EEO: Lecture 5 Flashcards
What are performance measures for the spine?
cervical deep flexor endurance test
5 x STS
prone plank
side plank
Sorensen
When do you clear the spine?
If the main complaint is NOT the spine
What are you looking for when clearing the spine?
if there is a change or reproduction of their non-spinal symptoms
How do you clear the spine if a patient is NWB or a major fall risk?
What is included in clearing the spine?
AROM cervical spine
-flexion, extension, sidebend, rotation
Resisted testing in neutral spine
overpressure
compression/distraction
Where are the common areas for hinge points in the spine?
transition zones: lower cervical, lower lumbar
- they are shaped differently
which parts of the spine are prone to exhibit a reverse lordosis?
upper thoracic
-from looking down at phone
What are the two kinds of spinal stenosis?
central (vertebral foramen) and foramina (intervertebral foramen) stenosis
What is the MOI of intervertebral foramina stenosis
prior injuries, repetitive motions
Foraminal stenosis
-Narrowing of intervertebral foramen, pinching the spinal nerve root.
-SHOOTS IPSILATERAL RADICULAR PAIN DOWN THE ARM
What tests should you give to a patient who has foraminal stenosis, central stenosis, or a cervical disc lesion?
-NDI
-Grip strength dynanometer
-Cervical flexor endurance test
What is a primary difference in the symptoms of foraminal stenosis vs. central stenosis?
Foraminal stenosis will have unilateral symptoms
central stenosis will have bilateral symptoms
What tests or measures can you give to someone who has foraminal stenosis?
-Cervical AROM
-Cervical MMT
-Reflex testing
What are typical causes and symptoms of central stenosis?
Anteriorly: Disc pathology
-affects motor and sensory function
Posterior: Hypertrophy of the ligamentum flavum
-affects certain types of sensory function
What are some unique tests and measures for central stenosis?
-Testing balance
-Hoffman reflex
-Shumizu reflex
These can be done because central stenosis will cause a UMNL, whereas foraminal stenosis will cause a LMNL!
What is a cervicogenic headache, and where would you expect the patient to report pain from?
-A headache that starts at the neck and migrates to the head
-Pain is usually experienced at the top of the head as well as the suboccipital region
-affects concentration, ability to read, vision, and mood
What is likely the cause for cervicogenic headaches?
-likely due to an upper cervical spine dysfunction (C0, C1, C2)
What is the function of the OA joint?
yes motion
what is the function of the AA joint?
no motion
What are some questions to include in the subjective interview for someone with cervicogenic headache?
-Which exact areas of the head or face hurt? Point to one specific area.
-Which activities bring on the headache?
-How much screen time do you have?
-What does a typical day look like for you?
What cranial nerve may contribute to cervicogenic headache?
Trigeminal (CN V)
In what age range are vertebral disc problems most common?
20’s to late 40’s
What are common causes of cervical disc pathology?
-prolonged flexion or whiplash
-typically dislocates posteriorly / towards the spinal canal
What are common symptoms of cervical disc pathology?
-BILATERAL presentation, motor symptoms first then can progress to sensory
-sensitivity to weightbearing
-will sometimes cause radiating pain down the arm. Not always!
True or false. Disc problems most often lead to chronic pain that does not dissipate.
False!
Disc problems tend to come in waves, with periods of relief then returning symptoms later on.
This is why it is important to ask patients if they have had previous episodes of radicular pain if you suspect disc pathology!
What are the patient presentations presentations of whiplash?
-Muscle spasm and tightness
-Disc-like symptoms in lower cervical spine
-Can sometimes present like brain stem-type injury in upper cervical spine
What are the tests and measures you would use for a patient who has whiplash?
-JPSE Laser-proprioception test
-Test UE reflexes like Shimizu for UMNL
-Eye movements for CN damage
-Screen cervical AROM and ROM as well as endfeels
-Cervical MMT
-UE myotomes + dermatomes
What is the typical cause of degenerative disc disease?
Spondylosis and/or wear and tear
Basically, the nucleus pulposis dehydrates with age which causes the discs to shrink and become more convex
What are some outcome measures you can use for lumbar DDD?
-Oswestry Disability Index (ODI)
-Modified plank
-5x Sit -> Stand
-Functional lumbar index (FLI)
When are some tests and measures to use for lumbar DDD?
-Assessing posture and gait
-Trunk and hip MMT
-Thoracolumbar AROM
-Nerve screen of the LE’s
What is the typical MOI for lumbar spine disc pathology?
Flexion and rotation, causes most of the discs to herniate POSTERIORLY
L4 and L5 are most commonly hurt!
What do the symptoms of lumbar disc pathology present?
-UNILATERAL presentation
-can be both motor and sensory, depends on how severe the herniation
-pain is reproduced with Valsava or weightbearing
A patient with lumbar DDD will typically have more pain at what time of day?
The morning
What are important subjective questions to ask in the differential diagnosis of DDD?
-Do you have any areas of the leg with less sensation?
-Any loss of strength to the lower leg or foot?
What motion will someone with lumbar DDD have a hard time performing?
Squatting
Before assessing a patient coming in for UE or LE pain, what should you ALWAYS DO?
Clear the spine!
What is the lumbopelvic rhythm?
Rhythm for bending forward (opposite when going back up)
1. Lumbosacral flexion
2. Anterior pelvic tilt
3. Hip flexion
what are some common errors associated with lumbopelvic rhythm?
-only pelvic motion
-only lumbar motion
- a + Gowers sign
- a + “S” or “C” upon standing upright
What is the typical MOI of spondylolisthesis?
MOI:
-repetitive or macrotraumatic hyperextension
-typically affects L5
What is the typical presentation of spondylolisthesis (minor vs. major)?
-if minor injury, localized pain
-if major injury, bilateral radicular symptoms
What motion will cause problems with someone who has spondylolisthesis of the lumbar spine?
Extension!
What are some tests and measures to aid in the differential diagnosis of spondylolisthesis?
-POSTURE. Can feel where the vertebra dislocates
-Lumbar AROM (be careful or avoid extension!)
-Reflexes
-Derma + Myotomes
-Trunk MMT
What are some subjective factors to keep in mind when assessing chronic low back pain?
-Motivation interviewing
-Activity level of the patient
-Pain psychology
-Patient education
What are some aggravating and relieving factors of lumbar spinal stenosis?
Aggravating - walking or standing for a short period of time
Relieving - Sitting in a flexed or slouched position
What functional outcome measure is best for someone with lumbar spinal stenosis?
6 minute walk test to assess for pain that starts after walking for a little bit
Basically any measure that assess walking endurance will be good!
SIJ Hypermobility MOI
-More common in young or pregnant females
-Aggravated with macrotrauma
SIJ Hypermobility patient presentation
-Pain at SI joint, can unilaterally radiate down posterior limb to the knee
-often seen in a hypermobile patient
What is functional instability MOI?
-repetitive motion
-macrotrauma
What is the patient presentation with functional instability?
can’t sit or stand in unsupported position for prolonged time
-altered or abnormal movement patterns
-can happen in any part of the spine
-weakness in deep stabilizing muscles
What are some clinical practice guidelines for functional instability?
Subjective
-ask about tolerances for sitting and standing
Performance measures
-look at endurance posture tests such as the Sorensens, side plank, or prone plank
-Lumbar AROM
-Hip and trunk MMT
Cervical flexion AROM Values
Flexion = 40 degrees
Cervical extension AROM Values
Extension = 50-70 degrees
Cervical side bending AROM Values
Sidebending = 22 degrees
Cervical rotation AROM Values
Rotation = 70-90 degrees
Thoracolumbar flexion AROM Values
Flexion = 60 degrees
Thoracolumbar extension AROM Values
Extension = 25 degrees
Thoracolumbar sidebending AROM Values
Sidebending = 35 degrees
Thoracolumbar rotation AROM Values
Rotation = 45 degrees
Lumbar flexion AROM Values
Flexion = 40-50 degrees
Lumbar extension AROM Values
Extension = 15-20 degrees
Lumbar side bending AROM Values
Side bending = 25 degrees
What are the two most common self-report measures for the spine?
Neck Disability Index (NDI)
Oswestry Disability Index (ODI)
What performance test can be done for older patients experiencing low back pain?
5x Sit to stand
In kyphosis, the convexity of the spine faces ______, but in lordosis the convexity of the spine faces _____.
Posteriorly; anteriorly
What is postural dysfunction normally caused by?
Changes in normal kyphosis and lordosis
Aggravating and relieving factors for foraminal stenosis
Pain relieved by bending AWAY from the affected side, opens up the foramen
Pain is made worse by bending TOWARDS the affected side. Closes the foramen even more!
Which spinal levels affect grip strength?
C6-C8
Which outcome measure is useful for assessing the severity of central or foraminal stenosis in the cervical spine?
Cervical flexor endurance test
Steps for goniometry
1: first before motion passively, noting endfeel
2: patient performs motion actively
3: use goni to measure
4: document findings!
Steps for MMT
1: patient performs mvmt while you palpate the muscle
2: patient performs mvmt again, stopping short of end range
