L34: Exam Info Lecture Flashcards
What happens when you can’t tolerate prone?
Do PAIVMs in sidelye or PPIVMs in sidelye (this is better)
What is the difference between repeated movements and directional preference?
- With acute LBP –> Into a position helps with your pain
- What we are looking for
- Repeat movements and reassess
- Pain management
- Exercises to directional preference
What are the 2 purposes of PAVIMs?
- The ‘reactivity’ or pain associated with movement of the vertebral segment
- The mobility of the segment
What grade for PAIVM assessment is used?
- The ‘reactivity’ or pain associated with movement of the vertebral segment
- The mobility of the segment
- Compared to above and below
So… if the patient’s pain is severe and irritable, we might only need information from #1. This only requires ENOUGH stimulus to ascertain if this is the patient’s symptoms – so could range from grade 2 through to 4.
If we want to ascertain information on #2, we need to put enough pressure through to compare it to other movement segments.
How do I differentiate nerve pain from muscle pain?
This is the sensitising manouver – it helps to differentiate between hamstring or calf and neural tissue.
To differentiate hamstring and nerve – we add dorsiflexion.
To differentiate calf and nerve – we can bring the leg back down to neutral (out of hip flexion) and add dorsiflexion and the calf would bring on symptoms with leg down and leg up. Nerve would only give symptoms with leg up in hip flexion (demonstration)
What are 2 situations to use combined/quadrant tests in AROM exam?
- Only if AROM is pain free (With overpressure)
- If AROM is relatively mild, and you want to see if adding another component of the movement makes it worse to determine that that movement (ie extension rotation) is the problematic movement
We wouldn’t use it if the patient is irritable or has a significant loss of ROM
Flexion quadrant: picking up things from the ground
Extension quadrant: gymnastics
Why am I measuring AROM?
As a baseline and re-assessment
What are 4 reasons why we measure AROM?
- So that we can objectively see if the patient is getting better or worse with treatment and/or time.
- To see if there are side to side differences
- So that we can communicate with other health professionals (even insurers etc) and to help with documentation about the patient
- To demonstrate to the patient that they are getting better
- Track improvements –> Can sometimes have slow improvements in persistent pain –> can give patient some encouragement
Why is the Thomas test used in assessment of LBP?
Biomechanically…..a lack of hip extension ROM means the patient is required to have more lumbar extension to compensate on functional tasks.
So…walking, standing, running etc is an issue – especially in spinal stenosis or spondylolysis, we can see if a lack of hip extension is a contributing factor
When is Thomas Test done in assessment?
Not a priority day 1
When are sliders used in neurodynamics?
In most cases. (eg. Radiculopathy)
To reduce sensitivity of nerve, to reduce threat/fear associated with nerve symptoms. To improve physiological movement of nerve
Start with a slider because nerve tissue can be irritable and flare up
When are tensioners used in neurodynamics?
Where Mechanosensitivity may be contributing to a pain presentation
Not a natural progression from slider. Most people will be managed just with slider.
- Nerve pain can go way quite quickly –> if nerve pain resolves –> do not need to progress
Very low irritability and severity present to use.
How to explain neurodynamic exercises?
These are to reduce pain and sensitivity of the nerve.
Explain to the patient that you found there was sensitivity with moving the nerve (from your tests) and the exercise is to help reduce the sensitivity of the nerve and to allow it to move more easily.
Link explanations back to subjective –> how technique/management is relevant to their problem
Few times a day –> at home (depending on how they can fit it in their day)
What are 2 progressions of directional preference exercise for flexion and extension?
Pain management strategy for acute LBP and radiculopathy
- Often don’t require many ‘progressions’ as they are used in the short term or to relieve symptoms during exacerbations
- As they are not ‘strengthening’ exercises, progressing is not a huge priority
However, as the patients range and symptoms improve…
Extension:
- Starting prone, progressing to standing (and progress repetitions as they improve)
- If they can go on prone –> standing is quite hard –> progression –> standing
Flexion:
- Starting in supine – knees to chest, progressing to 4 point kneel (Sit onto heel), progressing to standing (some patients may tolerate all of these)
- Some people will not tolerate = repeated flexion in standing
What are 2 situations where patients brace and breath-hold?
- Acute low back pain where there is high levels of pain (not habitual or maladaptive)
- Those with maladaptive habits with fear avoidance and/or protective responses- Persistent pain
With those with acute low back pain, we can make them aware of it but will likely get better as they improve
- Give some adjustments to help with comfort for acute phase –> should settle
With the latter, addressing this should be a priority – address these behaviours cognitively (through education and advice and making them aware) and through exercise.
- Making them worse –> cognitive re-structuring and specific exercises wo/breath holding and bracing
