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Advanced Orthopedics > Full Mckenzie Lumbar > Flashcards

Full Mckenzie Lumbar Flashcards

1
Q

What percentage of adults experience back pain in their lifetime

A
  • 50-80%
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2
Q

Back can be episodic, recurrent, and persistent (True/False)

A
  • True
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3
Q

What are the risk factors for back pain

A
  • PMH of prior back pain
  • Heavy lifting or frequent lifting
  • Whole body vibration (driving/machinery)
  • Prolonged/frequent twisting
  • Prolonged/frequent bending
  • Awkward postural stresses
  • Psychosocial factors
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4
Q

The average person flexes how many times per day

A
  • 3000-5000 times per day
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5
Q

What posture causes increased and decreased disc pressure

A
  • Kyphosis & flexion = increased disc pressure
  • Lordosis & extension = decreased disc pressure
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6
Q

Innervated structures of lumbar spine that can produce pain

A
  • Facet joint capsule
  • Out layer of annulus fibrosis of intervertebral disc
  • Vertebral bodies, dura mater
  • Nerve root sleeve & connective tissue of nerves
  • Spinal musculature
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7
Q

Describe chemical pain

A
  • constant
  • acute onset
  • Signs of inflammation: swelling, rubor, calor, tenderness
  • all movements are painful
  • no movement reduces symptoms
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8
Q

Describe mechanical pain

A
  • intermittent but can also be constant
  • certain repeated movements reduce or abolish/centralize symptoms
  • movements in one direction may lessen symptoms whereas symptoms in another direction may increase symptoms
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9
Q

Describe chronic pain

A
  • may not be influenced by mechanics alone
  • need to account for psychosocial factors
  • length of time present does not mean mechanical assessment and treatment are not beneficial
  • may take longer than patient’s that are not chronic
  • chronic pain may not respond to treatment.
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10
Q

What are the 3 tissue repair phases

A
  • Inflammatory: 0-5 days
  • Repair: 5-21 days
  • Remodeling: 21+ days
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11
Q

Describe the components of the intervertebral disc

A
  • Concentric layers of annulus fibrosis surround nucleus pulposus
  • Nucleus distributes forces evenly
  • Outer annulus is innervated
  • Posterolateral annulus is weakest
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12
Q

Define the intervertebral disc terminology

A
  • Displacement: intradiscal mass displacement within annulus
  • Protrusion: intact annular wall (disc bulge); reducible condition
  • Extrusion: annular wall breached by intradiscal mass that protrudes through but remains in contact with the disc
  • Sequestration: annular wall breached by intradiscal mass that has separated from disc (irreducible)
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13
Q

What are the cardinal features of MDT

A
  • Classification of subgroups
  • Focus on centralization
  • Self treatment & patient education
  • Progression of forces
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14
Q

Describe lumbar dysfunction pain

A
  • Pain caused by mechanical deformation of structurally impaired soft tissue
  • Contracture, scarring, adherence, adaptive shortening of tissue
  • Pain is intermittent
  • Pain only occurs at end range of restricted movement
  • Present at least 6-8 weeks
  • Pain is localized (except in case of adherent nerve root)
  • Symptoms do not persist after repeated movement testing
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15
Q

Describe a lumbar extension dysfunction

A
  • End range pain in extension that does not remain worse upon repeated movement
  • Ext ROM will not progress with repeated movement
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16
Q

Describe a lumbar flexion dysfunction

A
  • End range pain in flexion that does not remain worse after repeated movement
  • Flexion ROM will not progress with repeated movement
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17
Q

Describe postural syndrome

A
  • Intermittent pain brought on only by prolonged static position.
  • Rarely seen in clinic
  • Pain is localized
  • No pain with movement
  • No ROM deficits
  • Posture correction decreases symptoms
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18
Q

Define derangement

A
  • Clinical presentation which demonstrates directional preference in response to loading strategies & is typically associated with the movement loss
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19
Q

Describe a lumbar derangement

A
  • Most common classification
  • symptoms are variable, inconsistent and can change
  • movements can increase/decrease symptoms
  • sustained postures can increase/decrease symptoms
  • temporary deformity may be present: lateral shift, lordosis or kyphosis
20
Q

Patterns in patient history for derangement

A
  • Symptoms local, referred or radicular
    onset can be gradual or sudden
  • Symptoms can change sides
  • Symptoms can move proximal/distal
21
Q

Patterns in examination for derangement

A
  • ROM Loss in one or more directions
  • May have obstructed movement (movement loss that is temporary and changes rapidly with repeated movements
  • Can have temporary deformity: Lordosis, kyphosis, lateral shift
  • May have deviation with movement
  • Repeated movements and sustained loading strategies
  • Cause symptoms DURING and AFTER
  • Can increase or decrease baseline ROM
  • Range of motion can increase or decrease
22
Q

What is a hallmark of derangement

A
  • Rapid change
23
Q

Define directional preference

A
  • Clinical phenomenon where a specific direction of movement results in a clinically relevant improvement in symptoms
  • There is not always a change in the location of the pain
24
Q

Define centralization

A
  • Phenomenon by which distal pain originating from the spine is progressively abolished in a distal to proximal direction
  • This is in response to a specific repeated movement and/or sustained position & this change in location is maintained over time
25
Q

Describe Directional Preference and Centralization

A
  • Only Present in Derangement Syndrome
  • Occurs with repeated movement/sustained positions
  • Most common with Extension
  • Less common with lateral or flexion
  • Will see improvement in symptoms
  • May see improved function and/or mechanics
  • If present this indicates a good prognosis
  • Failure to find this indicated poor prognosis
26
Q

Red flags/contraindications for MDT of the lumbar spine

A
  • Serious spinal pathology
  • Cancer
  • Infections
  • Fractures & osteoporosis
  • Cauda Equina Syndrome
  • Spinal cord signs
  • Ankylosing spondylitis
  • Recent surgery: fusion 3 mo to 1 year for good stabilization; discectomy no concerns
27
Q

Red flag clues

A
  • Age >55
  • Hx of cancer
  • Unexplained weight loss
  • Constant, progressive, non-mechanical pain, worse at rest
  • Systemically unwell
  • Persisting severe restriction of lumbar flexion
  • Widespread neurological deficit
  • Prolonged steroid use
  • Hx of intravenous drug use
  • Hx of significant trauma enough to cause Fx or dislocation
  • Hx of trivial trauma & severe pain in potential osteoporotic individual
  • No movement or position centralizes, decreases, or abolishes pain
28
Q

Describe a R versus L lateral shift

A
  • R lateral shift: vertebra above has laterally flex to the right in relation to vertebra below. Shoulders to the right
  • L lateral shift: vertebra above has laterally flexed in relation to the vertebra below. Shoulders to the left.
29
Q

If during motion testing the pain abolishes or centralizes further testing of movements is not necessary (True/False)

A
  • True
30
Q

When is static testing indicated

A
  • Severe pain or very acute pain
  • When repeated movements do not effect symptoms
  • If patient only reports symptoms with prolonged position
31
Q

Lists the lumbar static tests

A
  • Slouch sitting
  • Long sitting
  • Sitting erect
  • Standing slouched
  • Standing erect
  • Lying Prone in extension
32
Q

Terminology during movement

A
  • Increase (↑): Symptoms already present increase in intensity
  • Decrease (↓): Symptoms already present decrease in intensity
  • Produce (P): symptoms produced that were not present
  • Abolish (A): Symptoms disappear during testing
  • Centralising: Movement of pain from distal to proximal
  • Peripheralising: Movement of pain from proximal to distal
  • No Effect (NE): movement has no effect during testing
33
Q

Terminology after testing

A
  • Worse (W): Symptoms produced or increased with movement and remain aggravated after testing
  • Not Worse (NW): Symptoms produced or increased with movement return to baseline after testing
  • Better (B): Symptoms decreased or abolished during movement remain better after testing
  • No Better (NB): Symptoms decreased or abolished during with movement or loading return to baseline after testing
  • Centralised: Distal pain abolished by movement that remains abolished after testing
  • Peripheralized: Distal pain produced during movement testing remains after testing
  • No effect: Movement or loading has no effect on symptoms after testing
34
Q

Describe a red light situation

A
  • Produce worse
  • Increase worse
  • Peripheralize worse
35
Q

Describe a yellow light situation

A
  • Produce not worse
  • Increase not worse
  • Decrease not better
  • Abolish not better
36
Q

Describe a green light situation

A
  • Decrease better
  • Abolish better
  • Centralizing better
37
Q

Slide 61

A
38
Q

What are the 4 stages of management of derangement

A
  • Reduction
  • Maintenance
  • Recovery of function
  • Prevention of recurrence
39
Q

Clues for extension/posterior derangement for central symmetrical symptoms

A
  • Hx: flexion injury/activity at onset
  • Aggravating factors: sitting, b ending, rise from sitting
  • Alleviating factors: lying with legs straight, standing, walking, sitting upright
  • Exam: reduced lordosis
  • Repeated motions: repeated flexion may increase or worsen
40
Q

Clues for flexion/anterior derangement for central symmetrical symptoms

A
  • Worse with walking and standing
  • Have obstructed flexion ROM
  • Improve with sitting
  • May have excessive or fixed lordosis no reversal of curve in flexion
  • Good response to flexion in lying
  • Usually have a dramatic improvement in flexion ROM when rechecked in standing
  • Test end range sustained extension prone lying on elevated plinth 2-3 mins: Pt will have obstructed flexion ROM
41
Q

Clues for lateral component

A
  • Unilateral or asymmetrical symptoms
  • Activities of flexion and extension are aggravating factors
  • Asymmetric ROM loss with side glides
  • Centralizing or reduces symptoms with lateral movements
  • Peripheralization or worsening with prone lying or extension in lying
  • Symptoms unchanged after several days of extension exercises
  • Is there a shift that needs to be corrected?
42
Q

Extension with lateral component

A
  • Position hips off center away from the painful leg
  • Prone lying in extension with hips off center
  • Extension in lying with hips off center
  • Extension in lying with hips off center and clinician overpressure
  • Side glides in standing
  • Extension mobilization with hips off center
  • Rotation mobilization in extension
  • Consider return to sagittal plane extension once centralized.
43
Q

Exercise prescription

A
  • 10-15 repetitions, multiple sets if needed of appropriate principle.
  • Exercise should be least force that decreases, abolish or centralize symptoms
  • Have patient perform every 2 hours.
  • Consideration for ability level (may need less frequency)
  • Consideration for severity of symptoms (may need increased frequency)
  • Avoid movements that exacerbate symptoms
44
Q

Is derangement stable

A
  • End range symptoms produce no worse
  • No pain during movement
  • Symptoms that produce do not remain worse
  • Symptoms do not peripheralize
  • Symptoms should not increase with repetitions
45
Q

Describe recovery of function “5x5x5”

A
  • Reintroduce flexion
  • Begin with least force: flexion in lying
  • Progression flexion force as tolerated~ every 5 days
  • 5-6 repetitions, 5-6 times per day
  • Follow with5 reps extension
  • Avoid flexion in early AM
  • Recovery of function not required with anterior derangements
  • Don’t need to recover extension with anterior derangement
46
Q

Prevention of recurrence

A
  • Continue recovery of function program for 6 wks
  • HEP: 2x/day, 10 reps flexion & 10 reps extension for life
  • Continue use of lumbar support roll for life

Advanced Orthopedics (29 decks)

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