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מסקולוסקלטל ליד > Final Part 2 > Flashcards

Final Part 2 Flashcards

1
Q

Lumbar Stabilization

2 subsystems

A

Train the local subsystem

LOCAL: need to stabilize
muscles that attach directly to the lumbar Vertebrae: multifidus, internal oblique, transverse abdominals QL
–spinal posture maintain

Global: larger muscles that dont attach directly but are prime movers and generate torque–>rectus abdominus, external oblique, illiocostalis lumborum

–psoas and erector spinae in global even though attach to spine

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2
Q

Lumbar Stabilization

Neutral Zone

A

position of spine and where minimal resistance when it begins to move in all directions

  • spinal stability from passive subsystem: ligaments, capusle
  • active system: muscles
  • neural system
    instability: cannot stabilize to maintain the IV neutral zone within physiological limits
  • multifidus important in the neutral zone
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3
Q

Lumbar Stabilization

Feedforward muscles

A

TA contract before all other abdominals in anticipation of trunk and limb movement

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4
Q

Lumbar Stabilization

Patients with LBP, what muscle delayed?

A

TA

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5
Q

Lumbar Stabilization

tx chronic LBP did motor control exercises

A

exercises improved activity, short term global activity

but did not reduce pain long term

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6
Q

Lumbar Stabilization

systematic review on spinal stablization for chronic LBP

A

some studys showed helps and some showed it doesnt

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7
Q

Lumbar Stabilization

non radicular LBP patients oswestery

A

Helped in patients who

  1. subject under 40 years old
  2. SLR at least 90 degrees
  3. positive prone instability test (lumbar instability test)–hypermobile
  4. positive aberrant motions –jutter/catch in forward bend

didnt help:

  1. negative prone instability
  2. not aberrant motions
  3. high FABQ
  4. hypomobility with spine
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8
Q

Lumbar Stabilization

Prognostic factors that cause increased lumbar multifidi activation in patients with LBP

A

measured thickness of TA during DRAWING IN MANEUVER and SLR in patients with chronic LBP

decreased MULTIFIDI lumbar activation in these patients with LBP–decreased thickness of multifidi
(but no change in TrA thickness)

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9
Q

Lumbar Stabilization

Goals of lumbar stabilization

A

1) To improve FUNCTION level
2) Facilitate EFFICIENT MOVEMENT
3) Prevent/minimize / manage SX
4) Increase segmental STABILITY, STRENGTH, ENDURANCE and COORDINATION
5) Use the neuromuscular system to PROTECT spinal joint structures from INJURY (and distal segment)

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10
Q

Lumbar Stabilization

Philosophy of LBP: a condition that has either resulted in or perpetuated low back function leading to disability

A

1) Movement and physical activity is necessary and healthy
2) Pt tend to feel better, complain less, and are more functional when EXERCISE REGULARLY
3) Physically CONDITIONED patients often recover from injury faster
4) Patients learn best by DOING. They need to establish appropriate functional ways of doing activities.

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11
Q

Lumbar Stabilization

Indications: which patients do lumbar stabilization ?

A

1) HYPERMOBILE segments
2) Spondylolisthesis
3) Post-op (laminectomy, disectomy) without restrictions for stabilization program

-deconditioned
really anyone

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12
Q

Lumbar Stabilization

What is a neutral spine?

A

The optimal position within which the Spine functions most efficiently

Different person to person, day to day,
-position of no symptoms: assymptomatic
-natural curves maintained without stress or strain
-all aspects of the column are relatively neutralized
(so for one person this may be more of a pelvic tilt )

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13
Q

Lumbar Stabilization

Neutral Spine and Functional Range

A

May change as condition changes

1) first find a functional range: find the boundaries of the functional range (in a painfree range) to find a neutral zone in the middle

–Cautious with end range movements and exercises: patient specific

–>Some need the end range for job or activity so teach them to CONTROL the end range

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14
Q

Muscles in lumbar stabilization

A

a. Lumbar multifidus
b. Transverse abdominus
c. Fibers of internal obliques
d. Pelvic floor

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15
Q

Lumbar Stabilization

Local Subsystem

A
  1. multifidi: hug spinal segments, span 2-3 segments (start at C2)
    (can cue pelvic floor to get multifidi to contract)
  2. TrA: corset
  3. Pelvic Floor : contain contents in pelvic girdle and resist against increase in intrabdominal pressure so nothing spills out
  4. internal obliques

hope erector spinae will be silent if it is an isometric contraction

Rectus abdominals should remain relaxed

layers of obliques: should remain relaxed (you would see rib depression if used)

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16
Q

Lumbopelvic stability training

A

PHASE I: local semental control

  • -the deeper local subsystem muscles
  • cognitive phase of learning: reliant on your feedback cannot yet self correct

PHASE II: introduction of global subsystem on local segmental control

  • -associative phase: can self correct, less cuing
  • -add on other movements to it
  • -Intorduce global subssytem on the local segmental control, understand more, able to self correct with less VC from you
  • -Can add movements as long as maintain global control

PHASE III: dynamic/functional tasks
–integreate into ADL, sit to stand, get out of bed, drive car, lift box, carry groceries

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17
Q

Principles of training

lumbar stabilization

A

Start stable surface–>unstable surface progression

BOS, rocker board, cushion

Saggital plane movement easiest –> frontal plane –> progress to multiplane

Simple progress to more complex

——Wherever they lose stabilization, keep within successful range and then make it more complex there ie increasing speed

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18
Q

General progression for training

lumbar stabilization

A

1) Pelvic rocks: determine neutral zone
2) Determine neutral zones
3) Breath pattern: affect ability to recruit muscles, and once they do recruit them we want them to breathe normally : we correct breathing pattern before begin the stabilization
4) Maintain neutral zone (isometrics)
5) Introduce LE or UE movements
6) Layer complexity via number of joints, planes of motion, position, BOS

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19
Q

Lumbar Stabilization

Cueing for TA

A

—Draw naval into spine without changing position (not tuck pelvis)

—Draw in each of your ASIS, hip bones towards eachother

–imagine zip tight pair of jeans

–waist narrowing

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20
Q

Lumbar Stabilization

Multifidi cue

A

have fingertips on either side of SP
“image your muscles under my fingers swelling up so they dont tuck pelvis or arch their back with erector spinae:

draw your pelvic floor in

men: imagine walking into cold lake -scrotal withdrawl

Swell out your muscles under my fingers without moving your pelvis

Lace of your spine

Draw your pelvic floor in and up

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21
Q

Lumbar Stabilization

Progression for traiing

A

a. Pelvic rocks:
b. Determine neutral zones
c. Breath pattern: affect ability to recruit muscles, and once they do recruit them can they breathe normally
d. Maintain neutral zone (isometrics)
e. Introduce LE or UE movements
f. Layer complexity via number of joints, planes of motion, position, BOS

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22
Q

Lumbar Stabilization

Pelvic rocks:

A

imagine a clock on your pelvis and ribcage 12 pubic bone 6, roll marble to 12 and down to 6

–make sure from pelvis and not arching spine, not erector spinae

cue them by having them have heel of hands on hip bone and tip of fingers toward pelvic bone and make hand flat

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23
Q

Lumbar Stabilization

Determine neutral zones

A

bring awareness of middle zone halfway between your forward and backward rock

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24
Q

Lumbar Stabilization

Breath pattern:

A

Note if chest or diaphragm breather

can train in diaphragmatic breathing:
have pt hand on his stomach and ask him to have it rise to the ceiling and come back down

their hand on their belly to see it rise and fall

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25
Q

Lumbar Stabilization

Maintain neutral zone (isometrics)

A

Isometric contraction: contract on exhalation of diaphragmatic breath

take a deep inhale belly rises now squeeze the air out and abdominals come in, my hand on medial ASIS to feel TrA

Inhale belly rise, exhale naval to spine feel the contraction, breath and maintain this

—May need them to do small sips of air to maintain the contraction to start

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26
Q

Lumbar Stabilization

Introduce LE or UE movements

A

WATCH THE PELVIS MAKE SURE IT IS NEUTRAL THE WHOLE TIME

Inhalation belly rise, exhale belly draw in maneuver, breath continues to flow:

slide your leg out and slide it back in I watch the pelvis for tilting

now bring leg up and down and other leg up and down.

Can do heel slide, march, lateral knee fall out and back in while maintianing the neutral pelvis ,…arm reaches…

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27
Q

Lumbar Stabilization

Layer complexity via number of joints, planes of motion, position, BOS

A

.

28
Q

Lumbar Stabilization

Exercercise prescription for isometric TrA

A

1) 10 pelvic rocks to find spine neutral
(can be pain modulation if do in painfree range to relax stuff, gentle mobilization, BF into area)

2) isometric Tra: maintain steady contraction with the breath cycle
10 seconds x 10 sets while breathing normally

3) increase with indurance
progression: 15 seconds x 5 –> 20 seconds x 4–> 30 seconds x 2

4) different people need different positions
positions: hookline, prone (pull naval off pillow), sidelie, standing, quadruped

29
Q

Lumbar Stabilization

Stabilization training:

A

1) Hookline: neutral
2) Pelvic rocks (marble on clock)
3) Stop at middle zone ½ between each rock
4) Watch for rib flare or rib depression as breath in and out and have maintain the draw in and maintain neutral spine and lift leg into air and lower it down—see if stabilizing, the pelvis will rotate so cue to anchor the opposite side to counter that so pelvis doesn’t twist –sometimes tying leg lift with exhale helps
5) Take a breath in and squeeze as raise one leg then the other then lower one then lower the other—if transverse cannot support it the rectus will come in
6) Kegals, isometrics, arms, legs

30
Q

Lumbar Stabilization

Hookline

A 
kegal
isometric
arms: B/L-->reciprocal-->unilateral
Legs: heel slides, marches, lateral knee fallouts, up-down-up-down, toe taps
Deadbugs: opposite arm to opposite leg
31
Q

Lumbar Stabilization

Prone

A

isometrics
one arm extension
one leg extension
alternate arm and leg extension

32
Q

Lumbar Stabilization

Bridges

A

static
dynamic
with abduction/adduction
bridge with march

33
Q

Lumbar Stabilization

Quadruped

A 
isometrics
one arm reach
one leg reach
A/P WS
bird dog
34
Q

Lumbar Stabilization

Kneeling

A

bilateral arms
reciprocal arms
hinge

35
Q

Lumbar Stabilization

Standing

A 
B/L arms
Reciprocal Arms
WS side to side
WS forward
WS backwards
36
Q

Lumbar Stabilization

Principles of Advanced Stabilization

A

1) lengthen lever arms
2) progress to less stable/unstable surface
3) endurance training
4) increase speed, reps, resistance
5) move in combined axes
6) integrate into functional task

37
Q

Lumbar Stabilization

equipment ideas

A

foam roller
air disc
physioball

38
Q

What is ergonomics

A

• Ergo = work
• Nomos = law
• Definition from international ergonomics associations
o Scientific discipline
o “optimize human well-being”
o optimize “system performance”
o “fitting the physical work space to the worker”

39
Q

Ergonomics: why companies care about it

A

work place injuries/ fatalities

• 2014 index: most disabling workplace injuries in 2012 ~$60 billion in workers comp
• each day btwn 12 & 13 U.S workers dies as a result of a traumatic injury on the job
o big graph…
o overexertion is the most expensive

40
Q

OSHA

A

Occupational safety and health admin

–Established by Occupation and health act, 1970

**Part of the US Department of Labor: regulates and enforces workplace safety and health initiatives

**healthcare workers most injured

41
Q

NOISH

A

National Institute of Occupational Safety and Health

–Part of CDC & Dept of Health and Human services

***Makes recommendations for preventing injuries and illnesses related to work

  • Conducts research
  • Provides education and disseminates information
42
Q

Type top 5 work injuries

A
  1. overexertion involving outside source (lift, carry)
  2. fall on same level
  3. struck by object/equipment
  4. fall to lower level
  5. other exertions or body actions (basic human movements: kneeling, sitting, twisting, ..)
43
Q

NOISH epidemiology report

A

workplace stress and injury of the Neck, UE, low back report

  • -evidence that lifting and forceful movements related to back injuries
  • -full body vibration related to back injuries

Positive relationship between heavy physical work and bending and twisting (defined as an akward posture)

there is insufficient evidence of static posture being related to back injury

44
Q

how the PT is involved in ergonomics

A

OUR OWN safety during transfers, lifting, prolonged standing, repetitive activities

our understanding of human performance and musculoskeleetal disorders make us ideal consultants for workplace

45
Q

where does ergonomics apply?

A

Workplace
o Office
o factory floor
-retail, show, retail, car

Required work tasks/equiptment
o Overhead work
o Keyboarding
desk, bag, desk, computer

46
Q

The role of PT in ergonomics

A

Examinations
o Worker
o Work site and work station

Evaluation
o Productivity needs of the employer
o Health and safety needs of the worker

Recommended preventive strategies
o Conduct on site training

Rehab of the injured worker

Assist the worker with return to work prn
o Work hardening

47
Q

Physical demand description

—Ergonomics: Examination

A

Physical demand description

  1. Prepare–who is involved, equipment need, schedule test
  2. Observe & data collection: tasks, classify essential and nonessential tasks
  3. Report: distribute for signoff
48
Q

Functional capacity evaluation (FCE)

Ergonomics

A

Designed systematically analyze the workers ability and capacity to EXECUTE their work tasks
–can the worker do the tasks needed for the job

Procedure

  1. Take a history
  2. Perform a preevaluation screening examination
  3. Perform functional testing
  4. Inerpret results
  5. Prepare a report

Indications: to order an FCE: • no plateaued progress • discrepancy btwn subjective vs. objective • difficulty returning to work • legal settlement

Contraindications: not medically stable, cannot follow direction

Target variables:
• body mechanic • ROM • Strength • Endurance • Pace • Coordination • Balance • Safety

Special consideration:
• PAIN IS NOT CONTRAINDICATED for functional testing and is expected if individual has been inactive >4 weeks

*note FCEs

49
Q

Review of 10 FCE’s (King, 1998)

Ergonomics

A

• Differences

Variations in # of measurements, degree of standardization, clarity of concepts and underlying theories, variety in choice of measuring instruments, adequacy of measurement for certain injury groups, controlled vs. uncontrolled

Isenhager work systems -> workwell
o Designed by Susan J. Isernhagen in 1998
o Duration 4-6 hrs, 1-2 days
-Better to mimic what they do (how many hours they actually are working)
-But so many FCEs variability, not testing the specific tasks

Assessment tools
o Nextgen ergonomics: software and instrumentation for ergonomics & biomechanics
o Washington state department of labor & industries

Lifting calculator

Recommendations
o Safety recommendations about resident transfers

50
Q

OSHA has E tools for Ergonomic reccomendations

A

Baggage handling, beverage delivery, computer stations, electrical contractors, sewing

51
Q

How do you balance the workers needs with the employer’s needs?

A

Perform the FCE and Physical Demand Description and make RECOMMENDATIONS to the employer

52
Q

What is an FCE?

Ergonomics

A

A functional capacity evaluation (FCE) evaluates an individual’s capacity to perform work activities related to his or her participation in employment (Soer et al., 2008). The FCE process compares the individual’s health status, and body functions and structures to the demands of the job and the work environment. In essence, an FCE’s primary purpose is to evaluate a person’s ability to participate in work, although other instrumental activities of daily living that support work performance may also be evaluated.

53
Q

Recommendations for Screens and eyestrain

Ergonomics

A

Video display terminal & eye strain (mayo clinic & american opthamology)

1) 25 inches from computer screen
2) screen position: eyes gazing slightly downward

3) lighting: effect eyestrain
• if light reflects on screen glare from screen makes u work harder–have it at a right angle: above or side
• when reading a book, light should be behind you,

4) directly focused on page
5) 20-20-20 rule (every 20 minutes gaze at objet 20 feet away for 20 seconds)
6) blink post-it
7) artificial tears
8) regular breaks

54
Q

how many inches from computer screen?

Ergonomics

A

25 inches

55
Q

how should computer screen be positioned?

Ergonomics

A

eyes gaze down

56
Q

General recommendations to prevent overuse syndromes

Ergonomics

A

o Regular rest breaks (15 min q 2-4hrs)

o Switch tasks often while working, eg alternate filing with keyboard use

o Frequent change in posture

o Minimize contact with sharp surfaces

o Rest eyes frequently, ensure adequate lighting

o Minimize forces you generate

o Keep hands warm

57
Q

Prolonged driving

Ergonomics

A

Adjustive seat angle (110),
Good suspension,
Adjust seat, steering for comfortable pedal use,
Lumbar support,
Tilt seat every 20-30 min to alter vibration location

o Have pt set up mirrors while in good position so when they can’t see again, they self adjust

58
Q

Performing artists

Ergonomics

A

• Stage conditions, backstage conditions, flying harnesses, costumes, shoes

59
Q

What is the focus of back school

A

1) Patient education
2) Behavior modification: to stop behaviors that contribute to the back pain
3) Minimize future episodes of back pain

Patient should undergo a thorough evaluation to determine areas of pathology, poor mechanics, postural deviations
Back school is an adjunct to treatment

60
Q

Back School Goal: help patient to

A

1) Understand their condition
Lack of understanding of the mechanics of condition—explain to help them control and manage the condition and symptoms, give them power over the condition

Independently manage their condition/ symptoms

2) Employ lifestyle changes:

stress –if pattern of pain follows their stress pattern need to address the stress—stress management—refer them

weight

61
Q

Backschool objective to

A

1) Body mechanics
2) Proper lifting techniques
3) Adaptations for work and home
4) Appropriate exercise
5) How to manage frequency and intensely of exacerbations
i. Teach the patient in patient education —re-herniation rates increase chance of herniation

62
Q

Backschool Educational Tools:

A

1) Anatomy models
2) Video clips followed by q and a session

3) Individualized instruction—especially in chronic LBP
- Help them understand the exercises and doing them correctly

4) Reading material

5) Practice real life situations: home, work, school
- See how they lift things
- Encourage behavioral changes
- Smoking cessation
- Caffeine consumption
- Balanced diet
- Regular exercise
- Stress management

63
Q

BACKSCHOOL EDUCATION

A

1) Functional anatomy and biomechanics
2) Discuss in terms patients will understand

3) Relate to principles of health and wellbeing
- -Being upbeat with the recommendations

4) Correct posture: static vs dynamic
- See how the patient gets out of the chair and then how you can correct it—if they are getting a shear causing the backpain work on stabilization and a weight shift – can they WX to bring buttocks up and then back down –then correct it and tailor it for them specifically

5) Lifestyle changes”:
- -Keep moving

–Walking program (They are not an athlete, give them walking,)

  • -Appropriate rest
  • For the super active people need to get them to rest more
  • Get adequate sleep, and this is when the body restores and regenerates and get nutrition in discs
  • Less stressing exercises
  • -Pillows/mattresses/ sleeping posture
  • How it contributes to symptoms—is the spine neutral

6) exercise
7) body mechanics

8) Proper nutrition (avoid laxatives)
9) Weight loss
10) Smoking cessation
11) Caffeiene consumption

64
Q

Progress / reduce exercise program based on symptoms

  • what to expect from exercise program
  • What to do about soreness
A
  1. Expect some soreness in exercise, determine where and what kind – is it the original symptoms or is it something else
  2. What can they do about the soreness-should they use ice, heat, cycling to flush out acid
65
Q

Proper body mechanics for lifting, carrying, housework

A
  1. Don’t bend over with knees straight
  2. Don’t reach over
  3. Don’t crouch over the desk
  4. Don’t sit far from the work and leaning forward
  5. Don’t sit asymmetrically at the chair
  6. Don’t sit with back unsupported
  7. Don’t work at a bench or table that is too low for you
  8. Be careful not to work overhead for long periods of time with you neck bent backwards
  9. Don’t thrust neck forward to read
  10. Don’t twist neck to hold phone
  11. Don’t jolt spine necessarily by jumping out of your truck or off a high object
  12. Don’t twist your neck to look behind you
66
Q

page 48

A

page 48

מסקולוסקלטל ליד (14 decks)

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