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MSK 2 > 3d - MDT & SI Joint > Flashcards

3d - MDT & SI Joint Flashcards

1
Q

what is the McKenzie Classification (MDT) system

A

system of assessment and classification of MSK disorders
- mechanical dx
- mechanical treatment based on mechanical dx
- prevention of recurrence

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2
Q

what does MDT place a strong emphasis on

A

patient ed and self treatment

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3
Q

what is the philosophical basis of MDT in the spine

A

the majority of LBP comes from the disc
- nucleus pulposis (disc itself)
- centralization
- peripheralization

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4
Q

what are the 2 main pain response subgroups? subgroups within these?

A
  1. centralized/directional preference
  2. non-centralization
    - directional preference (sx feel better)
    - no directional preference
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5
Q

what are components to a MDT exam

A

posture
mvmt in relation topain
repeated mvmts to reproduce
repeat mvmt 10-15xs then reassess sx
start in sagittal plane -> frontal –> transverse
- progress for what will be most provocative

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6
Q

MDT treatments

A

active and passive exercises
- trunk flex, ext, side gliding

NWB -> WBing based on centralization
- introduce mvmts opposite to preference

correction of lateral shift

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7
Q

how are pts classified per MDT and what are the classifications

A

uses pain behavior and its relationship to mvmts and positions

  1. postural syndrome
  2. dysfunction syndrome
  3. derangement syndrome
  4. other (no serious path, not severe sciatica w neuro deficits)
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8
Q

MDT postural syndrome: MOI

A

prolonged / sustained positioning
–> prolonged static loading of normal tissues

pain from mechanical deformation and sustained positioning

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9
Q

MDT postural syndrome: pain pattern

A

intermittent, midline & dull, never referred
gradual onset

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10
Q

MDT postural syndrome: aggravating and relieving factors

A

aggravating: standing, sitting, static positions
relieving: movement

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11
Q

MDT postural syndrome: clinical findings

A

no loss of motion

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12
Q

MDT postural syndrome: treatment

A

posture correction
interruption of end range stress at freq intervals
- get up and move!

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13
Q

MDT dysfunction syndrome: MOI

A

pain resulting from mechanical deformation of abnormal tissues
- contracted, fibrosed, adaptively shorted tissues, adherent nerve root (ANR)

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14
Q

MDT dysfunction syndrome: pain pattern

A

intermittent pain
local adjacent to midline
usually not referred, repeated mvmts don’t alter sx

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15
Q

MDT dysfunction syndrome: exam findings

A

restriction of end range motion

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16
Q

MDT dysfunction syndrome: emphasis of intervention

A

exercises at end range to remodel affected structures

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17
Q

MDT derangement syndrome: MOI

A

pain caused by internal disruption and displacement of tissue (primarily disc)

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18
Q

MDT derangement syndrome: pain pattern

A

sudden onset
constant, paresthesia or numbness down into leg
- peripheralization/centralization
central, unilateral, symmetric, or asymmetric

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19
Q

MDT derangement syndrome: aggravating factors

A

posterior derangement: flexion
anterior derangement: ext

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20
Q

MDT derangement syndrome: exam findings

A

lateral shift
loss of motion and function

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21
Q

MDT derangement syndrome: emphasis of intervention

A

perform mvmts to dec internal derangements and maintain stability

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22
Q

what is the guiding principle for treatment progressions in derangement syndrome and what are resulting categories

A

pt- controlled and generated mvmts that are assisted by clinician only when necessary
- static pt- generated force
- dynamic pt generated force
- clinician-generated forces

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23
Q

MDT category for pain during mvmt

A

derangement

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24
Q

MDT category for centralization of sx

A

derangement

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25
Q

MDT category for end range pain

A

dysfunction

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26
Q

MDT category for pain on prolonged static loading

A

postural syndrome

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27
Q

main intervention for postural syndrome

A

re-ed thru posture retraining

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28
Q

main intervention for dysfunction syndrome

A

remodel and stretch

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29
Q

main intervention for derangement syndrome

A

dec derangement

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30
Q

what does evidence say about the reliability and effectiveness of the MDT

A

good interrater reliability w/i therapists who are certified

not better than other rehab for dec pain and disability in acute LBP
however depending on comparative, better in dec pain and disability in chronic LBP

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31
Q

when can the dx of pelvic girdle pain be reached

A

AFTER EXCLUSION OF LUMBAR CAUSES and reproducible by specific clinical tests

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32
Q

what is pelvic girdle pain and common culprits

A

pain experienced between post iliac crest and gluteal fold

pregnancy, trauma, arthritis, OA

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33
Q

what is the function of the SIJ

A

multidirectional force transducer

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34
Q

what is controversial about the SIJ

A

some don’t agree that an injured SIJ can be cause of LBP

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35
Q

what composes the sacrum

A

5 fused vertebrae

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36
Q

interosseous ligs: location and main function

A

anterior
major SI stabilizer, creates pelvic ring

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37
Q

sacrotuberous ligs: location and main function

A

posterior
stabilize in sacral flex and taut in WB

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38
Q

long sacroiliac: location and main function

A

posterior
multifidi has some fibers which insert on the lig

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39
Q

sacral nutation vs counter nutation and their corresponding relative motions

A

nutation
- ant mvmt of base, post mvmt of apex
- post pelvic tilt

counter nutation
- post mvmt of base, ant mvmt of apex
- ant pelvic tilt

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40
Q

sacral nutation/flexion: motion resisted by ____, bilateral vs unilateral motion

A

resisted by sacrotuberous and interosseous ligs

(B) in initial stages of forward bending
unilateral during flex of LE

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41
Q

what position of the sacrum is more stable

A

nutation/flexion

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42
Q

sacral counter nutation/ext: motion resisted by ____, unilateral motion

A

resisted by long sacroiliac lig

(B) initial stage of backwards bending

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43
Q

what are the functional biomechanics of a forward bend

A
  1. ant pelvic tilt
  2. PSIS travel equally superiorly
  3. sacral nut inc relative to innominates for first 45-60deg of FB
  4. extensibility of tissues of sacrum reached so sacral counter nut w continued FB as pelvis cont to move forward
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44
Q

how and in what way specifically is torsion produced at pelvis

A

during climbing or walking

R innominate post rotates
L ant rotates
R sacrum nutated (relative to innominates)
L counter nutated (relative to innominates)

and vice versa

45
Q

when is stability of pelvis achieved and what are contributing components

A

when active, passive, and NM controls work together to transfer loads

dynamic stability (intrinsic, extrinsic)
form closure
force closure

46
Q

form vs force closure in the pelvis

A

form: passive stability
- ligs and bony attachments

force: active stability
- ms system, co-contraction

47
Q

what are the 2 components to force closure and what specific structures are involved in each

A

inner unit = local/stabilizing ms
- levator ani, multifidi = control sacral position
- TrA, pelvic floor = inc intra-abdominal pressure

outer unit = gross/mvmt ms (adds compression)
- glut max, contralateral lats
- glut med and min, contralateral ADDs

48
Q

what paths have a common pain referral over the SIJ

A

L3-4 facet
L4-5 nerve root
piriformis / sciatic nerve

49
Q

why is SIJ path a dx of exclusion

A

most common sources of SI region pain are lumbar and hip dysfunction

50
Q

SIJ pain: MOI

A

any trauma/fall/misstep
fall on glutes
quick upward force

51
Q

SIJ pain: PMH

A

EDS (connective tissue disorder), RA, AS
hypermobility, pregnancy, PMS

med dx and hypermobility –> excessive mobility –> less form closure

52
Q

SIJ pain: pain patterns

A

somatic pain referral rarely below knee

53
Q

SIJ pain: goal of clinical exam

A

reproduce pain at SIJ w provocative tests

54
Q

what is the order of the clinical exam for SIJ pain

A

palpation - static and dynamic
kinetics tests - type of dysfunction
ms length - confounding factors
leg length measurements
provocative tests - helps confirm SIJ dx
joint mobs

55
Q

what is obliquity at the pelvis

A

rotation of 1 innominate vs the other

56
Q

what is a significant finding of PSIS standing/supine alignment

A

~2.5cm difference

57
Q

what are some dynamic/kinetic mvmt tests to do at the pelvis

A

forward bend
gillets
prone press up/ knee bend
long sitting
active SLR

58
Q

what is a consideration before conducting a static palpatory non-WBing test

A

have them do a bridge up first to neutralize leg length

59
Q

how would a R upslip present in palpatory testing

A

R ASIS/iliac crest higher in supine
R PSIS higher in prone

60
Q

how would a R innominate ant rotation present in palpatory testing

A

R ASIS/iliac crest lower in supine
R PSIS higher in prone

61
Q

how will a true innominate rotation present in static palpatory tests

A

in both NWB and WB

62
Q

how will an upslip present in long sitting

A

leg length should change
- rotation will have femur pulled superior so malleoli won’t line up

63
Q

what is a consideration of any objective measures used in the pelvis

A

lack a gold standard

64
Q

what are the cluster of provocation tests used in the SIJ and how

A
  1. distraction
  2. post shear/thigh thrust
  3. Gaenslen L
  4. Gaenslen R
  5. compression

3/5 (+) indicates SIJ path

65
Q

what are all the possible provocation tests that can be used at the SIJ

A

distraction*
post shear/thigh thrust*
FABER
gaenslen L* and R*
compression*
sacral thrust/spring test
cranial shear

66
Q

when can a dx be achieved relating to an SIJ path

A

hx
r/o LBP and hip
3/5 provocative tests

67
Q

once SIJ dysfunction dx, what guides treatment directions

A

positional tests
dynamic tests
confounding variables
- posture ms
- balance
- leg length

68
Q

what are 6 classifications of pelvic girdle dysfunction

A

hypomobile
hypermobile
pain w normal mobility
pelvic girdle fx
coccyxadynia
ankylosing spondylitis

69
Q

hypomobile: onset

A

trauma/lift/twist
insidious
positional stressors
compressive force

70
Q

hypomobile: pain pattern and aggravating factors

A

pain over SIJ/into buttocks or post thigh

inc walking/stairs/rolling/STS

71
Q

hypomobile: normal exam findings

A

neg LB scan
hip ROM WNL

72
Q

hypomobile: abnormal exam findings

A

fixed palpatory obliquity
dec/fixed mobility w kinetic testing
dec arthrokinematics/mobs
(+) provocation tests

leg length discrepancy may be present

73
Q

what are the 3 main possible obliquities

A

ant rotated innominate
post rotated innominate
up slip (inferior translation)

74
Q

what are 3 ways to restore alignment when an obliquity is present

A

mobs
manips
MET

75
Q

what are the 5 CPRs for mob or manip the SIJ (show banana manip as what would be done)

A

FABQ <19
sx <16days
no sx below knee
hyposegment LB
hip IR >35deg

76
Q

acute hypomobile treatment

A

dec pain, inflammation, and MS spasm

77
Q

sub acute hypomobile treatment

A

inc ROM and strength
promote good posture and body mechanics

78
Q

chronic hypomobile treatment

A

ergonomics
dynamic stability
self management

79
Q

hypermobile dysfunction: onset

A

repetitive micro trauma / major trauma
hormonal changes / pregnancy

80
Q

hypermobile dysfunction: painpattern

A

pain location switches sides
- buttocks, thigh, pubic symphysis, groin

+/- clicking popping

81
Q

hypermobile dysfunction: aggravating and relieving factors

A

aggravating:
- unilateral WB
- wt shift

relieving:
- rest
- positions that don’t stress joint

82
Q

hypermobile dysfunction: exam findings

A

+/- positional faults
+/- gower sign
poor control (w wt shift)
poor isolation and endurance of stabilizing ms
antalgic gait (inc wt on one side)
change in dynamic/static palpatory tests
- difference in supine vs standing
inc joint glides
(+) active SLR

83
Q

hypermobile dysfunction: medical intervention

A

if systemic
- sclerosing/prolotherapy/ pharm

fusion (after failed Rx)

84
Q

hypermobile dysfunction: acute PT intervention

A

dec pain
inflammation and ms spasm
stabilization
SI belt

85
Q

hypermobile dysfunction: sub acute PT intervention

A

correct obliquity
inc pain free ROM
strength
promote good posture & body mechanics
stabilization exercise

86
Q

hypermobile dysfunction: chronic intervention

A

ergonomics
dynamic stabilization exercise
self-management (SI belt)

87
Q

pain w normal mobility: onset

A

overuse articular and myofascial structures
dysfunction somewhere else - biomechanical (ie LBP)

88
Q

pain w normal mobility: pain pattern and factors

A

same as hypo/hyper

pain over SIJ/buttocks/post thigh
inc w walking/stairs/STS

89
Q

pain w normal mobility: exam findings

A

leg length/trendelenburg
- ms imbalance b/w gluts and lats, gluts and ADDs
- look down kinetic chain

90
Q

pain w normal mobility: treatment

A

control aggravating factors
- ie running, walking, etc.
dec irritability
stability based exercise
- ie strengthen what is weak

91
Q

sacrum dysfunction: onset

A

trauma / lift / twist

92
Q

sacrum dysfunction: pain pattern and factors

A

same as hyper/hypo, normal mobility

pain over SIJ/buttocks/post thigh
inc w walking/stairs/STS

93
Q

sacrum dysfunction: exam findings

A

positional fault
- upslip
- nutation, counternutation
—> when test flex/ext, not getting equal mvmt (B)

94
Q

sacrum dysfunction: treatment

A

restore alignment
- MT
- METs
- repeated motions

95
Q

pelvic girdle fx: onset

A

trauma
(+) radiographs

96
Q

pelvic girdle fx: pain pattern and why

A

unable to WB
- fx anywhere on pelvic ring, WBing w any mvmt will cause pain bc of ligs that surround the ring and creates tension

97
Q

pelvic girdle fx: exam findings

A

point tenderness over bony prominence

98
Q

pelvic girdle fx: acute vs outpatient treatment

A

acute: external fixator
- compensate/mobility/fxn

outpatient: assess hypo/hyper mobility
- address impairements

99
Q

coccyxadynia fx/sublux: onset

A

fall on buttocks
- missed chair/toilet seat
- fell down stairs

100
Q

coccyxadynia fx/sublux: pain pattern and aggravating factors

A

localized over coccyx
strong/sharp pain w contact on coccyx

sitting worse than standing/walking

101
Q

coccyxadynia fx/sublux: exam findings

A

sitting posture
pain palpation/mobs

102
Q

coccyxadynia fx/sublux: treatment

A

mob or protect
function/strength

103
Q

ankylosing spondylitis active vs late phase

A

active
- inflammatory process affecting ligs causing progressive fibrosis and low-grade fever

late
- bony ankyloses, bamboo spine risk for multiple stress fx

104
Q

ankylosing spondylitis: demographics

A

young men
17-35yo

105
Q

ankylosing spondylitis: sx

A

pain worse in AM, >3mo
- AM stiffness >3mo, >30min

LBP/ stiffness –> loss of motion

stiffness onset in SI region often
–> followed by progressive limit in mvmt

aggravated by inactivity
better w mvmt

106
Q

ankylosing spondylitis: exam findings

A

dec ROM, general hypomobility
imaging

late stages:
- mobility
- gait
- breathing (rib cage)
- morbidity

107
Q

ankylosing spondylitis: active stage interventions

A

medically managed
- NSAIDS
- corticosteroid injections
- PT not indicated**

108
Q

ankylosing spondylitis: remission stage interventions

A

this is when they go to PT

posture
- promote ext sleeping
ext exercise
joint mob only in early non active stage
- contraindicated in late stages
aerobic
education

MSK 2 (20 decks)

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