Exam 2 Prep Flashcards
What are William’s flexion exercises? What is the rationale behind them?
-Posterior pelvic tilt: strengthens the abdominals
-Single and double knee to chest: opens the posterior elements
-Hamstring stretch: keeps the posterior longitudinal ligament taught
What does lumbar spine extension do to the disc?
If the disc is protruding, lumbar spine extension “closes the barn door” on the disc
What must be ruled out before the McKenzie method is used?
-Rule out major underlying systemic disease
-Rule out major structural pathology of the spine
What are the three diagnostic categories of the McKenzie method?
-Postural
-Dysfunction (flexion or extension)
-Derangement
What is the criteria for diagnosing postural syndrome?
-Younger
-Insidious onset (not any specific injury)
-No acute episodes or trauma
-Delayed onset pain with extended static positions
-Localized ache
What are findings in the physical exam that could lead to diagnosis of postural syndrome?
-Abnormal sagittal plane posture (no lateral shift)
-Fully correctable
-No movement limitations
-Negative neuroscan
What is the dysfunction syndrome?
-Patient will say “something is stiff”
-Flexion (pain at end range flexion, posterior element tightness)
-Extension (pain at end range extension, anterior element tightness)
What are criteria for diagnosing dysfunction syndrome?
-Older
-Episodes of acute dysfunction
-Localized pain (w/ exception of an adherent nerve root)
What are objective findings that would lead to the diagnosis for dysfunction syndrome?
-Loss of normal posture and range of motion
-Negative neuroscan
-Unidirectional stiffness
-Movement into stiffness aggravates end range pain
-With repeated movement pain is relatively unchanged or mildly better
What are objective findings for flexion dysfunction?
-Increased lordosis
-Limited forward bending
-Loss of lumbar curve reversal
-Hamstring tightness
What are some ways to manage flexion dysfunction?
-Williams flexion exercises
-Childs pose
-Cat in cat-cow
What are some objective findings for extension dysfunction?
-Loss of lordosis
-Limited backward bending
What are some ways to manage extension dysfunction?
-Cobras
-Extension over ball
-Extension over bolster
What is derangement syndrome?
-A disc lesion
What are some criteria for diagnosing derangement syndrome?
-Age (middle aged people)
-Hx of progressive episodes
-Mechanism of injury (flexion, twisting, or loading)
-Localized and/or referred symptoms
What are different postures that can be associated with derangement syndrome? Why do people have these postures?
-Guarded flexion
-Lateral shift
-To get off of the disc
What are objective findings that can help diagnose posterior derangement syndrome?
-Positive neuroscan
-Repeated movements will quickly exacerbate symptoms either centrally or peripherally, or can improve or worsen limitations in range
What happens if you correct someone’s lateral shift and the symptoms stay localized? What if symptoms go down the leg?
-If symptoms stay localized then it is reducible and the disc is no longer protruding
-If the symptoms go down the leg then it is irreducible and you should not treat it
What happens if you put someone into flexion or extension and the symptoms stay localized? What if symptoms go down the leg?
-If symptoms stay localized then it is reducible
-If symptoms go down the leg then it is irreducible
What can you do if someone has irreducible posterior derangement?
-Mechanical traction
-Educate patient on how to self traction
What can you do if someone has a reducible posterior derangement?
-Give them McKenzie’s extension exercises
-Target progressive end range loading into extension
What does one spinal segment consist of?
-Adjacent two halves of vertebrae
-Disc
-Facets
-Associated ligaments
-Associated muscle, fascia, and integument innervated by the spinal nerve
What is the orientation of the cervical facet joints?
~45 degrees
What is the orientation of the thoracic facet joints?
Vertical
