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Final Exam Msk PART LBP Flashcards

1
Q

What are the three stages for treatment-based classification?

A
  1. Determine appropriateness for PT vs referral or consultation
  2. Determine severity and stability of pt’s symptoms
  3. Match pt with most appropriate intervention
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2
Q

Simplified model to 4 interventions for signs and symptoms LBP according to treatment based classification?

A

 Specific Exercise
 Manipulation
 Stabilization
 Traction

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3
Q

What is Centralization

A

in response to therapeutic loading strategies, pain is progressively abolished in a distal-to-proximal direction with each progressive abolition being retained over time until all symptoms are abolished”

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4
Q

Manipulation Subgroup

A 
 Symptom duration <16 days
 No symptoms distal to knee
 FABQ-Work subscale score <19/42
 At least 1 hypomobile segment with prone PA spring test
 Prone Hip IR >35 on at least one side
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5
Q

First contact provider triage what are 3 approaches to care?

A
  1. Medical management
  2. Self-management
  3. Rehabilitation management
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6
Q

STarT Back Screening Tool

A

Score determines categorization of pts into Low, Medium, or High-risk for persistent pain and disability and subsequent management strategies based on category

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7
Q

Örebro Musculoskeletal Pain Questionnaire

A

Scores grouped according to risk for developing persistent pain and disability

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8
Q

Lumbar Stability: 3 sub systems

A

Passive
Active
Neuromuscular Control

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9
Q

Passive Sub system consists of what?

A

Ligaments
thoracolumbar myofascia
Osseous structures

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10
Q

Active Sub system consists of what?

A

Global superficial stabilizers: rectus, obliques, QL, erector spinae

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11
Q

Active Sub-system: Global Stabilizers what is there function?

A

€ Function as guy wires to stabilize
spine
€ Transmit force across multiple segments
€ Respond to forces that shift center of mass
€ Control trunk movements

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12
Q

Active Sub-system: Segmental Stabilizers do what for the lumbar spine?

A

have direct attachment to vertebrae

control motion at segmental level

rotators and intertransversarri may play a role

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13
Q

What is the neutral zone?

A

Minimal resistance to intervertebral motion from passive structures

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14
Q

What systems provide stability at the neutral zone?

A

Active and neuromuscular control

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15
Q

What is the elastic zone?

A

€ Significant resistance to intervertebral motion from passive structures

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16
Q

What is the definition of instability ?

A

loss of motion stiffness such that forces applied to a given segment produce greater displacement than would occur normally

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17
Q

Lumbar Segmental Instability what zone will patients have less control in?

A

Neutral zone

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18
Q

If the following test are positive then you will test positive for LSI instability?

A

€ SLR
€ Prone instability test
€ Passive lumbar extension test

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19
Q

Principles of treatment for lumbar spine instability?

A
  • Begin with activation and motor control
  • incorporate other muscle groups
  • Increase challenge
  • progress to strengthening and resistance
  • activity specific training
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20
Q

Principles of MDT?

A

 Primarily uses symptom response and mechanical change to develop diagnosis and guide treatment

 Emphasizes patient self-management with decreased reliance on therapist

 Utilizes progression of forces in treatment approach from least to most force

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21
Q

Directional Preference

A

is the direction in which posturing or repeated movements cause pain to decrease and/or abolish, or centralize and ROM increases

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22
Q

Centralized

A

indicates that all distal pain has abolished and that the pt has only central LBP.

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23
Q

Centralization of LE symptoms:

A

Foot to ankle to calve to thigh to buttock to back

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24
Q

Peripheralization

A

the phenomenon by which proximal symptoms originating from the spine are progressively produced in a proximal to distal direction

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25
Q

Peripheralized

A

Indicates application of inappropriate loading strategies that have caused distal symptoms that were produced to last

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26
Q

Disc model Flexion

A

Anterior disc compressed and posterior annulus stretched

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27
Q

Disc model extension

A

Posterior disc compressed and anterior annulus stretched

28
Q

Postural Syndrome

A

 Pain remains local only to lumbar spine and is time-dependent
 No LE pain and no parasthesias
 Lumbar ROM is full and painfree

29
Q

Dysfunction Syndrome

A

 Named according to direction of movement loss
 Similar to tissue shortening, scar tissue, etc.
 Pain is local to lumbar spine. No LE pain and/or parasthesias
 Pain present >8 weeks
 No pain at rest, only at end-range ROM
 Will likely see loss of ROM in 1 direction (i.e. full lumbar ROM except for extension)

30
Q

Derangement syndrome

A

Hallmark is rapid change in symptom severity and location with repeated motions

 Patient can have pain at rest, during movement, and at end-range of movement
 Pain onset can be acute or chronic
 Pain &/or paresthesias can be in spine or LE
 Disc or other tissue is obstructing motion. Utilize repeated movements to “clear the obstruction”
 Utilizing disc model and patient’s history allows for hypothesis of best treatment approach

31
Q

Posterior derangement prefer what based movement ?

A

prefer extension based movement

32
Q

Posterolateral derangement prefer what based movement ?

A

combined with extension and lateral based movements

33
Q

Anterior derangement prefer what based movement ?

A

Flexion based movement

34
Q

Anterolateral derangement prefer what based movement ?

A

combined flexion and laterally based movements

35
Q

lateral shift

A
  • named according to the side shoulders are deviated towards
  • easily visible
  • disappear at rest
36
Q

Treatment principles force progression

A

self generated forces, SGF with self over pressure, RM with PT OP, mobilization, manipulation

37
Q

Treatment of Dysfunction Syndrome

A
  • repeated at end range loading direction of movement loss
  • pain should be abolished once load removed from end range
  • movement has to produce pain/discomfort in order to be effective
38
Q

Treatment of Derangement Syndrome

A

Repeated end-range movements or sustained posturing in direction that causes patient’s symptoms to centralize

 Disc model can serve as useful guide to treatment based upon pt’s pain location & response to repeated movements

39
Q

Treatment of Derangment

A
  1. reduce derangement
  2. maintain reduction
  3. recovery of function
  4. prevent reoccurance
40
Q

Hypomobile segments should be treated with?

A

Joint and soft tissue manipulation

41
Q

Hypermobile segments should be treated with?

A

Stabilization

42
Q

Identify the Arthrokinematic Motion at Each Facet flexion

A

Left and right facet upslide

43
Q

Identify the Arthrokinematic Motion at Each Facet Extension

A

Left and right facet downslide

44
Q

Identify the Arthrokinematic Motion at Each Facet Right sidebend

A

Left facet upslide

right facet downslide

45
Q

Identify the Arthrokinematic Motion at Each Facet Left sidebend

A

Left facet downslide

right facet upslide

46
Q

Identify the Arthrokinematic Motion at Each Facet Right Rotation

A

Left facet compress

Right facet gap

47
Q

Identify the Arthrokinematic Motion at Each Facet Left Rotation

A

Left facet gap

Right facet compress

48
Q

Facet capsular restrictions occur limit motion in what?

A

Upslides and gapping

49
Q

What is capsular pattern restriction of the right L4/L5 facet?

A

Flexion, Left side bend, Right Rotation

50
Q

When palpating for conditions what are the 3 Ts you are considering?

A

Temp, tenderness, tone

51
Q

Define osteokinematics?

A

Palpation of motion such as flexion, SB, etc…

52
Q

Define arthrokinematics?

A

Palpation of joint glides and spring testing

53
Q

With PIVMs what are you palpating for?

A

Excursion, end feel , quantity if they are normal, hypomobile, hypermobile

54
Q

With PAIVMs what are you testing for?

A

You are assessing for joint mobility, irritability, end feel, and if there is pain in the segment

55
Q

Mechanical therapy does what to patients?

A

stretch the tight tissues

snap intra articular adhesions

increase arthrokinematics and osteokinematics

56
Q

Rules for manipulation

A 
Symptoms < 16 days
No symptoms distal to knee
At least 1 hip IR >35˚
FABQ work subscale <19
At least 1 hypomobile lumbar segment
57
Q

According to CPR of lumbar manipulation what are the 2 variables shown to be predictive of success of spinal manipulation in the fritz article?

A

Symptom duration < 16 days

No symptoms extending distal to the knee

58
Q

Contraindications to Manipulation

A 
	Metastatic disease
	Congenital (i.e. dysplasia)
Iatrogenic (long-term use of  corticosteroids)
Inflammatory (rheumatoid
arthritis)
Trauma/suspected or confirmed  Fracture
Spondylolysis/spondylolisthesis
	Osteoporosis/osteopenia
59
Q

Contraindications vascular

A

 Aortic aneurysm
 Blood disorder (hemophilia)
 Use of anticoagulants

60
Q

What are the goals of neurodynamics?

A

 Goal is to increase nerve’s capability to slide
 Improve flow of axoplasm
 Decrease LE symptoms

61
Q

If you have a facet restriction what is a sign or symptom

A

Decreased ROM in Facet capsular pattern

62
Q

If you have a facet entrapment what are sign and symptoms?

A

Pain with movements requiring downslides

63
Q

Muscle guarding voluntary caused by pain or fear of pain. what are signs and symptoms

A

Decreased AROM/PROM and pt apprehension

64
Q

Muscle guarding involuntary caused by injury, trauma or dysfunction. what are signs and symptoms

A

 Hypertonicity

 Decreased ROM

65
Q

What are signs and symptoms of Disc Dysfunction?

A

 Acute-rip or tear and sharp pain
 LE- symptoms
 Neurological signs

66
Q

Lumbar Stenosis what are signs and symptoms?

A

 Central- bilateral LE, multi level
dermatomes/myotomes involved
 Foraminal- single level dermatome/myotome
 Neurogenic claudication with activity

MSK (5 decks)

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