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MS II > L-Spine classification systems > Flashcards

L-Spine classification systems Flashcards

1
Q

What percentage of patients in primary care that have LBP cannot reliably be attributed to specific disease or spinal abnormality?

A

85 %

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2
Q

What are 7 specific disorders that CAN be a source of back pain?

A 
Cancer = 0.7%
Compression fracture = 4%
Spinal infection = 0.01%
Ankylosing spondylitis = 0.3 – 5%
Spinal stenosis = 3%
Herniated disc = 4%
Cauda equina syndrome = 0.04%
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3
Q

What are 4 non-spinal sources of back pain?

A
  • Pancreatitis
  • Nephrolithiasis (kidney stones)
  • Aortic aneurysm
  • Viral syndromes
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4
Q

What is Level I of an exam?

A
  • Are they appropriate for PT
  • Yellow Flags: refer to psycho-social issues
  • Red Flags: Refer for medical work-up
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5
Q

What is Level II of the exam?

A
  • Determine the disability stage
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6
Q

What is Stage 1 disability? (4 aspects)

A
  • Acute/ recent onset
  • Pain dominates
  • Function is significantly affected (mostly by pain)
  • ODI > 25 %
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7
Q

What are the 3 factors of Stage 2 disability?

A
  • ODI a little higher than 20 %
  • Impairments dominate
  • Function moderately affected
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8
Q

What are the 3 factors of Stage 3 disability?

A
  • ODI < 20 %
  • Only lacking high level function
  • Chronic
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9
Q

What should be kept in mind when assessing stages?

A
  • They are not distinct
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10
Q

What stage is the treatment based classification applied to?

A

Stage 1

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11
Q

What is the main goal of stage 2?

A
  • Work on impairments and how they affect function
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12
Q

What is the main goal of stage 3?

A
  • Return the patient to a high level of functional activity
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13
Q

What 2 stages are the most likely to blend?

A

1 and 2

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14
Q

Who were the 3 authors of the KEY article in treatment based classification acute LBP?

A
  • Fritz JM
  • Cleland JA
  • Childs JD
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15
Q

Who came up with the first treatment based classification system?

A
  • Delitto et al
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16
Q

What is the 3 step process of classification?

A
  • Screen for red flags
  • Confirm that the L-spine is the soruces of the problem, and not another musculoskeletal impairment (strain, bursitis, etc…)
  • Categorize into: Manip, Spec Exercise, Stabilization, or Traction
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17
Q

What led to the development of the CPR for manipulation?

A
  • Some studies showed it was superior to placebo, while others said it was not
  • Wanted to determine what specific patients would benefit from the treatment
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18
Q

What 2 things can be determined by a CPR?

A
  • Determines who is likely to benefit

- Determines who may require a different approach

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19
Q

What is the CPR for spinal manipulation?

A

4/5 of the following

  • No symptoms distal to the knee
  • Symptoms < 16 days
  • FABQ score < 19
  • L-spine hypomobility as determined by PA assessment
  • IR of at least one hip > 35 degrees
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20
Q

How was success determined when creating the CPR for manipulation?

A

Symptoms 50 % better within 2 treatments

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21
Q

What are the 4 contraindications/ strong precautions for manipulation of the L-spine?

A
  • > 60 years old
  • Spondylolisthesis
  • Osteoporosis or other bony abnormalities/ weakening
  • Signs of nerve root compression
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22
Q

Have the lumbar CPR been validated?

A

Yes

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23
Q

Has non-thrust mobilization been proven be as effective as HVLAs?

A

No

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24
Q

Should the patient receive a lumbopelvic manip or a lumbar neutral gap manip?

A

It doesn’t matter.

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25
Q

What 4 exercises made up the HEP following manipulations/ mobilizations in Cleland’s study?

A
  • Cat & Camel
  • Crunch in neutral
  • Side plank
  • Quadriped arm and leg
26
Q

What exercise typically directly follows a lumbar manipulation?

A
  • Active ROM exercises
27
Q

What are the 3 effects of a manipulation?

A

Window for:

  • “Safe”, pain free ROM
  • Normalize muscle activity, and motor control
  • Analgesia, and autonomic effects
28
Q

According to Dr B, how many sessions are the manipulations typically performed?

A

< 3 - 4 sessions

29
Q

What are the 2 most important indicators for lumbar manipulation?

A
  • < 16 days

- No pain below the knee

30
Q

What are the CPRs for stabilization classification?

A

3/4 of the following:

  • < 40 years old
  • R/L average SLR > 91 degrees
  • Abberant movement during flexion/ extension
  • (+) prone instability test
31
Q

What are the 2 main deep/ segmental muscles trained for stabilization of the lumbar spine?

A
  • Tranvserse abdominis

- Multidi

32
Q

What are the 4 main superficial/ regional muscles?

A
  • Rectus abdominis
  • Obliques
  • Quadratus Lumborum
  • Erector Spinae
33
Q

Are the manipulation or stabilization CPRs better developed?

A

Manipulation.

34
Q

If 3/4 CPRs for stabilization exercise are positive, what is the percentage of patients that will improve 50 % in their disability index scores with treatment?

A
  • 80 %
35
Q

What are 4 CPRs for FAILURE of stabilization exercises?

A
  • Negative prone instability test
  • Lack of aberrant movement during flexion/ extension
  • Lack of hypermobility (as determined by PA assessment)
  • < 9 on FABQ
36
Q

If 3/4 CPRs are present for failure of stabilization exercises, what is the percent of patients that will not have successful outcomes?

A
  • 86 %
37
Q

Should deep or superficial muscles be targeted during stabilization exercises?

A
  • No evidence supporting either
38
Q

Besides stabilization exercises, how would Dr. B supplement treatment of patients in the stabilization classification?

A
  • Motor control

- Conditioning

39
Q

What phenomenon is the Specific Exercise classification based on?

A

The centralization phenomenon

40
Q

Describe the centralization phenomenon?

A
  • Repeated end-range movements cause a reduction in peripheral symptoms
  • Central symptoms may be increased
41
Q

What is directional preference?

A
  • Movements in one direction decrease symptoms

- Movements in the opposite direction increase symptoms

42
Q

Are both directional preference and the centralization phenomenon included in the specific exercise classification?

A

Yes

43
Q

Describe a general exercise prescription for a patient classified into the specific exercise classification.

A
  • Correct lateral shift
  • Position patient into increasing amounts of lumbar extension with prone press ups (Can place belt around pelvis and table) or standing extensions (with hands on the pelvis or glutes)
  • Progress ROM and/or force
  • Utilize PA mobilizations in extension position to assist the movement
44
Q

What positions should be avoided? How can the patient be educated?

A
  • Avoid prolonged or end-range flexion activities
  • Inform patient about what exacerbates symptoms/ progresses the condition
  • Use proprioceptive taping to reinforce positional knowledge
45
Q

What is a contraindication to the specific exercise classification?

A
  • Spondylolisthesis
46
Q

What are the CPRs for classification into Specific Exercise?

A

There is none yet.

47
Q

Which type of specific exercise has the most evidence?

A

Extension

48
Q

When is flexion Specific Exercise typically utilized?

A
  • Spinal Stenosis
49
Q

Besides the specific exercise its self, what other 2 interventions may be ultilized when the patient is classified into the specific exercise classification?

A
  • Manual therapy of the spine and hips

- Aerobic exercise

50
Q

What are William’s 1-2-3 flexion exercises?

A
  • Posterior pelvic tilt
  • PPT; lift one knee to chest; hold
  • PPT; lift both knees to chest; hold
51
Q

What are the 3-4 indicators for traction classification?

A 
- Symptoms below buttock
AND
- Signs of nerve root compression
AND
- Symptoms do not centralize (or peripheralize) with direction specific movements
OR
- (+) Crossed SLR Test
52
Q

What patient positioning combined with what exercise were found to be effective by Fritz and Lindsay?

A
  • Prone position

- Extension exercise

53
Q

How much force is recommended for traction?

A

30 - 50 % body weight

54
Q

According Judovich, is static or intermittent traction thought to be more effective?

A
  • Static
55
Q

If a patient’s symptoms do not centralize or peripheralize with any movement, do not occur distal to the knee, and are recent onset (< 16 days), what is their treatment bsaed classification?

A

Manipulation

56
Q

If a patient has:

  • An average SLR ROM of 103
  • Aberrant movement in active lumbar flexion
  • Is 50 years old

What is their treatment based classification?

A

Stabilization

57
Q

If a patient’s symptoms peripheralize with flexion, what is the treatment based classification?

A

Specific exercise

58
Q

What classification do younger patients typically fit into?

A
  • Stabilization
59
Q

How does classification into treatment based classification typically affect outcomes?

A
  • Less PT visits
  • Less pain and disability (ODI)
  • Decrease in medications, injections, and MRI at 1 year follow up
60
Q

What are the 5 treatments for Stage II LBP?

A
  • Motor control
  • Strength
  • Endurance
  • Flexibility
  • Psychosocial education (hurt does not equal harm. We are not damaging tissues)
61
Q

What are the 3 elements of stage III LBP treatment?

A
  • Psychosocial (Know pain or no gain)
  • Gradual exposure to higher level function
  • Continue to address impairments

MS II (20 decks)

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