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MSK 2 > 3b - TBC DP traction and manip > Flashcards

3b - TBC DP traction and manip Flashcards

1
Q

what is centralization

A

spinal pain and referred sx are progressively abolished in a distal-to-prox direction in response to therapeutic loading or mvmt strategies

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2
Q

what is peripheralization and what is this associated with

A

spinal pain and referred sx spread distally or further into limb as a result of loading strategies

associated w poorer prognosis

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3
Q

what is a directional preference

A

direction in which centralization (or sx alleviation) occurs

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4
Q

what does evidence say about the prevalence in centralization and what this indicates

A

low prevalence but was a pos prognostic indicator even if pain worsened

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5
Q

what predicts higher disability in radiating pain

A

baseline elevation in fear-avoidance beliefs about work and lack of centralization phenomenon
- lack of centralization also predicts higher pain intensity

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6
Q

what are the strongest predictive variables of chronicity in LBP

A

pain patter classification (noncentralization) and leg pain

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7
Q

what are the possible classifications under sx modulation

A

directional preference
- flex
- ext
- lateral shift

traction/active rest

manip/mobilization

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8
Q

ext preference: demographics

A

25-40yo

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9
Q

ext preference: MOI

A

*trauma (high load/lift and twist)
excessive repetitive motion
insidious

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10
Q

ext preference: aggravating factors

A

*flexion sensitivity *
prolonged flex activities
- sitting, driving, biking

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11
Q

ext preference: relieving factors

A

dec sleep in fowler position
walking short distances
standing
backwards/ext stretching

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12
Q

ext preference: functional ranking of pain in walking, standing, sitting

A

worst
1. sitting
2. standing
3. ext
best

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13
Q

if ext preference sx alleviated in fully supine position what can this indicate

A

mechanical stress

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14
Q

ext preference: ROM/quality of motion findings

A

limited & painful flex
end range ext may have pain
(+) repeated ext motions alleviates sx and may centralize sx

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15
Q

ext preference: joint play findings

A

hypomobile PA glide in lumbar spine

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16
Q

ext preference: ms function findings

A

strength, control, and endurance
- weak glut max/med
- poor pelvic control
- poor TrA, multifidi activation

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17
Q

ext preference: neuro exam findings

A

may have myotomal weakness
may have sensory deficits

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18
Q

ext preference: helpful special tests that may be positive and what could they indicate

A

possible signs of NRCS
(+) neuro exam
(+) SLR - herniated disc, neural tension
(+) slump - herniated disc (esp if crossed)

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19
Q

ext preference: interventions

A

start w preference
- end range ext exercises

mobilization to inc ext

functional training w short term task modifications
- ant pelvic tilt -> pelvic control
- esp in sitting w post tilt, ant tilt will provide relief

browder ext protocol

treat impairments!

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20
Q

what is a good strategy for interventions in ext preference pt who is highly volatile

A

browder ext protocol
- prone -> POE -> prone press up -> standing ext

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21
Q

flex preference: demographics

A

typically >50yo
younger (16-25) if after trauma

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22
Q

flex preference: MOI

A

insidious in older (>50yo)
- d/t degen changes over time
- spinal stenosis -> narrowing leads to more space in a flex position

trauma in younger, athletes
- spondylosis - articularis fx
- high load
- lift and twist
- excessive repetitive motion

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23
Q

flex preference: aggravating factors

A

ext based activity
- walking
- standing
- standing from a chair**

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24
Q

flex preference: relieving factors

A

sitting
- not always better, more in oldies
leaning forward on cane
leaning on grocery cart

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25
Q

flex preference: ROM/quality of motion findings

A

limited/painful ext

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26
Q

flex preference: joint play findings

A

hypomobile LS/tspine in older
hypermobile LS in younger
hypomobile hip capsule

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27
Q

flex preference: ms function findings

A

strength, control, and endurance
- weak glut max/med
- poor pelvic control
- poor TrA, multifidi activation

flexibility, ms length
- stiff psoas or rectus fem

28
Q

what role do muscle function findings play in sx modulation w a flex preference and why is this important

A

if stiff psoas and hip capsule (common in sitting a lot), motion happens thru path of least resistance
- if pt has stiff hip and thoracic, the lumbar spine has to take a majority of ext

important bc we can’t change bone structure but we can change mobility of hip and spine

29
Q

flex preference: neuro exam findings

A

may have myotomal weakness
may have sensory deficits

30
Q

flex preference: special tests that may be important and what do they tell us

A

(+) 2 stage treadmill test

possible signs of neurogenic claudication
possible signs of NRCS

31
Q

when does reclassification happen for those initially classified as sx modulation w a directional preference and what is a consideration of this

A

reclassify when no longer in sx modulation
- may continue to have directional preference in movement control classification

32
Q

flex preference: interventions and examples

A

flex biased exercise
- post pelvic tilt
- single/double knee to chest
- dead bugs
- child’s pose

mobilization
- early stages: to LS to inc flex
- mob hips and thoracic spine into ext

functional training
- post pelvic tilt -> pelvic control
- teach them ant tilt after to connect to function and why feels worse when doing activities

treat other impairments!

33
Q

what will be your main directional preferences

A

flex and ext
- lateral is less common

34
Q

lateral shift: MOI

A

trauma
- high load
- lift and twist
- excessive repetitive motion

35
Q

lateral shift: aggravating factors

A

pain w most motions
- worst SB in opposite direction of shift

pain worst sitting > standing > walking
- may be different, less consistent

36
Q

lateral shift: relieving factors

A

laying flat (often w legs up)

37
Q

lateral shift: posture findings

A

shoulders deviated from pelvis in frontal plane
- shift named direction shoulders are moved in relation to lumbar spine

38
Q

lateral shift: ROM and quality of motion findings

A

directional preference for pelvic translational mvmts

asymmetrical SB

39
Q

lateral shift: neuro exam findings

A

may have myotomal weakness
may have sensory deficits

40
Q

lateral shift: special tests that may be positive

A

possible signs of NRCS
(+) neuro exam
(+) SLR
(+) slump test

41
Q

lateral shift: 3 interventions

A

manual therapy to correct shift

functional training w short term activity modifications

graded loading exercises

42
Q

what are types of graded loading exercises to do with a lateral shift

A

TrA
-> pelvic tilting (mid range)
—–> progressions of “core” activation

43
Q

what is an important positioning consideration of traction in lateral shift and why

A

supine traction
- when they stand up, will feel way worse

44
Q

what does evidence say about the efficacy of direction preference specific interventions (ie flex, ext, lat)

A

people have tendency to get better in general

but people will get better faster and more often w good treatment that is specific to directional preference
- matching care matters in LBP

45
Q

what pt pop in general fits in traction/active rest group for sx modulation

A

someone having difficulty w centralizing and peripheralizing
- not clear what feels better and what is worse

46
Q

traction/active rest: demographics

A

any age

47
Q

traction/active rest: MOI

A

often an event such as bending, twisting, lifting

48
Q

traction/active rest: aggravating factors

A

higher compressive activities

49
Q

traction/active rest: relieving factors

A

mvmt (but not too much mvmt)

50
Q

traction/active rest: ranking of walking, sitting, standing

A

best
walking
standing
sitting
worst

*follows pattern of compressive activities

51
Q

traction/active rest: key exam findings

A

s/sx of NRCS
- (+) CSLR

pain and numbness extending distal to buttock in previous 24hrs w/o ability to centralize thru repeated mvmts

52
Q

what are 7 types of lumbar traction

A

mechanical
sustained (static)
intermittent
manual
autotraction
positional
inversion

53
Q

what are 2 benefits to using harness traction

A
  1. allows for manual adjustments based on directional preference
  2. line of pull is from pelvis
    - if you apply traction via legs, creates slight ant pelvic tilt bc acetabulum is slightly ant to pelvis
54
Q

what is Steve’s issue w traction in PT

A

if can give someone self-traction techniques to do at home
- you have improved person’s self-efficacy –> sx are better –> improve px

55
Q

what are 7 contraindications to manips in the LS

A
  1. signs of NRCS, myelopathy, or cauda equina
  2. OP or other bone dz
  3. fx
  4. acute inflammation
  5. unstable med condition
  6. progressing CNS disorder
  7. demyelinating disorders (ie MS, ALS)
56
Q

what is the evidence for lumbar manip in the LS

A

really good lol

57
Q

what is the lumbar spine clinical prediction rule

A

classifying pts w LBP who, will respond favorably to HVT (4 of 5 signs)
1. duration of sx <16days
2. no sx distal to knee (aka no NRCS)
3. LB hypomobility
4. 1 hip >35deg IR
5. FABQ work subscale score <19
(aka low fear avoidance)

58
Q

TBC manip category: MOI

A

typically inciting incident
- bending, twisting, lifting
- may be after repetitive motion

59
Q

TBC manip category: aggravating factors

A

pain w most motions

60
Q

TBC manip category: pain levels

A

high

61
Q

TBC manip category: posture

A

guarded/stiff
- walking carefully

62
Q

TBC manip category: ROM and quality of motion

A

limited and painful
stiff, guarding motions that are limited

63
Q

TBC manip category: joint play

A

hypomobile

64
Q

TBC manip category: neuro exam and special tests

A

no sx distal to knee (pain, sensation, weakness)

(-) CSLR, aka neg for NCRS
- if (+) must have neg reflexes, strength, sensation testing

65
Q

what interventions should follow manips

A

mid range ROM
- pelvic tilts
- lower trunk rotation
- cat camel

66
Q

what are the 3 buckets we triage pts w LBP into based on appropriateness for therapy

A

med management
rehab management
self-care management

67
Q

those who classify into sx modulation will be treated with one of what 4 subgroups

A

active rest
traction
directional preference
manip

MSK 2 (20 decks)

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