core assessment and treatment Flashcards
what effect does core treatment have on back pain?
-helps to improve pain & function in people with chronic LBP
-stabilisation/ motor control training as a most effective treatment for non specific LBP
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what is the strong evidence for low back pain?
-exercise for chronic low back pain eg trunk muscle strengthening, trunk muscle activation exercise
-exercise for chronic low back pain with movement control impairment eg trunk muscle activation and movement control
-pain education and active Rx eg yoga, stretching, pilates
describe some moderate evidence for chronic LBP
-active education strategies including remaining active, pacing strategies and back protection techniques
what are some surface anatomy markings for the anterior abdominal wall?
-linea alba
-costal margin
-iliac crest
What are some of the anterolateral abdominal muscles?
-pyramidalis
-rectus abdominis
-external oblique
-internal oblique
-transverse abdominis
what is the function of rectus abdominis?
-flexion of trunk
-tension of abdominal cavity
-posterior pelvic tilt
what is the bilateral and unilateral function of external obliques?
-bilateral: trunk flexion
-unilateral: lateral flexion (to the same side)
-unilateral: rotation (contralateral)
what is the function of transverse abdominis?
bilateral: intra-abdominal pressure, expiration
unilateral: ipsilateral rotation
what muscles are in the posterior abdominal wall?
-thoracocolumbar fascia
-erector spinae
-quadratus lumborum
-psoas major
-psoas minor
what muscles does the thoracolumbar fascia attach to?
-trapezus
-lats
-glut maximus
-hamstrings
what are the 3 erector spine muscles?
-spinalis
-longissmis
-iliocostals
what is the function of the lumbo-pelvic hip complex?
-enhance trunk stability and muscular co-ordination
-reduced risk of injury
what does a subjective assessment of a LBP patient involve according to the clinical translation framework?
-what is their problem?
-pain
-previous Rx
- what are their goals with physio?
- red flags
-MOI
-medications and PMhx
-social history
-emotional well being and psychological factors (yellow flag)
-what is the patients end goal eg run a marathon or be able to carry their baby grandchild
what are examples of pain outcome measures we could use for patients?
-McGill pain questionnaire
-Roland - Morris low back pain and disability questionnaire
what does an objective Ax of LBP involve?
-gait
-posture
-spinal AROM
-single leg stance control
-neuro exam
-neurodynamic tests
-hip and sacroiliac joints
-palpation
-lumbopelvic awareness and motor control
-functional tests
what could a neuro assessment for LBP involve?
-myotomes eg heel raise, toe raise,
-dermatomes
-reflexes
-balance eg tandem, Romberg
how could you screen the hip?
-flexion - active and passive
-IR/ER - PROM
-FABER
-FADIR
-quadrant
-scour test
how to screen sacroiliac joint?
-compression
-distraction
-FABER
-sacral thrust
-thigh thrust
what are examples of functional tests for LBP?
-deep squat
-SLS
-single leg mini knee bends
-movement impairments or painful activities
how could you assess motor control?
-single leg stance
-single leg knee bend
-single leg with rotation
-reverse lunge
-step down
-deep squat
-active SLR
how to palpate the transverse abdominis?
patient is in crock lying (one leg bent and one not bent)
-find ASIS, 2 inches towards midline and 1 inch inferior
-apply gentle pressure and ask patient to switch on muscles below thumb
what does a single leg stance access?
-static balance
-pelvic control
-strength eg glutes
what does an active straight leg raise assess?
the lumbo-pelvic control with open chain long level leg lift
-can also be used as part of flexibility or sport screening or strength!
what does a bridge assess?
-hip extensor strength
-lumbo-pelvic and trunk control
how can we manually strength test the rectus?
-curl up to test rectus abdomoninis
how can we manually strength test the obliques?
rotation in curl up position on plinth
what is a pressure biofeedback unit?
- a device that helps to detect movement of the lumbar spine through an air filled reservoir
-unit is placed under the lumbar spine and inflated to 40mmHg
what are examples of good evidence based core exercises?
-bridge
-dead bug
-bird dog
-plank
what are examples of some functional and multi planar exercises for core?
-forward or reverse lunge with trunk rotation
-side plank with rotation
-lateral lunge with toe taps
what is the evidence behind trunk and LB rehab with a bridge?
-improves motor control and trunk muscle co-activation patterns for spine stabilisation
-activates glute max and erector spinae
what is the evidence behind the dead bug exercise?
-improves core stability
-helps with transfer of forces during throwing , striking, kicking and pushing etc
what is the evidence behind bird dog exercise?
-whole body balance exercise
-it is effective in activating the lumbar erector spinae
