L3 Thoracolumbar Exam Flashcards

1
Q

categorize impairment based on need for

A

symptom modification
movement control
functional optimization

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2
Q

Categorize based on response to

A

manipulation
stabilization
traction
directional preference

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3
Q

Manual skills are good but

A

not site specific
audible pop doesn’t always happen
manipulations are safe

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4
Q

For non-specific LBP

A

manipulation
traction
stabilization
directional preference
SI joint dysfunction

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5
Q

LBP with known pathology or dysfunction

A

Refer and Treat

stenosis
spndyolisthesis
scoliosis
post-operative

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6
Q

LBP with potentially serious pathology

A

Refer

tumor
infection
fracture
AAA
visceral
Cauda Equina Syndrome

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7
Q

Natural Course of LBP

A

16% are sick listed due to LBP at 6 mo
60% report relapses
33% need a break from work again
2x risk of LBP w/hx of LBP

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8
Q

Thoracolumbar RF for Acute Episode

A

-Female
-Individuals with monotonous jobs or lots of lifting
-previous significant episodes of LBP
-weak spinal extensors (<58s on Sorenson’s)
-Not associated with ROM

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9
Q

Thoracolumbar RF for development of Chronic LBP

A

age
obesity
smoking
higher levels of baseline disability
depression/anxiety
non-concordant care

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10
Q

Who may not get better from LBP

A

-persistent LBP prognostic factors or non recovery at 3 mo
-> 45 years of age
-smokers
-2 or more neuro signs
-high scores on psychological screening
-high levels of distress

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11
Q

Altered Lumbopelvic Rhythm

A

forward bending = hip motion > than lumbar spine motion during the first 1/3 of movement OR lumbar spine motion > hip motion during last 1/3 of movement

standing up = lumbar motion > hip motion in first 1/3 OR hip motion > lumbar motion in last 1/3

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12
Q

Gower’s Sign

A

return to upright stance performed by using hands to climb up the thighs

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13
Q

Deviation from sagittal plane

A

movement away from the primary sagittal plane, including rotations and/or lateral flexion

movement lasting more than a few degrees of primary sagittal plane movement

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14
Q

Instability, catch, shake, judder

A

sudden acceleration, stop, or deceleration; observations of a momentary quiver, vibration, shake seen in the paravertebral muscles or brief out of plane movements

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15
Q

Painful arc of motion

A

pain noted by patient that increases through a portion of total arc of movement, general increase in pain throughout the motion does not constitute painful arc

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16
Q

Functional Testing for Thoracolumbar

A

single leg balance
squat
step down

17
Q

Vertical Compression Test

A

-patient standing relaxed
-PT applies downward force through pts shoulders
-look for buckling and/or pain
-retest after intervention/re-education

standing stability test

18
Q

Elbow Flexion Test

A

standing stability tests

force must be straight down

assesses how much force they can withstand, buckling, pain

retest after intervention/re-education

19
Q

Hip Clearing Tests

A

Squat
FABER
FADIR

20
Q

Prone Instability Test

A
  1. find the painful segment during PA testing with feet on ground, paraspinals relaxed
  2. repeat PA with bilateral hip extension

Positive test if S/S are reduced with LE extended

this combined with aberrant movement increases likelihood pt will positively respond to lumbar stabilization

21
Q

SI Joint Provocation Tests

A

Thigh thrust, distraction, compression, sacral thrust, Gaenslen’s

if the first two are positive, no further tests are needed

if one test is +, add compression

after compression is negative, add sacral thrust

if 3+ are positive, high SN/SP for SIJ pathology

22
Q

Key Exam Findings for Manipulation/MOb

A
  1. no s/s distal to knee
  2. recent onset (<16 days)
  3. Low FABQ
  4. Lumbar hypomobility
  5. Hip IR PROM >35°
23
Q

Contraindications for Manipulation

A

-patient reported poor/adverse outcome previously
-lack of dx
-lack of proper set up
-unable to find ed range due to pain/resistance
-lack of consent

24
Q

If patient fits the manipulation rule…

A

it will help them feel better quicker/decrease their ODQ score

25
Q

Combo of MT and Exercise…

A

better than MT alone and better than advice to stay active

26
Q

STM prior to SMT…

A

may be helpful for a successful SMT outcome or in patients where SMT is not indicated

27
Q

Massage is effective…

A

in the short term for pain and function but not recommended as a stand-alone tx OR expect long term improvements

does not change ROM significantly, but will help improve comfort

28
Q

Key Exam Findings for Mobs

A
  1. No symptoms distal to knee
  2. Recent onsent <16 days
  3. Low FABQ <19
  4. lumbar hypomobility
  5. hip IR PROM >35°

interventions include mob, manip, AROM, address regional deficits, stabilziation

29
Q

Initial Potential Exercise Interventions following SMT

A

Manual therapy effects can be short lived so its imperative the pt moves more afterwards

movement is what keeps people better