exam 1: set 2 Flashcards
obebro used for what
early ID of persistant back problems
good predictor of future absenteeism due to sickness and function
START back
tool to predict the progression of chronic status
ID high risk LBP in primary care
identifies individuals at risk of a worse prognosis
pelvic funtional mechanics
the movement and position of the pelvis is influence primarily by the position of the LE
the pelvis is the functional link between the LE and the spine
pelvis movement in the sagittal plane
ant and post rotation
pelvis movement in the frontal plane
downslip and upslip
pelvis movement in the transverse plane
infare and outflare
what is a the pubic symphysis
a strong ligament at the anterior of the pelvis
how much movement does the pubic sym allow
small amount of movement
- rotation
- inf and sup
whne does movement occur in the pubic sym
amb
unilateral stance
anterior rotation of the ilosacrum
ASIS inferior
PSIS superior
posterior rotation of the ilosacrum
ASIS sup
PSIS inf
pelvic component pain pattern
rarely have symptoms below the knee,
pain in the butt, lateral thigh
o Status quo pain – pain does not centralize with movement
pelvic component - neuro
do not often have neuro signs
when is the pelvic compent people more symtomatic
later in the day
pelvic landmark palpation
ASIS
PSIS
iliac crest
interpretation of pelvic landmarks - all land marks a level
normal
interpretation of pelvic landmarks - all landmarks are high on one side
leg length discrepancy
interpretation of pelvic landmarks - asymmetrical height differences
pelvic component
what are the three thing you need to perform the standing flexion test
- Symmetry visible
- 60-degrees forward flexion
- And preform with a reasonably pelvic rhythm
what does positive standing flexion test look like
one PSIS rises more in the superior direction while the patient is flexed.
gillet test - negative and positive
negative: PSIS moves inferiorly
positive: PSIS does not move or moves cranially
how can you have a flase negative in gillet test
trandelenburg
when we stand on our left the right side will drop
what is in cibulka’s criteria
standing flexion
seated asymmetry
lone sit test
prone knee flexion
fortins sign
what is fortins sign
pain at the PSIS
what are the treatment for pelvic component
supine lumbopelvic roll (favorite)
prone iliac correction
long axis distraction
Prone leg lift technique
hand placement for the prone iliac correction
below the PSIS
pushing the anterior/lateral direction
for Non-chronic back pain do we want to use a thurst or a
yes
we do not want to use a thrust for chronic bacck pain
sagittal plane movement of the sacrum
nutation and counter-nutation
nutation of the sacrum
movement into the pelvis
occur in response to lumbar extension
occur with trunk movement and standing with to feet on the ground
counter-nutation of the sacrum
movement back into place
sacral component sym complaints
– Fortin’s sign - pain right at the PSIS
– ~vague, non-segmental radiating features
– Decreased Tolerance for Activities requiring Unilateral Stance
– Difficulty with transitional movements
– Difficulty actively extending the spine
sacral component history
– Slip and fall onto the buttock
– Asymmetrical loading mechanisms
* Not on the last step on the stairs
– Failure of “ilial” interventions
– Hypermobility of the Pelvis
* Trauma – rear end motor vehicle accidents
* Recent Pregnancy
* Birth Control Medication
what is included in laslett’s criteria
distraction
thigh thrust
sacral thrust
compression test
Gaenslen’s test
what two component of laslett’s do you need to have a positive sacral component
distraction and thigh thrust
treatment for sacral component
Side lying muscle energy sacral correction
Prone sacral correction - hand placement
Place hand medially from the PSIS – apply pressure obliquely in the angle of the SI joint
what do we do in thoracolumbar testing
AROM standing
combo AROM exercises
seated thoracic rotation - is this abnormal then the thorax is involved
PA spring testing
criteria for success with stabilization
Age: < 40 y.o
(+) Aberrent Motions
(+) Prone Instability Test
FABQ: > 8 (physical activity score)
(+) Spring test for hypermobility
Anteroposterior/Rotational Stability screen
Unilateral Bridge with Leg Extended
Posteroanterior/Rotational Stability
Quadruped with Alt. UE and LE Extended
Lateral Stability
Unilateral Side Support with Legs Extended
unilateral bridge - Bent leg side
hamstrings
unilateral bridge - extended leg
activation of the abdominal obliques, multifidus, other trunk extensors
unilateral bridge - fall out to unsupported side
inadequate abdominal support
Quadruped with Alt. UE and LE Extended - general acctivation
external oblique
Quadruped with Alt. UE and LE Extended - extended arm
upper trunk extensors
Quadruped with Alt. UE and LE Extended - extended leg
hamstring, gluteus maximus, and multifidus
Unilateral Side Support with Legs Extended - down side
Unilateral involvement of the Gluteus Medius, Multifidus, External Oblique on the activated side
Unilateral Side Support with Legs Extended - general activation
Rectus Abdominis
Activation Phase
Specific training and re-activation phase
Spinal muscle activation and specific stabilization tasks
Motor re-education/re-programming
Lower level, lower intensity tasks
Controlling symptomatic behavior
Overcome anxiety, apprehension regarding exercise
how long is the activation phase
2 to 4 weeks duration/5 to 8 sessions
Acquisition Phase
Stable symptomatic presentation
Has passed the basic screening test parameters
Intent is to make gains in both strength and endurance components
Moderate to higher levels of exercise intensity
Goal: Succeed with Advanced Screening Mechanism, progress to Assimilation Phase
how long is acquisition phase
3 to 6 weeks/6 to 18 sessions
Advanced Screening for Sufficient Stability
Sorensen Test with Legs Supported at Horizontal Level for 80 seconds
Double Straight Leg Lowering Test
Double Straight Leg Lowering Test
men v.. women
Men: approx 15 degrees from Horizontal
Women: approx 37 degrees from Horizontal
assimilation phase
Functional integration phase
Dynamic stability considerations
More complex than just muscle performance alone
Higher level tasks, often repetitive in nature
Goal: return to activity, work, sport
Maintenance program strategies
Awareness and education
how can we tell a leg length change
Asymmetrical Standing Landmarks
Symmetrical Seated Landmarks
(-) Long Sit Test
Long leg in starting position, relationship of legs unchanged in ending position
(+) Prone Knee Flexion Test
Finding of “short to less short”
