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MSK > Assessment and treatment of the Lumbar spine > Flashcards

Assessment and treatment of the Lumbar spine Flashcards

1
Q

Name three things that can go wrong with a vertebra.

A
  1. Fracture
  2. It can weaken (e.g. osteoperosis)
  3. Bone can grow excessively (e.g. bony spurs, fusion)
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2
Q

Name two functions of the annulus fibrosus.

A

Stabilizer
Spacer
Shock absorber

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3
Q

How many layers does the annulus fibrosus have?

A

12 layers:

- 6 going in one direction and 6 going in the other.

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4
Q

If a joint/ disc becomes sloppy in the lumbar spine, what are two ways the body will compensate?

A
  1. Muscles will tighten around the area.

2. Bony spurs or fusion of the discs

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5
Q

Name three things that can go wrong with the nerve root.

A
  1. impingement
  2. Compression of the nerve supply to the nerve root
  3. Tension
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6
Q

Name three things that can go wrong with the ligaments/joints.

A 
Dislocation
Sprain
fixated joint
Laxity
Hypomobility
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7
Q

What is the name of the fascia that is important for stabilizing the lumbar spine?

A

thoracolumbar fascia

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8
Q

True or false.

The psoas major stabilizes the lumbar spine.

A

True

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9
Q

Name three things that can go wrong with the muscles in the lumbar region.

A 
Strain
Spasms
Atrophy
Soreness
Tightens - Can increase compressive load.
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10
Q

Will pain be felt if their is damage to the inner 2/3rds of the annular fibrosis? Why?

A

No, because the inner 2/3rds of the annular fibrosis are not innervated.

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11
Q

When do radial fissures become painful?

A

When they creep out into the outer 1/3rd of the annular fibrosis.

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12
Q

What complications does a herniation cause?

A

Compression of the nerve root or compression of the blood supply to the nerve root.

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13
Q

Patient comes to you with unrelenting pain down their leg and no pain in their lower back. What are these signs of?

A

Extruded disk fragement

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14
Q

Patient comes in with LBP. Their job involves a lot of repetitive flexion with some rotary movement. At MOI, felt something, but not overly painful. LB became stiff and uncomfortable over an hour or two. Pain in the morning and at the end of the day. Made worse with sitting, coughing, sneezing, bearing down for a BM. Made better with short walks, extension activities and changing positions. What is the most likely cause of their S&S?

A

Disc bulge or herniated disc.

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15
Q

What is spondylosis? What joint may have increased weight bearing in extension or compression due to it?

A

It is a degenerative disc disease and the facet joint may have increased weight bearing.

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16
Q

Which physiological movement of the discs will unload the disc in the lumbar spine?

A

Extension will unload it.

17
Q

Which movements produce pain in a person with an acute sprain of the facet joint? How is pain usually reduced?

A

All ROMs may be affected.

Pain is reduced by decreased weight bearing and movement in midrange

18
Q

True or False

Compressed discs leads to stiff joints.

A

False.

Compressed discs leads to lax joints.

19
Q

Patient comes in with intermittent LBP with posterolateral leg pain. Pain is brought on by activities involving extension. Pain is relieved by resting in flexed position such as sitting or crook lying. What is the most probable cause? Describe the impairment.

A

Spinal stenosis.

Narrowing of the spinal canal by bony protrusions. Can irritate nerve roots.

20
Q

What is spondylolisthesis?

A

A specific instability whereby one vertebra slips anteriorly on the vertebra below. Usually due spending prolonged periods of time in extension or flexion, which allows for creep and slippage due to gravity.

21
Q

What is the cause of the LBP in spondylolisthesis?

A

Vertebra begin to slip or creep posteriorly or anteriorly and muscles will tighten to prevent it and cause LBP.

22
Q

What usually decreases LBP for patients with spondylolisthesis?

A

Activities that keep optimum muscle tone

23
Q

What is commonly associated with spondylolisthesis, but not always.

A

Fractured pars interarticularis

AKA Scotty dog fracture

24
Q

Name a common muscle imbalance affecting the lumbar spine.

A

Pelvic Cross Syndrome:

  • Tigh erector spinae and hip flexors
  • Weak abdominals and gluteal muscles
25
Q

What are some of the effects on posture caused by pelvic cross syndrome?

A

Increased anterior pelvic tilt
Lordosis
Increased weight bearing on the facet joints.

26
Q

What are the 4 types of loads that cause tissues to fail?

A
  1. Macrotrauma
  2. Summative/ modulating failure load = repetitive loads
  3. Sustained load = creep
  4. Repetitive stress over time + aging process
27
Q

What kind of treatment would you provide someone with a hypomobile joint? (Think general)

A

Manipulation/mobilization

28
Q

What kind of treatment would you provide someone with a hypermobile joint? (think general)

A

Stabilization

29
Q

What kind of treatment would you provide someone with a movement that stresses a pain producing tissue and the opposite movement reduces the stress on the same tissue? (Think general)

A

Specific exercise

30
Q

What kind of treatment would you provide someone with nerve root irritation? (Think general)

A

Traction

31
Q

Where does injured facet joints refer to?

A

Posterior thigh

32
Q

Passive tests should be negative for all sub groups except ______.

A

Stabilization

33
Q

What is a positive sign for prone instability test?

A

Pain when pressure applied to spinous processes with muscles relaxed. Then the patient is asked to lift legs and pressure is applied and the pain/ excessive movement is gone.

34
Q

What should you do if you relieve a muscle spasm?

A

Educate the patient on why there was muscle spasm and what not to do.

35
Q

Why is it important to restore the movement passively before the patient actively does the movement?

A

The movement will take the path of least resistance and the movement will occur in the looser region rather than the stiff area which you intend to mobilize.

36
Q

True or False

Disc cracks are not able to heal if unloaded.

A

False.

They are able to heal if unloaded.

37
Q

what is the most important part of treatment for disc patients?

A

Education. Make sure they know the movements they should avoid and think about “emptying the bucket analogy”.

38
Q

What can be changed to reduce the aggravating forces from vacuuming that cause LBP?

A

Avoid vacuuming
Stop flexing while vacuuming
Dance with the vacuum AKA hold in front with both hands and not to the side with one. Stops rotation.

MSK (8 decks)

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