Exam 3: Lumbar (1-4) Flashcards
1
Q
true or false:
Spinal treatment should be approached in the same way as with the extremities
A
true
2
Q
__% of adults have LBP at some point in their life. ___ million north americans will have LBP
A
80; 10
3
Q
____ accounts for 25% of all lost work days. Secondary to ____
A
back pain; headaches
4
Q
LBP is the most common cause of disability in those under ___ years old
A
45
5
Q
True or False:
There is a lot of evidence to support how PT’s can treat LBP
A
false, there is little evidence which has caused a lot of lab myths
6
Q
True or False:
Most people with low back pain will get better no matter what you do
A
False, that is a myth
7
Q
True or False:
Disability from LBP has decreased over the last 25 years
A
False, it has dramatically increased and even is causing disability
8
Q
True or False:
The medical community knows how to approach the problem and has a grip on treating LBP
A
False
9
Q
True or False:
Where an individual lives and the medical professional they see, often determines the rate of surgery
A
true
10
Q
True or False:
The united states has the lowest rate of back surgery when compared internationally
A
False, it is at least 40% higher than any other country
11
Q
True or False:
Surgical intervention has shown to have better effectiveness in treating pain over other non-surgical management
A
false, it has not shown to be better
12
Q
List 5 risk factors for LBP
A
- Smoking - causes coughing/poor oxygen
- Spending more than 1 hour a day in a car
- Spending more than 1 hour a day enduring vibratory forces
- Full term pregnancy with vaginal delivery
- Heavy lifting (weak)
13
Q
List 5 work requirements that can be predictors of LBP
A
- Unexpecting lifting (PT and patients)
- Lifting and rotating
- Static work positions
- Vibrations
- Handling materials while seated
14
Q
True or False:
Workers that see a PT one month within the initial injury, are likely to return to work faster than those who see a PT after 1 month of the injury
A
true
15
Q
Explain the correlation between individuals taking time off work for LBP and the rate at which they will return to work
A
A person who is away from work for 6 months has a 50% chance of returning. Any time greater than 1 year away drops down to 25%
16
Q
The biopsychosocial model encompasses numerous aspects besides physical dysfunction including \_\_\_\_\_\_ distress attitudes and \_\_\_\_ The social \_\_\_\_\_ Illness behavior
A
psychological
beliefs
environment
17
Q
True or False:
Precise diagnosis for LBP is unknown in 80-90% of disabling cases
A
true
18
Q
Although true pathoanatomical LBP is uncommon, the pain could also be either ___ or _____ in nature.
A
biochemical and neurophysiological
19
Q
True or False:
The spine can be tested like the extremities
A
False
20
Q
True or False:
The tissue in the spine react like those in the extremities and response favorably to non-destructive stress
A
true
21
Q
Serotonin a good thing in the (CNS/PNS) system, but it is an inflammatory/pain producer in the (CNS/PNS)
A
CNS is good
PNS is pain
22
Q
Nociceptors are generators of ____
A
pain.
23
Q
True or False:
Nociceptors increase in activity in the presence of inflammatory response chemicals like prostaglandin or serotonin
A
True
24
Q
(nociceptors/muscles) = free nerve endings
A
nociceptors
25
(nociceptors/muscles) = many nerve endings
muscles
26
Explain the results of the "Management Patterns in Acute Low Back Pain" study with Medicare beneficiaries
There was a strong associations between PT and a decrease in likelihood of subsequent surgery/injections. Seeing a PT sooner rather than later also decreases the likelihood of surgery/injections
27
True or False:
General physicians were the highest proportion of visits but had the lowest rate of PT referrals
true
28
What is the first rule of medicine
do no harm
29
What are four functions of the lumbar spine
1. Supports the body
2. facilitates movement
3. Protects the spinal cord
4. Shock absorber
30
Development of the spine includes ossification, notochord recession, blood flow to the IVD, and bone density. What are the two subparts of ossification
sacralization and lumbarization
31
True or False:
Lumbosacral anomalies are often the source of LBP
False, they are asymptomatic
32
What are the implications of tropisms and pain/function
Tropisms occurs as a stress response and may cause asymmetric loading later in life or as a developmental issue, but there is no clinical relevance linking tropisms to pain
33
Development of the spine includes ossification, notochord recession, blood flow to the IVD, and bone density. What is the subpart to notochord recession
schmorl nodules
34
The ____ is the defining structure of the spinal development, and serves as a major skeletal element of the developing embryo.
notochord
35
What is a schmorl's node
A variety of herniation from nucleus into the vertebral body
36
True or False:
Schmorl's node are related to LBP
false; 1/3 people have schmorl's node and don't know it
37
What parts of the spine do schmorl's occur the most
lower thoracic and upper lumbar
38
Even though Schmorl's nodes do not cause back pain, but under what circumstance can they can be correlated to pain
When underlying conditions like osteoporosis or degeneration occurs
39
What is scheuermann's disease
Where 5 vertebrae have an anterior wedge greater than five degrees in the anterior spine
40
True or False:
Scheuermann's disease will increase thoracic kyphosis
true
41
Development of the spine includes ossification, notochord recession, blood flow to the IVD, and bone density. What are the two subparts of blood flow to the IVD
avascular IVD and disc degeneration
42
True or False:
The vertebra AND disc are both vascular in the fetus and infant
true
43
A picture on a slide shows a transverse section of a fetal disc. We know what the picture is showing because blood vessels and nerves grow into the outer annulus in fetal life. The ____ disappear in childhood, but the ____ remain.
blood vessels; nerve
44
True or False:
The adult disc is avascular
true
45
___ exercises have been shown to produce some of the largest amounts of fluid transfer in the IVD and also to decrease IVD swelling/pressure
extension
46
Development of the spine includes ossification, notochord recession, blood flow to the IVD, and bone density. What are the two subparts of bone density
osteoporosis and disc degeneration
47
When a child begins ambulating the lumbar endplate changes from (convex/concave) to (convex/concave)
convex to concave
48
How to identify osteoporosis in an image
you will see a central compression with bowing of endplates and central expansion of discs
49
As one ages, how will the change in lumbar vertebrae shape change
they will become shorter, wider, and have increased endplate concavity
50
Females have a lifetime risk of __% of developing osteoporosis compared to men who have __%
40; 13
51
Which is more common hip fx or vertebral body fx
vertebral body
52
The vertebral body fx prevalence of 5% at age _____, 10-15% at age _____, and 50% at age ____
5 at 50
10-25 at older than 50
50 at older than 80
53
In the aging lumbar discs, proteoglycans and water are decreased. What is the role of the proteoglycans
they attract water
54
When will a fissure become symptomatic
when it reaches the outside of the annulus
55
True or false:
A loss of stature is mostly contributed for the thinning of the lumbar disc
False, it is more from the loss of vertebral body height rather than disc space
56
A loss of stature/shortened height from shorter vertebral body height will caused (increase/decrease) (kyphosis/lordosis)
decreased lordosis
57
True or False:
Sacralization and lumbarization are not linked to pain
true
58
True or false:
Schmorl nodules are correlated to pain
false, they are not. only a poor correlation with scheuremann's disease
59
What is absolutely needed with avascular IVD
MOVEMENT
60
Is disc degeneration linked to pain
poorly and only if other contributing factors may lead to the developmental pain
61
True or False:
Aging is closely linked to LBP
False, there's really no correlation
62
What location do a lot of stress fx have within the bony structures of the spine
pars inticularis
63
What are the three parts to an intervertebral disc
annulus fibrosus
cartilage endplate
nucleus pulposus
64
Why are the rings angled in the annulus fibrosus
to handle tensile forces for rotation
65
What are the two parts of the annulus fibrosus
ligamentous outer
| cartilaginous inner
66
The outer ligamentous annulus has low _____ content meaning there is low water content
Proteoglycan
67
The (inner/outer) annulus has a high proteoglycan content so it serves as load bering
inner
68
True or false:
The outer annulus of the intervertebral disc are innervated by nociceptive nerve fibers
true
69
Describe the relationship between the blood vessels and nerves with the outer annulus
blood vessels and nerves grow into the outer annulus, but during childhood, the blood vessels disappear and the nerves are left
70
The ____ ____ is a pathway for diffusion for nutrients to disc and is a barrier between avascular nucleus and vascular
cartilage endplate
71
Describe the blood flow to the vertebra and disc as aging continues
In fetus and infant life the vertebra and disc have blood supply. During childhood the disc loses its blood supply but the vertebra continues to be highly vascular
72
If the adult disc is avascular, how do the disc cells receive and supply the nutrients essential for cellular activity to remove wastes
The discs rely on diffusion from blood vessels at the discs margin
73
What is the best way to improve disc nutrition
get up and move
74
In erect posture, ___% of axial loads pass through the vertebral bodies and IV discs
85
75
What does prolonged axial loading do
It reduces stature by squeezing water out of the discs
76
In the (morning/evening) there is increased loading on the nucleus and inner annulus
morning
77
In the (morning/evening) a person is more likely to damage the nucleus and inner annulus)
morning
78
In the (morning/evening) the disc is more loaded
morning
79
In the (morning/evening) there is increased loading on the outer annulus
evening
80
In the (morning/evening) a person is more likely to damage the outer annulus fibers
evening
81
In the (morning/evening) the facet joints are loaded more
evening
82
On average, an adult loses ___cm in stature over the course of the day. Mainly in the (morning/evening)
1.5; morning
83
Intradiscal disc pressure studies have correlated disc pressure to _____ _____
breathing rhythms
84
During inspiration, pressure (increases/decreases) in the IVD
increases
85
during expiration, pressure (increases/decreases) in the IVD
decreases
86
True or False:
Disc pressure is decreased in degenerative discs compared to young, healthy adults
true
87
What happens when you "throw your back out"
Tears occur in the annulus and rim lesions, if the tear gets to the outer 1/3 then it becomes painful
88
Describe the classic "story" that presents with throwing your back out
injury occurs and causes local pain after loading. Pain goes away after a couple day but then each time the injury is tweaked, the paid lingers longer.
89
Describe the pathological stuff behind the classic story of throwing your back out
Progressive radial tears occur with scar formation. The tears get larger and eventually reach the outer rim. The tweaking of original injury weakens the annulus over time
90
What are three things that can accelerate lumbar disc degeneration
1. genetics
2. heavy lifting
3. frequent loading positions
91
Functional changes in the disc as you get older include (increased/decreased) creep and hysteresis
increased
92
(creep/hysteresis) is the progressive deformation/strain of a structure, or of tissues under prolonged loading/stress.
creep
93
(creep/hysteresis) is the recovery from distortion or the lag of recovery from deformation after the load has been removed
hysteresis
94
True or False:
discs are designed to bulge out
true
95
True or False:
Mechanical pressure to a nerve causes pain
false, it causes tingling not pain. Pain only comes if the pressure is prolonged and becomes ischemic
96
Several studies have show that disc bulges reabsorb over time. This can happen in a matter of ____
days or weeks
97
Bulging disc _____ has the highest probability of spontaneous disc regression out of the various types of disc lesions
sequestration
98
True or False:
At least 40% of normal people have a bulging disc proven by an MRI, and have no LBP
true
99
True or False:
Time of day can impact MRI results
true
100
Explain why the time of day can impact MRI results
Discs are swollen 20% more in the morning compared to evening
101
At what level do lumbar disc lesions occur the most at
L4/L5 or L5/S1
102
An endplate fracture causes blood to go into the nucleus. Explain why this is bad and what happens next
This is a problem because cytokines (inflammatory enzymes) will be activated which will lead to more pain and swelling. The inflammation can irritate the DRG (super sensitive bc no myelin). Endplate fx wont become apparent right away because the DRG has a latency period of about two weeks
