L Spine Exam & Eval

Question 1

L spine physical exam must include assessment of NMSK and vascular structure of

Answer 1

L spine
pelvic region
hip region
LEs

Question 2

which back/abdominal related impairment is suspect for 10-20 yo?

Answer 2

spondylolisthesis

Question 3

which back/abdominal related impairment is suspect for >65 yo?

Answer 3

cancers
compression fxs
stenosis
AAA

Question 4

which back related impairment is suspect for 15-40 yo?

Answer 4

disc herniation/dysfunction

Question 5

which back related impairment is suspect for >45 yo?

Answer 5

OA/spondylosis

Question 6

T/F: most pts with acute LBP present with at least one red flag (>80%)

Answer 6

T

Question 7

what is the ultimate goal of treating LBP?

Answer 7

self-management by the pt

Question 8

which approach works better with spine dysfunction: structure-based (Cyriax) or Treatment-based (McKenzie & Maitland)

Answer 8

Treatment-based (McKenzie & Maitland)

Question 9

piriformis syndrome is typically a diagnosis of

Answer 9

exclusion

Question 10

which motions increase sx with piriformis syndrome?

Answer 10

stooping or lifting

Question 11

spondylolysis is a defect in the

Answer 11

pars interarticularis (isthmus)

Question 12

which level does spondylolysis usually occur?

Answer 12

L5

Question 13

which position does spondylolysis pts prefer?

Answer 13

flexion

Question 14

list the susceptibility to compression of spinal structures in order of most to least

Answer 14

END-PLATE
vertebral body
disc

Question 15

disc protrusion

Answer 15

disc bulge without annulus fibrosus rupture

Question 16

disc prolapse

Answer 16

only outer layers of AF contain NP

Question 17

disc extrusion

Answer 17

AF perforated and disc material moves into epidural space

Question 18

disc sequestration

Answer 18

disc fragments from AF & NP disconnect

Question 19

sx of end-plate fx

Answer 19

acute pain/spasm
- SLR
+ compression test

Question 20

sx of internal disc disruption

Answer 20

LBP and/or referred hip/upper leg pain
- SLR
dx with discogram

Question 21

sx of disc protrusion and prolapse (contained)

Answer 21

LBP and/or referred hip/upper leg pain
pain w/ cough & sneeze
- SLR

Question 22

sx of disc extruision and sequestration

Answer 22

LBP
pain with cough and sneeze
TRUE SCIATICA (radicular pain)
+ SLR

Question 23

nerve compression (via disc) usually affects which nerve root

Answer 23

lower segment
Ex: L4/L5 –> effects L5

Question 24

S&S of spinal stenosis

Answer 24

persistent buttock pain
limping
lack of sensation in LEs (claudication)
decreased walking/standing ability

Question 25

is localized or referred pain more common with facet joint dysfunction?

Answer 25

localized

Question 26

what is the hallmark sign in instability (for any joint)?***

Answer 26

inconsistent symptomology

Question 27

how is fibromyalgia diagnoses?

Answer 27

11/18 tender points w/o other reason for tenderness

Question 28

when is herpes zoster contagious?

Answer 28

when sores open and oozing

Question 29

what rash is in a dermatomal pattern?

Answer 29

herpes zoster

Question 30

impairments with acute or sub-acute LBP with mobility deficits

Answer 30

segmental or global hypomobility pain in back, buttock, groin, or thigh impaired functional movements - neuro test!! onset of sx < 3 mo

Question 31

impairments with acute, sub-acute, or chronic LBP with movement coordination impairments

Answer 31

pain worsens with end range movements + prone instability test

Question 32

impairments with acute LBP with referred LE pain

Answer 32

+ repeated measures test onset of sx < 3 days hypo or hyper mobile

Question 33

impairments with acute or sub-acute LBP with radiating pain

Answer 33

+ neuro exam + neurodynamic tests + repeated measures tests radiating pain in dermatomal pattern

Question 34

impairments with acute or sub-acute LBP with related cognitive or affective tendencies

Answer 34

inconsistent MSK exam results onset of sx <3 months + Waddell's test high FABQ scores

Question 35

impairments with chronic LBP with related generalized pain

Answer 35

no structural issue for pain inconsistent with MSK dysfunction changes in brain & sensory structures onset of >3 mo high FABQ scores

Question 36

manual therapy criteria

Answer 36

no sx distal to knee less than 16 days score of less than 19 on FABQ-W at least 1 hypomobile segment in L spine at least 1 hip w/ >35 deg IR

Question 37

stabilization criteria

Answer 37

<40 yo post-partum SLR >91 deg instability catch or aberrant movements during flx/ext ROM + prone instability test

Question 38

post-partum criteria for instability

Answer 38

+ posterior pelvic provocation + ASLR + modified Trendelenburg test OR pain with palpation of long dorsal SI lig or pubic symphysis

Question 39

criteria for extension direction-specific

Answer 39

sx distal to buttock symptoms centralize with L ext symptoms peripheralize with L flx direction preference for ext

Question 40

criteria for flexion direction-specific

Answer 40

>50 yo directional preference for flex L spinal stenosis

Question 41

criteria for lateral shift direction-specific

Answer 41

visible frontal plane shift of shoulders relative to pelvis directional preference for lateral translation movements of pelvis

Question 42

T/F: pt does not have to have radiating pain for directional preference category

Answer 42

F

Question 43

interventions manual therpay category

Answer 43

lumbopelvic HVLAT L and LE ROM exercises

Question 44

interventions for stabilization

Answer 44

- isolated contraction and co-contraction of deep stabilizer (multifidi and TA) - strengthen large spinal stabilizers (ES, internal & external obliques)

Question 45

interventions for extension preference

Answer 45

end range extension exercises mobilize to promote extension avoid flexion

Question 46

interventions for flexion preference

Answer 46

mobilize & manipulate spine strength & flexibility exercises body-weight supported treadmill training (non WB exercises)

Question 47

interventions for lateral shift preference

Answer 47

exercises to correct lateral shift traction

Question 48

which impairment must be addressed first before categorizing (if present)?

Answer 48

lateral shift

Question 49

____% of patients fit >1 classification group

Answer 49

25%

Question 50

presence of ___ & ______ weaken a treatment effect

Answer 50

psychosocial factors & co-morbities