Final Review Flashcards
What term best describes a change in length of a ligament or joint capsule when a continuous of sustained force is applied to it?
Creep
A doctor reports, “irritation of the nerves from subluxations (joint dysfunction) in your lower spine may be the cause of your menstrual pain.”
Which reflex are they referring to?
Somatico-visceral reflex
Creating relative extension preload (with 3-finger palpation) prior to adjusting the downwards sacroiliac joint, when our patient is lying with right side down, is most like what assessment procedure?
Asking the patient to raise the left knee while palpating her right SI in standing Gillet’s test
What listings may be adjusted with an L2 contact, pisiform spinous push, patient right side up?
L2/L3 right rotation restriction/right lateral flexion restriction
PRS L2
If you could give only one brief piece of advice to your habitually slumping patient with back and neck pain, what would it be?
Sit and stand tall
If a patient:
- spends many hours at a computer
- has thoracolumbar region stiffness and achiness
- symptoms worsened by sitting and relieved with yoga
- symptoms do not radiate
- coughing or sneezing does not increase pain
- thoracolumbar range of motion is mildly limited
- mild to moderate thoracolumbar paraspinal muscle hypertonicity is found
Then what is the most sensible beginning diagnostic impression?
Thoracolumbar joint dysfunction
Eccentric contraction of the left QL muscle would control what trunk motion from the upright position?
Right lateral flexion
Which term would best help to quantify a diagnostic finding?
Size
How can subjective complaints be measured?
Assigned by utilizing:
- Visual analog scale
- Verbal analog scale
- Oswestry Low Back Disability scale
(all of the above)
In the gait cycle, heel strike and toe off are both in the category of…
double support
When performing a side-lying hypothenar/sacral base push for a lumbosacral extension, why do we roll the patient forward as a unit?
To apply a safe and ergonomically sound P to A thrust to the sacral base
During gait, a hyperpronated foot/ankle will cause internal rotation of the tibia and femur.
This occurs due to the presence of…
a closed kinetic chain in the single support phase
You have decided to alter your spinal manipulation technique to better accommodate the anatomical limitations of your 81-year-old patient.
Which condition would most likely have influenced this decision?
Osteoporosis
True or False:
If a patient complains of multiple symptoms of arthritis, but her x-rays show few degenerative changes, she is almost certainly malingering (pretending symptoms for secondary gain, such as falsified disability).
False
What is the patient positioning for hypothenar (pisiform) spinous push to create left rotation/left lateral flexion in combination at L2/L3?
Right side-lying position (left side up)
The Gonstead spinous listing of L2 PLS could be corrected with which adjustive procedure?
Side-lying hypothenar/spinous push for same side rotation/lateral flexion combination
What statement best defines Sherrington’s Law of reciprocal inhibition (law of reciprocal innervation)?
Increased hypertonicity of the agonist causes further weakness (inhibition) in the antagonist
Which of these exhibits the least fear avoidance behavior?
1. “I need you to do your magic, you’re the expert not me”
2. “I need advice on things I can do for myself to get through this”
3. “Every time I exercise it hurts, none of these please”
4. “My hip clicked a little last night. Do you think it went out and I’ll be back on crutches?”
- “I need advice on things I can do for myself to get through this”
Trunk extension motion is initiated with…
isotonic contraction of erector spinae
Which postural (tonic) muscle/phasic muscles (in that order) is also involved in lower crossed syndrome?
Iliopsoas/gluteus maximus
If we apply true static concepts, the procedure “side-lying calcaneus/sacral apex push for downside SI extension” is not an appropriate procedure to correct the static listing PI ilium because…
you would need to correct the misaligned ilium to correct static listing, which you do not do when performing that named adjective procedure
We have been able to assess and adjust for the movements of unilateral lumbosacral flexion and extension by virtue of which theoretical concept?
The oblique axis of the sacrum
In disc herniation terminology, an extruded disc that has separated from its parent disc, creating a free nuclear fragment is called…
nuclear sequestration
What is an example of a subjective finding?
Pain
What is the segmental contact point when adjusting to correct for a right unilateral lumbosacral flexion restriction?
Left side sacral apex
What best describes the procedure we use to perform a prone reinforced calcaneus/SI joint line push with gravity assist to correct a sacroiliac rotation restriction?
Preload the joint in the direction of desired motion (internal rotation) and apply a gravity-assisted impulse
True or False:
A viscero-somatic reflex chart can help you identify referred pain patterns in your patients which may be of non-musculoskeletal origin
True
The biopsychosocial model of low back disorders was created to help clinicians…
take into account the totality of a patient’s life when considering the origin and/or persistence of their pain and disability
Which of these chiropractic clinic would most likely utilize a biopsychosocial approach to patient care?
1. Pop and go chiro “2 minute adjustments we don’t waste your time?”
2. Dr. Crunch “Weekly body alignment package special ends Labor Day!”
3. Dr. Jack’s Crack Shack “Back out of whack? Come get a crack”
4. Main street comprehensive spinal care “We treat you as a person”
- Main street comprehensive spinal care “We treat you as a person”
Counter nutation of the sacrum is associated with which of the following motions?
Flexion of the L/S junction and extension of the SI joint
Which term could be used when referring to lumbar spine x-rays that show degenerative disc disease?
Objective findings
As the intervertebral disc changes with age, the distinction between the nucleus and annulus becomes less apparent.
This is partly due to…
the thickening of nuclear collagen fibers and the thinning of those in the annulus
“Hurt does not necessarily mean there is harm.”
You might say this to a patient with moderate back pain, in an effort to reassure him, if…
he is afraid to move at all, for fear he will just get worse
Patient findings must be qualified and quantified to give them meaning. Which of the following does not belong in the qualify category?
1. Color
2. Shape
3. Texture
4. Blood pressure
- Blood pressure
Which of these patients might most benefit from a side-lying calcaneus/sacral apex push for lumbosacral flexion?
1. Sits at desk all day with a “rounded” (flexed) lumbar spine
2. Forward head carriage and upper crossed syndrome
3. Crossing guard with lower crossed syndrome, including a significant hyperlordosis
4. Roofing contractor with a posterior pelvic tilt and L5 flexion malposition
- Crossing guard with lower crossed syndrome, including a significant hyperlordosis
Which of these patients most likely has chronic systemic inflammation?
1. “Pear-shaped” physique
2. 44 inch waist and high blood pressure
3. Athletic trainer with high HDL cholesterol, loves bagels with cream cheese
4. Drenches salads in olive oil
- 44 inch waist and high blood pressure
True or False:
Your patient, who is in visible distress with a flexion antalgia, complains of severe lower back pain, 8/10 on verbal scale. He is able to bend forward 45 degrees of flexion, but cannot stand erect due to pain.
This encounter involves all four of these patient assessment terms: subjective, objective, signs, and symptoms.
True
If a patient:
- lifts a heavy object bent at the waist and twists hearing a pop
- has a jab or pain locally
- then has an ache worsened through the day
- pain does not improve and now is a deep ache in lumbar region
- sitting makes it worse, as does coughing or sneezing
- pain in the right buttock, but no leg pain
- prior back injuries, each much milder and resolving without care
Then what is the most likely cause of their pain?
Contained disc lesion
True or False:
Although osteoarthritis is considered a non-inflammatory joint disorder, diet-induced chronic systemic inflammation can worsen symptoms
True
What is the vector of correction (line of drive) for a side lying hypothenar/spinous process push performed to correct an L2/L3 left lateral flexion restriction?
Left to right and P to A
If a patient:
- steps off a curb and experiences immediate pain at the right PSIS
- the pain is worst when he steps out of his truck
- has a right sacroiliac sprain
- full flexion of the right hip is not painful, but extension produces sharp pain
- lying prone is uncomfortable
- there is left SI extension restriction
- he can tolerate HVLA
Which adjective procedure should you perform to correct this restriction?
Side-lying calcaneus/sacral apex push to induce left SI (relative) extension, right side up
Which statement most accurately connects pelvic function and gait?
The sacrum laterally flexes towards the side of the loading response
What term best describes asymmetry between right and left articulating facets in the lumbar spine?
Facet tropism
The progressive decrease in range of motion of the aging lumbar spine is primarily due to the stiffening of the…
intervertebral disc
Decreasing body mass index helps decrease joint pain by what mechanism?
- Less expression of inflammatory mediators from adipocytes
- Decreased mechanical load on joints
- Better overall health encourages movement
(all of the above)
The adjustive procedure we learned to correct a unilateral PS sacrum in the prone position involves…
an inferior (inside) hand reinforced hypothenar/ipsilateral sacral base contact
Heat, redness, swelling, pain, and loss of function are considered the “pillars” of what?
Inflammation
Which of these is an example of a viscero-somatic reflex?
1. A heart attack causing left arm and jaw pain
2. Bowel distress due to anxiety over an exam
3. Low back muscle spasms causing constipation
4. Event is triggered by pulling your grandfather’s finger
- A heart attack causing left arm and jaw pain
What is the correct order of the negative cascade (in the direction of initiation to end result) as described by Palmer/Kirkaldy-Willis/Schneider?
Hypertonic muscles, joint dysfunction, instability, stabilization
Which structure is the “weakest link” (structure most likely to fail) under sudden axial compressive loading in an 85-year-old?
Weakened cancellous bone structure with resulting vertebral body compression fracture
