2B Flashcards
What is the chance of someone experiencing LBP in their lifetime
90%
T or F: There are NO strong risk factors to predict outcomes of effective treatments for LBP
T
T or F: Presence of radiating pain is always a higher amount of complexity when it comes to treating LBP
T
When should a patient with LBP immedialely be referred to a PT
When positions, postures, activities, movements increase or decrease the patients symptoms or produce sciatica
If a patient has evidence of a serious, systemic problem, drop foot, loss of B&B function, areflexia, hyperreflexia, unexplained weight loss, or a psychosomatic component….
who does the patient need to go see?
Refer to specialist before PT
what does boney pain feel like in the back?
what does nerve pain feel like in the back?
Deep ache/ boring pressure \
sharp, knife-like, shooting, burning, tingling, numbness, weakness
what age range is most affected by spondylolithesis?
what age range is most affected by disc herniation/dysfunction
10-20
15-40
At what age range are people susceptible to cancer, compression fx, stensis, or AAA
at what age range are people susceptible to OA/Spondylosis
65+
45+
what is an important question to ask patients regarding their pain, when it comes to making goals
What is the impact of the symptoms, what is the pain preventing them from doing
The presence of serious pathologies in patients with LBP is ____________
how many LBP patients present with atleast 1 red flag?
Low
80%
Examine findings for consistent patterns and multiple red flags
What is the ultimate goal of therapy for patients with LBP
Self managment
How is piriformis syndrome commonly diagnosed
what test will come back positive for patients with piriformis syndrome
Dx of exclusion
+ SLR test
Spondylolysis is a defect in ________________ , usually asymptomatic
Typically occurs at ___ vertebrae
patients prefer what position
par interarticularis
L5
flexion over extension
What is spondylolisthesis?
How is it graded?
Fx of pars interarticularis and slip of the vertebrae forward. Leads to instability
grade 1: 1-25% slip
grade 2: 26-50%
Grade 3: 51-75%
grade 4: 76-100%
grade 5: over 100% slippage
When is surgical intervention indicated for spondylolisthesis
when conservative managment has failed
when patient has progressive neurological symptoms
What parts of the vertebrae/disc are most susceptible to compression injury
- End Plate
- vertebral body
- Disc
Disc Protrusion:
Prolapse:
Extrusion:
Sequestration:
Disc Protrusion: disc buldge w/o AF rupture
Prolapse: only outer layer of AF contains the NP
Extrusion: AF has now perforated the NP and moved into epidural space
Sequestration: disc fragments have escaped the AF and are broken off into the epidural space
How does an End plate fx present?
SLR test?
Compression Test?
Trauma/speicifc MOI
Acute pain/spasm
Negative SLR test
positive compression test
Will an internal disc disruption have a positive or negative SLR test?
negative
Disc protrusion/prolapse (contained) will present how?
SLR test?
Some AF and PLL are intact
LBP referred to hip/upper leg
pain w/ cough and sneeze
negative SLR
Disc Extrusion and sequestration (uncontained) will present how?
LBP
Pain w/ cough and sneeze
true sciatia (radicular pain)
POSITIVE SLR
a disc pathology at L3-L4 will compress what nerve?
L4
A disc pathology at L4-L5 will compress what nerve?
L5
Facet joint _______mobility is more common
hypo
Loss of normal passive restraints
Inconsistent symptoms
Positive prone instability test
reports of catching/locking of back
Instability
In what population is anklyosing spondylitis most common?
Males 30+
90-95% of pts have human leukocyte antigen B27
What is the most common kind of scoliosis?
Idiopathic scoliosis
How is fibromyalgia diagnosed?
11 out of 18 total tender points w/o reason for tenderness
Should you treat a patient w/ herpes zoster
Halt PT until rash is no longer contageous
What are the 6 ICF lowback pain categories
Acute/subacute LBP w/ mobility decifits
Acute, Sub-acute, chronic LBP w/ movement coordination deficit
Acute LBP w/ related (referred) LE pain
Acute/ Subacute/ chronic LBP w/ radiating pain
Acute/Subacute LBP w/ Related cognitive or affective tendencies
Chronic LBP w/ related generalized pain
Impaired functional movements
Segmental Hypomobility
Pain in back/buttock/groin/thigh
negative neuro tests
onset of symptoms less than 3 months
Acute or subacute LBP w/ mobility deficits
Segmental/global instabilities
Pain in back/buttock/groin/thigh
decreased NM control
Muscle weakness
Impaired activity tolerance and functional movements
positive prone segmental instability test
Acute/subacute/chronic LBP w/ movement coordination impairments
Significant pain in back/butock/groin/thigh
segmental or global hypomobility
postural deficit
decreased activity tolerance and impaired functional movements
onset of symptoms under 3 days ago
POSITIVE repeated movement test
Acute LBP w/ related (referred) LE pain
Segmental hypomobility/instability
Radiating pain in dermatomal pattery
muscle weakness
decreased activity tolerance and functional movements
Positive neuro exam
Positive neurodynamic testing
Positive repeated movement test
Acute/Subacute/chronic LBP w/ radiating pain
Sensitivity to noxious stimuli
Pain in leg/buttock/groin/back/lower leg
High score on FABQ
decreased activity tolerance
impaired functional movements
inconsistent MSK exam
Onset of symptoms less than 3 months
Positive Waddell’s test
Acute or subacute LBP w/ related cognitive or affective tendencies
Generalized pain
changes in brain and sensory structure
high score on FABQ
Decreased activity tolerance
Inconsistent MSK findings
Onset of symptoms over 3 months
Chronic LBP w/ generalized pain
Manual Therapy Classification Criteria
Anatomical location of symptoms:
Duration:
Score on FABQ:
Results of mobility test:
Hip Internal Rotation:
No sx distal to knee
Less than 16 days
Score of less than 19
Atleast 1 hypomobile joint
Hip Int rotation over 35 in atleast 1 hip
Stabilizaton criteria:
Age:
Flexibility:
Movements in lumbar:
Lumbar instability test:
Patients who are……….
Younger age: <40
Greater flexibility SLR over 91
Abberant movements: Instability catch
Positive Prone Instability test
Post-Partum with posterior pelvic pain provacation, ASLR, modified trendelenberg test
Pain W/ palpation along long dorsal SI ligament or pubic symphysis
Patients with a lateral shift are typically also restricted into __________
extension
Extension criteria patient
Anatomical location:
Distal to buttock
Flexion preference patient classification:
Age:
Imaging evidence of:
Over 50
Lumbar Spinal Stenosis
When patients classify for more than 1 type of treament group, how should we decide the treatment
Prioritize order based on: level of risk, psychosocial factors, comorbidities
Presence of psychosocial factors and comorbidities weaken treatment effects
