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MSK II > Class 3-4: LBP-IDD > Flashcards

Class 3-4: LBP-IDD Flashcards

1
Q

why is the general classification non specific LBP

A

nearly all cases have an unidentified nociceptive source

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2
Q

what does the STarT back tool do

A

determines risk of persistent diabling pain and matches treatment

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3
Q

prevalence of lumbar LBP

A

leading cause of worldwide disability and activity limitation/work absence

half of people over 65 will have it

80% of people will experience in their life

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4
Q

prevalence factors for LBP

A

women
older
lower edu status
higher physical work demands

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5
Q

risk factors for LBP

A

previous LBP
co-morbidities
poor mental health
smoking
obesity
low activity level
awkward posture
heavy lifting
fatigue
genetics with ARDC ONLY

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6
Q

functional lumbar flexion ROM for sit to stand

A

35-42 degrees lumbar flexion

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7
Q

functional lumbar flexion ROM for picking up objects on floor

A

60 degrees lumbar flexion

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8
Q

how many asymptomatic individuals will have positive findings on imaging

A

1/3

i.e. IDD, ARDC, N compression, or facet hypertrophy

2/3 had disc changes from 30-80 years old

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9
Q

how many symptomatic individuals had positive scan findings

A

1/2 had an abnormality

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10
Q

who should get imaging with LBP

A

over 50 years old AND hx of cancer
saddle paresthesias
bowel/bladder dysfunction
specific neuro deficits
progressive/disabling symptoms
NO improvement after 6 wks

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11
Q

problems that are presented with over-utilization of unsupported and ineffective PT Rx for LBP

A

higher costs
greater opioid addiction
greater imaging/radiation exposure
more likely to have invasive procedures/side effects
more absences from work

fear avoidance behaviors are promoted with passive interventions like modalities and even some manual therapies

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12
Q

things to keep in mind for the prevention component of LBP RX

A

inadequate research

most promoted preventions lack evidence

exercise is largely effective in adults

children = ergonomic furniture is effective but exercise is not evaluated

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13
Q

benefits of early PT with LBP

A

2% developed persistent LBP vs 15% with later PT

significant reduction in work absence

supported in many studies

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14
Q

what edu and advice should be given to LBP pts as a first line Rx

A

advise against bed rest and in-depth explanations of what is causing LBP

advise for:
-Spinal anatomical and structural strength
-neuroscience explanation
-overall good prognosis
-active P! coping mechanisms that decrease catastrophizing
-stay active and resume ADLs early
-emphasis on function

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15
Q

importance of edu in PT Rx for LBP

A

greater emotion = greater pain and persistence

improve emotions = less pain and persistence

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16
Q

validity of dry needling for any MSK condition

A

low/mod evidence of benefit on pain vs no treatment or placebo

no functional benefit

no support to use over exercise and manual therapy

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17
Q

effectiveness of modalities for LBP

A

generally ineffective/non reccomended

short term results at best; often no better than placebo

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18
Q

STM/massage effectiveness for LBP

A

only short term benefit

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19
Q

ways to overcome barriers to best practice in PT

A

increase consultation time and follow up

decrease lawsuits based on evidence

better incentives to return to work

public service announcements

reward quality and not quantity with reimbursement

increased provider knowledge of evidence and guidelines for use in clinical reasoning and decision makinh

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20
Q

what are the 4 LBP Rx subgroups

A

mechanical traction
directional preference
mobilization/manipulaiton
stabilization

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21
Q

effectiveness of intermittent traction with LBP

A

preliminary support for LBP when symptoms peripheralize during repetitive ext and when there is a positive SLR special test

22
Q

intermittent traction is more supported in prone and when..

A

18-60 yrs

paresthesias in last 24 hrs distal to knee

oswestry questionnaire > 30

+ n root compression, crossed SLR, and/or centralization

23
Q

there is moderate evidence against all types of tx when used alone in patients with…

A

acute, subacute, and persistent LBP

non-radicular LBP

varying symptom pattern

24
Q

how can you tell if a patients LBP has directional preference

A

pt centralizes with 2 or more movements in the same direction (i.e. flex or ext)

or

pt centralizes with movement in one direction and peripheralizes with an opposite movement

25
Q

effectiveness of mckenzie exercises for acute LBP

A

nor superior to other treatments for pain/disability

often utilized well with acute IDD in short term

26
Q

effectiveness of mckenzie exercises for persistent LBP

A

no difference in pain/function vs no intervention at all

27
Q

what classifies a LBP pt as a manipulation classification

A

recent onset of symptoms (<16 days)

no symptoms distal to knee

28
Q

least common IDD

A

acute herniations- nuclear migrations

29
Q

most prevalent IDD

A

disc changes due to variables that allow herniations that gradually develop over time

persistent IDD

30
Q

what region are IDD injuries most common

A

most common in lumbar

only 1-3% IDDs are symptomatic

95% at L4-S1

31
Q

most common portion of the disc to tear

A

posterolateral

weaker, thinner

has more vertical and less oblique fibers

just lateral to posterior longitudinal ligament

32
Q

how does the acute disc injury usually happen

A

forward bending at waist with or without twisting/lifting

33
Q

describe how the lumbar spine is not flexing like you think

A

b/c of pelvic tilt

less circumferential disc compression/uneven annular tension with lumbar flattening and pelvic tilt

less fixated end plate

more anterior shearing and possible rotating stresses with additional influence of gravity

increased and asymmetrical stress on weaker and thinner posterolateral annular and end plate fibers

34
Q

best way to squat

A

not holding lordosis; avoid excessive arch

let body move the way it wants

let lumbar region curve and pelvic tilt

allows symettrical compression

35
Q

are outer or inner annulus tears more common

A

outer + end plate avulsion more common

36
Q

once damaged how do disc structures act

A

immunoreactive

37
Q

what happens as a result of the large inflammatory response of the disc when injured

A

excessive osmotic pressure OR increased static fluid pressure and around disc and spinal nerve

static fluid has more inflammatory chemicals that sensitize nerves and cause pressure/tension

no lymph drainage

extended inflammatory phase

38
Q

typical posterolateral IDD symptims

A

dull achy pain

radiculopathy

referred pain into glutes and groin

decreased pain when unloading or lying/supported/walking

increased pain with FB/sitting/coughing/lifting

24 hr behavior: increased pain in the morning

39
Q

why does IDD cause dull/achy pain

A

annulus is highly innervated and very painful

significantly more swelling than cervical disc due to higher number of gags

40
Q

why might there be radiculopathy with IDD

A

possible segmental paresthesias within 24 hours

worse situations = radiculopathy + coldness bc vv have rich routes and high degree of resistance to ischemia

41
Q

observation of someone with posterolateral IDD

A

lateral shift of shoulders on pelvis common

SB away from pain

counter contralateral SB to levels

rare = smaller calf growth
-wasting likely at 4-6 wks of severe spinal n compression
-more a sign of persistent radiculopathy

42
Q

ROM findings for posterolateral IDD

A

all may cause pain

flx + SB away from injured side = limit/P!; pushes swelling toward n and puts tension on area of injury

ext + SB towards injury = less limited; often centralizes extremity pain BUT may increase spine pain from high osmotic pressure on disc (squeezing out swelling from pressure needed to relive leg pain)

43
Q

scan findings for posterolateral IDD

A

resisted and MMT = variable

possible + stress test with compression/distraction/PA pressures/torsion

neuro = possibly + depending on severity/timing

possibly + stability tests

44
Q

rare central IDD signs

A

cord or cauda equina S&S depending on level

immobilize and emergency referral

45
Q

mckenzie method based on what

A

belief that most of the spinal pain comes from injuries to the disc

classifies symptoms based on location of symptoms and positions/motions that decrease symptoms

research says this is NOT the case

46
Q

3 classification syndromes of the mckenzie method

A

postural = essential to correct posture

dysfunctional = essentially stretches to improve end ROM

derangement = essentially using end range motion to improve the theoretical nucleus migration in the disc

47
Q

effectiveness of mckenzie method

A

evidence suggests NOT superior to the other treatments for pain/disability

overall long term treatment effect is small; more needs to be done

48
Q

strong evidence for mckenzie method when

A

benefit with LE symptoms and when centralization occurs with acute IDD

49
Q

possible mechnisms of action for the mckenzie method

A

dynamic disc theory (nucleus repositions centrally) = unproven

fluid dynamics with or without herniations (squeezing swelling away with repetitive motion)

50
Q

PT Rx for acute IDD

A

POLICED

directional preference = 10-20 reps every 1-2 hours

intermittient traction if radiculopathy

posture/ergonomic edu

limited sitting

neural mobilizations

HEP for 1-2 weeks possible to avoid sitting while driving

unweighted walking lessening over time

51
Q

for acute IDD MET is ultimately for what purpose

A

tissue proliferation and stabilization

52
Q

why should we squat “like a toddler”

A

more circumferential disc compression

even annular tension with lumbar flexion/posterior pelvic tilt

more fixated end plate

less anterior segmental shearing and possible rotational stresses with additional influence of gravity

MSK II (18 decks)

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