DSE/Stabilization 1 Flashcards
Dianne is being eval’d for intermittent LBP. She doesn’t have pain in standing but does have it during flexion activities such as lifting her heavy backpack from the floor and putting groceries in the trunk. Early in the exam you notice that Dianne has pain during flexion that actually decreases as she approaches end ROM. What is the most appropriate prediction based on this finding?
A. She will probably have a (+) prone instability test
B. She will probably have a (+) extension direction preference
C. She will probably need a lumbar joint mobilization
D. She will probably need to be referred to a physician
A. She will probably have a (+) prone instability test
Donald’s back pain is reproduced when the PT does a CPA over L5>L4>L3
A. His LBP generator is primarily muscular
B. There was no real need to do part 2 of this test
C. Muscle contraction exercises are likely to reduce his LBP
D. He probably needs lumbar mobilization in addition to stabilization
C. Muscle contraction exercises are likely to reduce his LBP
53 y/o Mark is pretty active in martial arts and has never had back pain until this episode. This episode started with a bad fall a couple of months ago which caused a few weeks of back and right thigh pain but 80% of this pain resolved without treatment. Kicking forward is his worst agg factor. Sitting and lying are pretty much pain free. Standing flexion is unremarkable though moderately limited by back and thigh pain. Mark’s SLR is R 95 degrees, L115 degrees and his pain increases with dorsiflexion on the R. Which of the following is most true?
A. His SLR average is >91 so he belongs in the stabilization classification
B. His primary classification is probably NOT stabilization
C. Prone instability testing is contraindicated for Mark
D. Mark should be referred back to his MD because this doesn’t make sense
B. His primary classification is probably NOT stabilization
Which is the most true about the more generalized approach to lumbar stabilization?
A. It relies on maximal voluntary contraction of all of the abdominals whereas the specific approach asks only for a moderate contraction
B. It relies on brief but generalized contraction of all the abdominals whereas the specific approach asks for a more sustained contraction
C. It activates the superficial and deep muscles initially whereas the specific approach activates only the deep muscles initially
D. Once a pt learns the initial TrA contraction for the specific approach or the abdominal bracing for the generalized approach, the generalized approach requires much less practice than the specific approach to integrate with other movements and activities
C. It activates the superficial and deep muscles initially whereas the specific approach activates only the deep muscles initially
Which of the following is most true about spinal stabilization exercises?
A. Because these muscles need endurance, exercises should be performed for as long as possible to increase endurance
B. As long as the pt is not having pain, close supervision while they learn them isn’t really important
C. Adding the arm and leg raises in quadruped is done in order to add preferentially activate the TrA
D. Repetition and practice focus on coordination and endurance more than on strength
D. Repetition and practice focus on coordination and endurance more than on strength
What is the best description of the role of the gluteals in spinal stabilization?
A. They are often overactive which allows the spinal stabilizers to get weak from underuse
B. They are attached to the pelvis and provide significant pelvic stability which results in excessive lordosis
C. Clam shells are performed for selectively activating and strengthening the gluteals while stabilizing the lumbar spine
D. They are often underactive and generate somatic referred pain in pts with poor stabilization
C. Clam shells are performed for selectively activating and strengthening the gluteals while stabilizing the lumbar spine
What is the best description of the role of the gluteals in spinal stabilization?
A. They are often overactive which allows the spinal stabilizers to get weak from underuse
B. They are attached to the pelvis and provide significant pelvic stability which results in excessive lordosis
C. Clam shells are performed for selectively activating and strengthening the gluteals while stabilizing the lumbar spine
D. They are often underactive and generate somatic referred pain in pts with poor stabilization
Why is D not correct?
glutes are often underactive, but not the cause of somatic referred pain for people in the stabilization category
Davida’s physician has confirmed “bilateral lumbar stenosis” but she is a poor surgical risk so her physician has sent her to therapy to see if anything can be done. Your subjective reveals that she has intermittent back and bilateral thigh and calf pain but no bowel/bladder changes. Her sensation testing is normal but she reports that when her back hurts she gets bilateral tingling in her calves. DTR’s are 1+ B. Her agg factors, AROM and repeated movements all indicate a directional preference for flexion. Which of the following is the best assessment of these findings?
A. She needs to be referred back to her physician because of her B sx
B. She should be taught stabilization exercises in a posterior tilted posture if neutral increases her back and LE pain
C. She should be issued a lumbar roll which will enable to sit with more muscle relaxation and better posture
D. She needs to be assessed carefully to determine whether pressure relief should focus on the central canal or IVF
B. She should be taught stabilization exercises in a posterior tilted posture if neutral increases her back and LE pain
Determining whether relief should focus on central canal or IVF. Is this important?
- Not important to differentiate
- Will most likely treat the same regardless of specific structures involved
A pt says that RFIS increases his back pain but decreases his thigh pain. What is the best response to this?
A. This is a positive change because the thigh pain is the most important symptom right now. We can address your back pain more specifically once we figure out the thigh pain
B. This is a positive change because the back pain isn’t really important right now until we get your thigh pain resolved
C. This suggests that your back and thigh pain are really coming from two different problems. We’ll get the thigh problem fixed and then figure out the back problem
D. I’m only interested in the thigh pain right now but the fact that you also have back pain means that this problem will probably take a long time to get better
A. This is a positive change because the thigh pain is the most important symptom right now. We can address your back pain more specifically once we figure out the thigh pain
Tai is seeing you for back and posterior thigh pain and reports that FIS increases her back and thigh pain, but double knee to chest (FIL) only increases her back pain. What is the LEAST likely structure to be causing her thigh pain?
A. Joint capsule
B. Posterior annulus
C. Sciatic nerve
D. Trunk extensor muscles
A. Joint capsule
Tai is seeing you for back and posterior thigh pain and reports that FIS increases her back and thigh pain, but double knee to chest (FIL) only increases her back pain. What is the LEAST likely structure to be causing her thigh pain?
A. Joint capsule
B. Posterior annulus
C. Sciatic nerve
D. Trunk extensor muscles
Why is joint capsule the least likely to be causing her thigh pain?
- not likely to refer all the way to the knee
- “sings out” when it’s stretched (capsules are stretched in standing flexion as well as knees to chest, but not typically affected by load)
Tai is seeing you for back and posterior thigh pain and reports that FIS increases her back and thigh pain, but double knee to chest (FIL) only increases her back pain. What is the LEAST likely structure to be causing her thigh pain?
A. Joint capsule
B. Posterior annulus
C. Sciatic nerve
D. Trunk extensor muscles
Why is the posterior annulus not the best choice?
Difference in stress between standing and supine
- loaded in standing
- unloaded in supine
Pre-stressed: increased pressure on the NP in standing initially
Tai is seeing you for back and posterior thigh pain and reports that FIS increases her back and thigh pain, but double knee to chest (FIL) only increases her back pain. What is the LEAST likely structure to be causing her thigh pain?
A. Joint capsule
B. Posterior annulus
C. Sciatic nerve
D. Trunk extensor muscles
Why is the sciatic nerve not the best choice?
knees to chest puts nerve on slack below the knee joint
Tai is seeing you for back and posterior thigh pain and reports that FIS increases her back and thigh pain, but double knee to chest (FIL) only increases her back pain. What is the LEAST likely structure to be causing her thigh pain?
A. Joint capsule
B. Posterior annulus
C. Sciatic nerve
D. Trunk extensor muscles
Why are trunk extensors not the best choice?
- lever arm makes a difference
- muscles have to contract to control flexion
