Classificatioon Of Lumbo-Pelvic Health Conditions

Question 1

80-90% of LBP pts symptoms will be resolved within ___ weeks

Answer 1

4

Question 2

What is the recurrence rate of LBP?

Answer 2

40-50%

Question 3

Why is the recurrence rate of LBP so high?

Answer 3

bc the tissues often don’t have the time needed to fully properly heal

Question 4

What is the most common age group affected by LBP?

Answer 4

Those under 45 years old

Question 5

Why is LBP in epidemic proportions?

Answer 5

Bc of most people living a sedentary life and having poor posture

Question 6

Why is there little consensus on what we should be doing to treat LBP?

Answer 6

Bc every LBP case if unique

Question 7

What should be our compass for LBP?

Answer 7

Symptom response/reactivity

Question 8

What are the three R objectives of the exam?

Answer 8

Reproducible sign
Region of origin
Reactivity level

Question 9

Which of the three Rs confirms the presence of mechanical most disorder and the specific behavior at fault?

Answer 9

Reproducible sign

Question 10

Which of the following of the three Rs identifies the segmental locus of pathology?

Answer 10

Region of origin

Question 11

Which of the three Rs appreciates the level of irritability and behavior of the condition?

Answer 11

Reactivity level

Question 12

Do we need to know the pathological do to treat the pt?

Answer 12

Nope

Question 13

Is it better to use pathoanatomic-based do or impairment-based dx?

Answer 13

Impairment-based dx

Question 14

T/f: classification based on symptom behavior was a more reliable method of classifying LBP pts

Answer 14

True

Question 15

What is the theoretical framework of MDT (mechanical dx and therapy)?

Answer 15

Most spinal dysfunction is due to derangement of the IV disc secondary to prolonged and repeated flexed postures and loss of normal extension

Question 16

Is MDT or TBC being described: appropriate and subsequent intervention is based on a symptom-provocation/resolution model identified through single and repeated movt and finding the directional preference

Answer 16

MDT

Question 17

Why does MDT use repeated movt to find directional preference?

Answer 17

Bc it gives us a sense for what happens over a time span

Question 18

T/f: MDT establishes a directional preference

Answer 18

True

Question 19

What is the focus of the intervention in MDT?

Answer 19

Self management and centralization of symptoms

Question 20

What is the centralization phenomenon?

Answer 20

When pain/paresthesias improve distally and move proximally

Question 21

If a pts distal symptoms improve but their proximal symptoms get worse and spread out wider, should we be concerned that the condition is getting worse?

Answer 21

Nope, this is the centralization phenomenon and means the condition is improving

Question 22

T/f: leg pain at intake (not severity) is a significant predictor of chronic pain and disability

Answer 22

True

Question 23

Centralization is associated with ___ outcomes while peripheralization is associated with ___ outcomes

Answer 23

Better; poorer

Question 24

What are the MDT syndromes?

Answer 24

Postural syndrome
Dysfunction syndrome
Derangement syndrome

Question 25

What is a postural syndrome?

Answer 25

Normal structures under abnormal stress Ie. bad posture that causes pain and is resolved with a change in position or posture

Question 26

What is a dysfunction syndrome?

Answer 26

Adaptive shortening of soft tissues where moving in the painful direction a few times makes the pain better

Question 27

What is a derangement syndrome?

Answer 27

Alteration in contents of the disc w/peripheralization that has s/s that worsen with the painful movt

Question 28

With a dysfunction syndrome, do we want to move towards or away from the painful movt?

Answer 28

Towards the painful motion

Question 29

With a derangement syndrome, do we want to move towards or away from the painful motion?

Answer 29

Away from the painful motions

Question 30

If there is pain with flexion in a dysfunction syndrome, what direction should we move them into?

Answer 30

Flexion

Question 31

If there is pain with flexion in a derangement syndrome, what direction should we move them into?

Answer 31

Extension

Question 32

Does MDT or TBC use repeated motions, correct lateral shifts, focus on centralization, and move toward or away from the painful motion?

Answer 32

MDT

Question 33

What is theoretical framework of TBC (treatment based classification system)?

Answer 33

An examination approach four acute LBP that leads to a classification that specifically directs management

Question 34

Does MDT or TBC classification result in a detailed strategy w/the prescription of precise interventions?

Answer 34

TBC

Question 35

T/f: pts may change categories in TBC as progress is made

Answer 35

True

Question 36

How many classification levels are in the TBC classification scheme?

Answer 36

3

Question 37

What level of TBC classification is deciding whether to manage independently by the PT, manage with consultation, or referring to another practitioner?

Answer 37

Level 1

Question 38

What level of TBC classification is deciding between 3 stages of acuity?

Answer 38

Level 2

Question 39

Which TBC level of classification involves assigning pts to stage 1 syndromes?

Answer 39

Level 3

Question 40

What syndromes fall under stage 1 of the TBC classification scheme?

Answer 40

Extension Flexion Lateral shift Immobilization Traction Mobilization

Question 41

What deficits fall under stage 2 of the TBC classification scheme?

Answer 41

Flexibility deficits Strength deficits CV deficits Coordination deficits Body mechanics deficits

Question 42

What deficits fall under stage 3 if the TBC classification scheme?

Answer 42

Activity intolerance Work intolerance Sometimes some flexibility deficits

Question 43

What TBC stage involves severe pain and disability, extreme neuro symptoms, and inability to walk a quarter mile without pain?

Answer 43

Stage 1

Question 44

What TBC stage involves issues with IADLs?

Answer 44

Stage 2

Question 45

What TBC stage involves being relatively asymptomatic, ability to do ADLs, but difficulties with higher level functioning like work and sports?

Answer 45

Stage 3

Question 46

What are the TBC syndromes?

Answer 46

Mobilization syndrome Specific exercise syndrome Immobilization syndrome Traction syndrome

Question 47

What TBC syndrome merges lumbar and SI mobilization syndromes?

Answer 47

Mobilization syndrome

Question 48

What TBC syndrome is this: asymmetry of bony landmarks, positive structural special tests, and opening/closing patterns of motion

Answer 48

Mobilization syndrome

Question 49

What TBC syndrome merges MDT extension, flexion, and lateral shift syndromes?

Answer 49

Specific exercise syndrome

Question 50

What TBC syndrome involves centralization and peripheralization w/specific motions?

Answer 50

Specific exercise syndrome

Question 51

What are the treatments for mobilization syndrome?

Answer 51

Joint mobs (lumbar and SI)

Question 52

What are the treatments for specific exercise syndrome?

Answer 52

Direction of preference exercises with avoidance of the opposing direction Manual and self-shift correction

Question 53

Which TBC syndrome is similar to MDT dysfunction syndrome?

Answer 53

Specific exercise syndrome

Question 54

What TBC syndrome has a hex of trauma or frequent manipulations, generalized laxity, and instability “catch” during motion?

Answer 54

Immobilization syndrome

Question 55

What are the treatments for immobilization syndrome?

Answer 55

Dynamic stabilization Use of external support for a short period of time

Question 56

What TBC syndrome has s/s if nerve root compression and an inability to centralize symptoms with movt?

Answer 56

Traction syndrome

Question 57

What are the treatments for traction syndrome?

Answer 57

Manual and or mechanical pelvic traction

Question 58

T/f: evidence supports the ability of TBC classification system to discriminate bc pts with LBP

Answer 58

True

Question 59

T/f: subjects treated using extension and mobs responded to intervention at a faster rate than controlled with LBP

Answer 59

True

Question 60

T/f: subjects responded better when their interventions were guided by diagnostic classifications

Answer 60

True

Question 61

What are the 3 management approaches for LBP?

Answer 61

Medical management Rehab management Self care management

Question 62

What are the clinical findings that would indicate need for medical management of LBP?

Answer 62

Red flags Medical comorbidities precluding rehab Leg pain with progressive neuro deficits

Question 63

What are the clinical findings that would indicate need for rehab management for LBP?

Answer 63

Medium to high psychosocial risk status Low psychosocial risk status with predominantly leg pain Minor or controlled medical comorbidities

Question 64

What clinical findings would indicate the need for self care management of LBP?

Answer 64

Low psychosocial risk status Predominantly axial LBP Minor or controlled medical cormorbidities

Question 65

What are the 3 rehab approaches to LBP?

Answer 65

Symptom modulation Movt control Fxnal optimization

Question 66

What clinical findings would lead us to chose a symptom modulation rehab approach to LBP?

Answer 66

High disability Volatile symptom status High to moderate pain

Question 67

What treatments are involved in symptom modulation?

Answer 67

Directional preference exercises Manipulations Traction Active rest

Question 68

What clinical findings would lead us to using movt control rehab approach?

Answer 68

Moderate disability Stable symptom status Moderate to low pain

Question 69

What treatments are involved in movt control rehab approach?

Answer 69

Sensorimotor exercises Stabilization exercises Flexibility exercises

Question 70

What clinical findings would lead us to use a fxnal optimization rehab approach for LBP?

Answer 70

Low disability Controlled symptom status Low to absent pain

Question 71

What treatments are involved in fxnal optimization rehab approach to LBP?

Answer 71

Strength and conditioning exercises Work/sport specific tasks Aerobic exercise use General fitness exercises

Question 72

What is one of the cormorbidities associated with widespread pain that is disproportionate to provocative mechanical testing?

Answer 72

Central sensitization

Question 73

What is central sensitization?

Answer 73

Disproportionate pain

Question 74

What are the 2 types of central sensitization?

Answer 74

Hyperalgesia and allodynia

Question 75

What is hyperalgesia?

Answer 75

Increased pain with noxious stimuli

Question 76

What is allodynia?

Answer 76

Pain with non-noxious stimuli

Question 77

T/f: central sensitization is strongly associated with elevated psychosocial overlay

Answer 77

True

Question 78

T/f: all systems use the motion that is limited or painful to name the syndrome

Answer 78

True

Question 79

T/f: all systems strive to restore motion in all directions including the limited/painful motion

Answer 79

True

Question 80

The ability to address the primary impairment depends on what?

Answer 80

The level of reactivity

Question 81

Directional preference (bias) is _______ to the most painful motion and may be used as the primary intervention or to control reactivity

Answer 81

Opposite

Question 82

How many degrees is a typical cervical lordosis?

Answer 82

30-35 degrees

Question 83

How many degrees is a typical thoracic kyphosis?

Answer 83

40 degrees

Question 84

How many degrees is a typical lumbar lordosis?

Answer 84

45 degrees

Question 85

How many degrees is a typical sacrococcygeal kyphosis?

Answer 85

30 degrees

Question 86

Does the lateral shift of scoliosis follow the pelvis or shoulder?

Answer 86

Shoulder

Question 87

What is at the top of the pyramid of mobility testing?

Answer 87

Passive accessory mobility (PAIVM)

Question 88

What is second on the pyramid of mobility testing?

Answer 88

Passive physiologic mobility (PPIVM)

Question 89

What is at the bottom of the pyramid of mobility testing?

Answer 89

Active ROM