate them towards you (towards TP) and sidebend towards you to fine tune until pain at 3/10 or better
-Monitor 90 sec and slowly passively return legs to table then recheck

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15
Q

Demonstrate counterstrain treatment of AL2 tenderpoint

A
  • Patient supine and you stand on opposite side of TP (AL2-medial to AIIS)
  • With finger(s) on TP estabilish 10/10 pain scale
  • Place your leg on table and place pts legs on top
  • Flex pts knees and hips and rotate thighs 60 degrees towards you (away from TP) and sidebend trunk towards TP until pain at 3/10 or better
  • Monitor 90 sec and slowly passively return legs to table then recheck
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16
Q

Demonstrate counterstrain treatment of AL5 tenderpoint

A
  • Patient supine and you stand on same side of TP (AL5 TP-lateral to pubic symphisis)
  • With finger(s) on TP estabilish 10/10 pain scale
  • Place your leg on table and place pts legs on top
  • Cross pts ankles (leg opposite side of TP on top) and flex pts knees and hips in “frog legging” position until pain at 3/10 or better
  • Monitor 90 sec and slowly passively return legs to table then recheck
17
Q

Where are the Posterior lumbar transverse process tender points 1-3, posterior 3 & 4 tender points on iliac crest, and upper and lower pole 5th lumbar tenderpoints located and how do we treat them?

A
  • Posterior lumbar transverse process tender points 1-3: On tips of corresponding transverse processes
  • posterior 3rd tender point on iliac crest: 1/3 way from PSIS to posterior medial edge of tensor fascia lata
  • posterior 4th tender point on iliac crest: posterior medial edge of tensor fascia lata
  • upper pole 5th lumbar tenderpoint: superior medial surface of PSIS
  • lower pole 5th lumbar tenderpoint: inferior surface of PSIS
  • *treat with counterstrain technique
18
Q

Demonstrate treatment of tenderpoints on posterior 1-3 lumbar transverse processes

A

Tenderpoints are located on corresponding transverse processes tips

  • Patient prone with you standing on same side of tender point.
  • Monitor with finger or thumb and establish 10/10 pain scale
  • Reach medially under pts mid thigh of ipsilateral leg and extend, fine tune by lifting their pelvis using your bent leg as a lever and abducting the leg until 3/10 or better pain scale.
  • Monitor 90 sec and slowly passively return legs to table then recheck
19
Q

Demonstrate treatment of tenderpoints on posterior 3 & 4th lumbar posterior iliac crest points

A

PL3 crest point: from PSIS 1/3 way towards posterior medial edge of tensor fascia lata
PL4 crest point: on posterior medial edge of the tensor fascia lata
-Patient prone with you standing on opposite side of tender point.
-Monitor with finger or thumb and establish 10/10 pain scale
-Reach across under pts mid thigh of contralateral leg and extend and adduct leg until 3/10 pain or better scale
-Monitor 90 sec and slowly passively return legs to table then recheck

20
Q

Demonstrate treatment of tenderpoint on Upper pole 5th lumbar

A

UPL5 located superior medial surface of PSIS

  • Patient prone with you standing on same side of tender point.
  • Monitor with thumb and establish 10/10 pain scale
  • Reach medially under pts mid thigh of ipsilateral leg and extend and abducting or adducting according to patients comfort to fine tune the leg until 3/10 or better pain scale (can further elevate pelvis in extension by using your bent knee).
  • Monitor 90 sec and slowly passively return legs to table then recheck
21
Q

Demonstrate treatment of tenderpoint on lower pole 5th lumbar
**very different from upper treatment

A

LPL5 located inferior surv\face of PSIS

  • Patient prone & grasping table with both hands with you standing (or seated) on same side as tenderpoint.
  • Take pts leg off edge of table and place in 90 degrees hip and knee flexion by holding their ankle
  • Adduct leg by pushing it under the table (can internally rotate knee medially) until 3/10 pain or better scale
  • Monitor 90 sec and slowly passively return legs to table then recheck

OPP II (2 decks)

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