Active Motion

Question 1

McKenzie theory of BB

Answer 1

States that BB pushes nucleus forward which reduces bulge and relieves pressure from NR

Question 2

Paris theory of BB

Answer 2

States that forward movement of the nucleus with BB only occurs in healthy discs

Question 3

How does BB relieve pain?

Answer 3

1. Gate control theory: firing of large fiber proprioceptors block onward transmission of nocioception that will reduce and centralize pain
2. Elevates water content of the disc: repetitive motion has been shown on MRI to increase water content and lessen irritability of the disc to its peripheral & invading nocioceptors; painful discs are acidic and water acts as a buffer; movement helps flush out chemical irritants and bring in nutrition and water to raise the pH
3. Mobilizes the fact joint: BB stretches facets more than FWB
4. Promotes circulation
5. Helps to relieve fear of movement and promote functional recovery
6. Neural tension is decreased secondary to slackening of cauda equina when lordosis is achieved and maintained
7. Over time the disc protrusion loses its proteoglycans and its ability to attract water and shrinks

Question 4

Characteristics of normal motion

Answer 4

Smooth regardless of speed, adequate relaxation of antagonists, full range, pain free, normal muscle length, PROM > AROM

Question 5

Characteristics of abnormal motion

Answer 5

Limited range, unwillingness to move, painful arc, compensatory movement, crepitus, instability (shaking, juttering), pain at end range, PROM no greater than AROM

Question 6

Facet Capsular Pattern in Lumbar Spine

Answer 6

Upslide will be more limited than downslide 
Ex: L facet is limited: 
- FB: deviation L 
- BB: deviation away from tight side 
- SBR: limited 
- SBL: free 
- RL: limited 
- RR: free

Question 7

Myofascial Pattern in Lumbar Spine

Answer 7

FB limited
All other movements are relatively free
If the patient is able to SB bilaterally (demonstrate an upslide to the R and L), the patient should be able to bilaterally upslide with FWB
If they cannot, the restriction is most likely myofascial

Question 8

Facet Capsular Pattern in Cervical Spine

Answer 8

Ex: L facet is limited

• FB: possible deviation to the L
• BB: deviation away from tight side
• SBR: restricted
• SBL: relatively free
• RL: relatively free
• RR: most restricted

Question 9

Myofascial Pattern in Cervical Spine

Answer 9

No consistent pattern
Depends on muscles involved
Support pt’s arms to slacken UT and LS and assess SB bilaterally for an increase in range which may indicate the muscles are limiting

Question 10

Clinical Signs of Instability

Answer 10

1. History or demonstration of tissue relaxation/creep with in ability to sit still for long periods and c/o discomfort throughout day that is relieved with movement or rest
2. Increased involuntary muscle tone while standing
3. Presence of a “step” or rotation (spondylolisthesis or spondylolysis)
4. Disappearance of muscle tone, step or rotation in prone lying when compared to standing
5. Shaking, juddering while FWB
6. Difficulty coming up from FWB
7. Grade 5 or 6 on passive motion palpation
8. Radiological evidence of motion studies of FWB and BB showing increased angulation b/w vertebra or excessive translation (>4mm = instability)

Question 11

O’Sullivan on Instability Tx

Answer 11

Instability pts benefit from stabilization

• posture education
• endurance
• strengthening
• stretching above and below