HOC 2 Flashcards
Lower back complaints can be divided into non-specific and specific lower back complaints.
Explain the difference between the two and give some examples?
Non-specific lower back complaints are complaints of the lower back without a clear cause found for example in X-rays, blood tests, etc.
Specific lower back complaints can be proven. Examples of specific lower back complaints are a hernia nuclei pulposi (HNP) or vertebral fracture.
Specific neck complaints are provable through imaging tests.
What are some examples of specific neck complaints?
Examples of specific neck complaints are: cervical radicular syndrome, cervical myelopathy, neck complaints as a result of rheumatoid arthritis.
What is the name of the categorisation of neck and back complaints into specific and non-specific complaints?
Triage.
Explain the categories of the Triage, inc. percentages of sufferers.
Back complaints ->
- Non-specific back complaints (90%).
- Specific back complaints (10%).
- Radiculopathy (8%).
What signs and symptoms suggest a Lumbar Radiculopathy?
- Unilateral pain in the leg > backache.
- Pain usually radiates to the foot/toes.
- Not only discogenic cause (pain originating from a damaged vertebral disc, particularly due to degenerative disc disease).
- Paraesthesia, sensibility disorder.
- Neuromeningeal stimulus
- reduced straight leg raising, slump.
- Reduced motor, sensory or reflex function
- matching one segment.
Explain how pressure on a disc causes radicular syndrome?
If the nucleus pulpous pushes through the annulus fibrosis (herniation), it can compress the nerve root.
What are the Red flags for Lower back pain?
Accord. THIM there is total = 10
- First episode with LRP <20yr or >50yr
- Significant trauma?
- Recently unexplained weight loss ( >5kg / month)
- Malignant conditions in history.
- Fever
- Deformities (e.g. lumbar kyphosis)
- Long-term use of corticosteroids
- Intravenous administration of medicines.
- Progressive non-mechanical pain.
- Night time pain / pain that remains at night.
Specific low back pain is divided into two categories, name and explain them…
Lumbosacral radicular syndrome, a form of specific low back pain characterised by radicular pain in one leg, which may or may not be associated with neurological deficits.
Back pain resulting from a possibly serious underlying specific disorder, such as (osteoporotic) vertebral fractures, malignities, ankylosing spondylitis, severe forms of vertebral canal stenosis, or severe forms of spondylolisthesis.
What are the Red flags for Thorax?
Accord. THIM there is total = 9
- Recent trauma?
- Already existing (unexplained fever)
- Recently unexplained weight loss ( >5kg / month)
- Long-term use of corticosteroids
- Constant pain that does not decrease when changing position.
- Cancer in history.
- General feeling of unwell / malaise.
- Night time pain.
- Extensive neurological signs and symptoms.
How many grades of Neck pain are there?
4
Describe Neck pain Grade 1?
Neck pain and associated disorders with no signs or symptoms suggestive of major structural pathology and no or minor interference with activities of daily living.
A patient may say… I have pain in my neck, but am able to do just about everything. I am completely healthy.
Describe Neck pain Grade 2?
Neck pain without signs or symptoms indicative of major structural pathology but which may significantly affect daily activities.
A patient may say… I have neck pain and many things have become impossible for me to do. I am significantly limited in my life. I am otherwise entirely healthy.
Describe Neck pain Grade 3?
Neck pain without signs or symptoms indicative of major structural pathology but with neurological symptoms possibly caused by cervical herniated disc or spinal stenosis, such as reduced tendon reflexes, muscle weakness, or sensory disorders (hypoesthesia or hyperesthesia) in the upper extremity.
Cervical Radiculopathy?
Describe Neck pain Grade 4?
Neck pain with signs or symptoms indicative of SERIOUS STRUCTURAL PATHOLOGY. Major structural pathologies include (but are not limited to) fracture, vertebral dislocation, injury to the spinal cord, infection, neoplasm, or systemic disease including the inflammatory arthropathies.
What are the Red flags for Neck pain which could suggest a major structural pathology (Grade 4).
(Accord. THIM there is total = 9)
- Recent trauma?
- Already existing (unexplained fever)
- Recently unexplained weight loss ( >5kg / month)
- Long-term use of corticosteroids
- Constant pain that does not decrease when changing position.
- Cancer in history.
- General feeling of unwell / malaise.
- Night time pain.
- Extensive neurological signs and symptoms.
What is the Epidemiology of NSLBC patients?
60 to 90% lifetime prevalence 50-250 per 1000 people a year 70% has one single consult 50% recovers within a week 80 to 90% recovers within 4 to 6 weeks 95% recovers within 3 months
What is a guideline based on and why is it important for the treatment of a patient?
Based on:
- Science (evidence).
- Professional insights (what are the experiences/findings of our colleagues).
- Social insight.
Should lead to:
- Effectiveness
- Efficiency
- Tailored care
Which three measuring instruments are recommended when diagnosing LBC?
Numeric rating scale (NRS)
Patient Specific Complaints (PSC)
Quebec back pain disability scale (QBPDS)
How many Patient profiles are there for LBP?
3.
Describe LBP patient profile 1?
Profile 1
Non-specific lower back pain with a normal course of recovery.
Describe LBP patient profile 2?
Profile 2
Non-specific lower back pain with a divergent course, without dominant psychosocial recovery-hindering factors.
Describe LBP patient profile 3?
Profile 3
Non-specific lower back pain with dominant psychosocial recovery-hindering factors.
What is considered a ‘Normal course’ for LBC?
- When activities and participation gradually increase with time (up to the level of before the episode of complaints).
- Often the pain will reduce as well. This does not always mean that the lower back pain disappears completely, but rather that it does not (or no longer) impede performing the activities and participation.
What is considered a ‘Divergent course’ for LBC?
- When the limitations and participation problems do not reduce with time, but rather stay the same or even increase.
- We consider it to be a divergent course and delayed recovery if there is no clear increase of activities and decrease in participation problems within 3 weeks.
Which 4 Factors (as listed in the powerpoint) can delay the recovery of lower back pain.
- Back pain-related factors: high level of activity limitations, radiating pain, wide-spread pain.
- Individual factors: at a later age, poor general state of health.
- Psychosocial factors: psychological and psychosocial stress, pain-related fears/avoiding behaviour, somatisation, depression.
- Work-related factors: poor relationships with colleagues, demanding physical jobs.
Which three systems ensure the stability of the spine?
- The neural system: Nerves + CNS.
- Active system: Muscles, Tendons.
- Passive system: Vertebrae, Disci, Ligaments.
Explain the concepts of instability?
Loss of a normal pattern of spinal motion causes pain and/or neurologic dysfunction.
Explain the concepts of neutral zone?
The neutral zone (NZ) is a region of intervertebral motion around the neutral posture where little resistance is offered by the passive spinal column. The NZ appears to be a clinically important measure of spinal stability function. Its size may increase with injury to the spinal column, which in turn may result in spinal instability or low-back pain.
What are the clinical symptoms for the LSC?
Poor propriocepsis and reduced lumbar control (hesitating/pivoting)
Reduced strength/endurance in local muscles at the level of the unstable segmental area
Aberrant movement (abnormal course of movement)
Pain in static postures which are maintained for long periods of time
Gower’s sign: the patient ‘walks’ his hands back to neutral position
Movement too large (1 or 2 segments) during flexion-extension
Reduced willingness to move or fear of moving
Hyper mobility (during posterior/anterior (P-A) spring test)
Increased muscle tension/defensive tension
Poor posture and postural changes such as lateral shift and change of lordosis
Frequent audible cracking/popping/clicking sounds during a movement
Hypomobility of contiguous segments
Name and explain the three phases of the “Motor Learning Model” and the differences between those stages
Cognitive stage - Isolated training of the local muscular system, without involving the global muscular system.
Associative stage - Teaching specific partial movements, involving the global muscular system and checking for co-contraction of the local muscular system.
Autonomous stage - Integrating specific movements into ADL.
What are some causes of Pregnancy-related pelvic girdle pain?
- Hyper-mobility as a result of pregnancy.
- Trauma during pregnancy.
- Difficult childbirth.
- Wrong posture.
- Muscles that close the legs are too strong.
- The abdominal, buttock and back muscles and the muscles that spread the legs are too weak.
- The pelvic floor is too strong.
Where is pain most commonly felt in patients with Pregnancy-related pelvic girdle pain?
Pain
- Pubic bone - Coccyx - SI joint, lower back
Which activities become difficult with Pregnancy-related pelvic girdle pain?
Difficult activities
- Turning over in bed - Staying in the same position - Getting up from a (particularly low) couch or chair - Standing up, sitting, walking or walking stairs for longer periods of time - Bending down - Getting in and out of the bath tub or shower - Getting dressed and undressed (standing on one leg)
When perfoming a specific examination on a patient with Pregnancy-related pelvic girdle pain;
1) Which movements is pain and/or weakness most likely to be produced?
2) Which two tests will have a positive result?
3) hat can be established using an echograph?
1)
- Weakness and/or pain during forceful abduction of the hips (spreading the legs).
- Weakness and/or pain during forceful adduction of the hips (moving spread legs together).
2)
- PPPP test positive
- ASLR (Active Straight Leg Raise) test positive
+
- A pelvis strap/manual compression has a positive influence on pain and strength
3)
- The patient uses the stabilising pelvic muscles incorrectly. This can be established by using echographs, among other techniques.
Name 5 measuring instruments for Pregnancy-related pelvic girdle pain?
VAS = Visual Analogue Scale RDQ = Roland Disability Questionnaire IPA = Impact on Participation and Autonomy BPS = Behavioural Pain Scale PHODA = PHotograph series Of Daily Activities.
What are the 4 main goals when (actively) treating a patients with Pregnancy-related pelvic girdle pain?
- Advice and instruction
- Unblocking
- Stabilising
- Practice
When should you refer your patient to a pelvic physiotherapist specialist?
- Urinary incontinence
- Pain in the lower abdomen
- Pain during peeing, bowel movement, having sex
- No progress despite advice and practice.
List some Red flags for Pregnancy-related pelvic girdle pain? (before and after pregnancy).
- Persistent pain in the pelvic and lower back region that cannot be explained.
- Other physical symptoms including symptoms of the abdomen, organs and/or minor pelvis.
- Radiating pain in one or both legs that extends beyond the knee.
- The pain in the legs is more dominant than the pain in pelvis and lower back.
- Aggravated or severe loss of motor function.
- Aggravated or severe loss of sensory function.
- Total malaise.
- History of malignancy or trauma.
During the anamnesis of a lumbosacral radicular syndrome patient, the main independent predicting factors are..?
- Pain in the leg
- Typical (mono-radicular) pain in dermatome
- Increased pain in the leg when the pressure increases.
During the Physical examination of a lumbosacral radicular syndrome patient, what are you going to ask the patient to do and what will you examine?
- Finger-floor distance >25cm (modern SLR)
- Examining muscle weakness (myotomes)
- Further neurological examination;
Reflex and sensibility examination
When is imaging indicated for a patient with lumbosacral radicular syndrome?
When surgery is considered, or if there are certain red flags.
Neurological examination (level determination) to support imaging techniques.
If you suspect a patient has grade 3 neck pain, which too tests should the physical therapist carry out to confirm this suspicion?
Spurling’s test and/or the traction/distraction test.
Grade neck pain III is deemed likely if one or both tests have a positive outcome.
If the results of the Spurling’s test and/or the traction/distraction test for grade 3 neck pain are negative but grade 3 neck pain is still suspected, what test can the physical therapist do next?
Upper Limb Tension Test (ULTT)*- for the brachial plexus/median nerve to exclude (negative result) Grade III neck pain.
Which 2 assessment tools/instruments are to be completed before (in order to predict the course of the neck pain and to serve as baseline for treatment goals) and after (to evaluate recovery and outcomes) treatment?
How many point difference should there be to establish improvement or deterioration of symptoms?
- Patient-Specific Functional Scale (PSFS) questionnaire.
- Numeric Pain Rating Scale (NPRS).
There should minimally be a 2-point difference in both measurements (on a 0–10 scale) to establish improvement or deterioration of symptoms.
Which imaging studies could be recommended by the physical therapist?
The physical therapist should not recommend imaging studies because of the limited level of evidence supporting their use and the substantial chance of false-positive findings.
How many treatment profiles are there for Neck complaints?
4.
A,B,C,D.
Describe the case characteristics of a patient in treatment profile A.
Neck pain.
Grade I and II neck pain with a normal course.
Neck pain that (to a greater or lesser extent) has an impact on daily activities and which is expected to improve within the first 6 weeks after the onset of symptoms
Describe the case characteristics of a patient in treatment profile B.
Neck pain.
Grade I and II neck pain with risk factors for a deviant course of recovery but no psychosocial factors that could delay recovery.
Neck pain that (to a greater or lesser extent) affects daily activities and which is not expected to improve or which may even worsen within the first 6 weeks of the onset of symptoms or complaints. Psychosocial factors that could impede recovery are not present
Describe the case characteristics of a patient in treatment profile C.
Neck pain.
Grade I and II neck pain with risk factors for a deviant course of recovery, and psychosocial factors that delay or inhibit recovery.
Neck pain that (to a greater or lesser extent) affects daily activities and which is not expected to improve or which may even worsen within the first 6 weeks after the onset of symptoms or complaints. Psychosocial factors that could impede recovery are present.
