Final Exam Msk PART LBP Flashcards
What are the three stages for treatment-based classification?
- Determine appropriateness for PT vs referral or consultation
- Determine severity and stability of pt’s symptoms
- Match pt with most appropriate intervention
Simplified model to 4 interventions for signs and symptoms LBP according to treatment based classification?
Specific Exercise
Manipulation
Stabilization
Traction
What is Centralization
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”
Manipulation Subgroup
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
First contact provider triage what are 3 approaches to care?
- Medical management
- Self-management
- Rehabilitation management
STarT Back Screening Tool
Score determines categorization of pts into Low, Medium, or High-risk for persistent pain and disability and subsequent management strategies based on category
Örebro Musculoskeletal Pain Questionnaire
Scores grouped according to risk for developing persistent pain and disability
Lumbar Stability: 3 sub systems
Passive
Active
Neuromuscular Control
Passive Sub system consists of what?
Ligaments
thoracolumbar myofascia
Osseous structures
Active Sub system consists of what?
Global superficial stabilizers: rectus, obliques, QL, erector spinae
Active Sub-system: Global Stabilizers what is there function?
€ Function as guy wires to stabilize
spine
€ Transmit force across multiple segments
€ Respond to forces that shift center of mass
€ Control trunk movements
Active Sub-system: Segmental Stabilizers do what for the lumbar spine?
have direct attachment to vertebrae
control motion at segmental level
rotators and intertransversarri may play a role
What is the neutral zone?
Minimal resistance to intervertebral motion from passive structures
What systems provide stability at the neutral zone?
Active and neuromuscular control
What is the elastic zone?
€ Significant resistance to intervertebral motion from passive structures
What is the definition of instability ?
loss of motion stiffness such that forces applied to a given segment produce greater displacement than would occur normally
Lumbar Segmental Instability what zone will patients have less control in?
Neutral zone
If the following test are positive then you will test positive for LSI instability?
€ SLR
€ Prone instability test
€ Passive lumbar extension test
Principles of treatment for lumbar spine instability?
- Begin with activation and motor control
- incorporate other muscle groups
- Increase challenge
- progress to strengthening and resistance
- activity specific training
Principles of MDT?
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
Directional Preference
is the direction in which posturing or repeated movements cause pain to decrease and/or abolish, or centralize and ROM increases
Centralized
indicates that all distal pain has abolished and that the pt has only central LBP.
Centralization of LE symptoms:
Foot to ankle to calve to thigh to buttock to back
Peripheralization
the phenomenon by which proximal symptoms originating from the spine are progressively produced in a proximal to distal direction
Peripheralized
Indicates application of inappropriate loading strategies that have caused distal symptoms that were produced to last
Disc model Flexion
Anterior disc compressed and posterior annulus stretched