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PHTY2220 > L7: Lateral Shift and Intro to Pelvis > Flashcards

L7: Lateral Shift and Intro to Pelvis Flashcards

1
Q

How is radiculopathy diagnosed clinically?

A

No single tets

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2
Q

SLR has ____ (high/low) sensitivity, ____ (high/low) specificity. ______ (everyone/some people/very little people) with radiculopathy will have pain on SLR

A

high; low; everyone

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3
Q

_____ will sometimes be referred to as a ‘diagnostic’ test for Radiculopathy – but we use it to assess mechanosensitivity in a number of presentations

A

SLR

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4
Q

Neurological symptoms are a ______ to using Neurodynamic tests

A

precaution

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5
Q

What is assessed in the neurological assessment?

A

Conduction of nerves (whether they are sending messages normally)

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6
Q

What is assessed in the neurodynamic assessment?

A

mechanosensitivity

Whether your nerves are moving and how sensitive they are

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7
Q

What is the purposed of the neurodynamic assessment?

A

Used to gain an impression of neural tissue mobility and sensitivity to mechanical stress.

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8
Q

The presence of a ‘positive’ test in the neurodynamic exam does not enable the clinician to identify the ______ of neural tissue compromise; it indicates an increased amount of _______. It also doesn’t always accurately differentiate between _____ and _______(muscle, fascia, connective tissues) structures as these are largely a continuous system

A

specific site; mechanosensitivity; neural; non-neural

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9
Q

Patients with higher fear avoidant behaviours are more likely to have _____ (higher/lower) pain responses on neurodynamic testing

A

higher

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10
Q

A _____ is a common clinical observation associated with low back pain

A

lateral shift

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11
Q

What is a lateral shift described as?

A

Described as a vertebra rotated and laterally flexed (Away from the spine) in relation to the vertebra below. when the patient’s body is, either actively or reflexively, avoiding nerve root related pain through muscle spasm.

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12
Q

Can be towards the dominant side of pain (_____) or away (_____).

A

ipsilateral; contralateral

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13
Q

The majority of affected patients have a _____ (ipsilateral/contralateral) shift.

A

contralateral

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14
Q

Very occasionally, the lateral shift may change from __to ____.

A

side; side.

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15
Q

Must try and _______ the lateral shift when it is detected during the physical exam.

A

correct

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16
Q

The lateral shift is similar to _______ movement exam (treatment direction test).

A

repeated

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17
Q

How is the assessment of the lateral shift done?

A

visually assessing the patient.

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18
Q

Most patients respond rapidly to correction, especially if the shift is _____ (ipsilateral/contralateral)

A

contralateral

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19
Q

Correction of lateral shifts has been shown to result in superior outcomes compared to a ______ treatment of manual therapy and education

A

control

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20
Q

Why is important to correct lateral shift?

A

• Better short term outcome Able to manage their pain

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21
Q

What are 2 ways to correct a lateral shift?

A
  1. self-correction
  2. manual correction.
22
Q

What are the 4 steps in correcting a lateral shift?

A
  1. Patient stands with side that the shift is occurring to against wall with elbow on wall (or arm by side). Opposite hand on hip
  2. Gently leans hips of involved side towards the wall, holds for a few seconds and then returns – preferably only back to midline.
  3. Likely to be uncomfortable – continue if centralisation of symptoms are occurring and increased ROM/reduction of shift
  4. Reassess regularly – observation and ROM – patient can self observe in mirror
23
Q

What are 3 reasons why it is good to get them to self correct rather than the physio?

A
  1. Can use this as a management exercise for home program
  2. They can go within their own boundaries of pain (physio might aggravate symptoms)
    • Can progress within boundaries
  3. Give them self-efficiency, give them confidence as they can self-manage
24
Q

What are 3 characteristics of self-correction of lateral shift?

A
  1. Perform during the physical assessment – reassess with ROM and observation
  2. Get patient to self-detect using mirror and show them how to self correct
  3. Repetitions: consider 5-20 as needed (hold for 1-2 secs and back to normal), VERY gradual – discomfort can be ok – as long as symptoms are improving
25
Q

What is the 2 characteristics of manual correction of lateral shift?

A
  1. Same graduated/repeated movement as self-correction, applying over-pressure
  2. Likely to be uncomfortable – continue if centralisation of symptoms are occurring and increased ROM/reduction of shift
26
Q

What are lumbar coupled movements?

A

Rotation away and side flexion away

27
Q

What are 3 movements of the pelvis?

A
  1. Anterior/posterior rotation (also known as pelvic tilt)
  2. Lateral rotation (also known as pelvic drop)
    • Important for persistent and overuse injuries of spine
  3. Transverse rotation (also known as pelvic rotation)
28
Q

What plane is anterior/posterior pelvic rotation?

A

Sagittal plane

29
Q

What plane is lateral pelvic rotation?

A

Frontal plane

30
Q

What plane is transverse pelvic rotation?

A

Transverse/horizontal plane

31
Q

What movements are commonly coupled with pelvis and hips?

A

Eg

  • Hip flexion, extension
  • Pelvic anterior/posterior hip
32
Q

What are 4 characteristics of nutation (sacral locking)?

A
  1. Base of sacrum moves into pelvis- stable position of sacrum with maximal ligament & bone contact
  2. Inferoposterior glide of articular surface of sacrum on ilium
  3. Iliac bones approximate, ischial tuberosities spread
  4. Limited by interosseous, anterior sacroiliac, sacrotuberous and sacrospinous ligament
33
Q

What are 2 bilateral characteristics of nutation?

A
  1. Early trunk extension
  2. EOR trunk flexion
34
Q

What is a unilateral characteristic of nutation?

A

Hip flexion

35
Q

What is the mechanism of injury of nutation?

A

Traumatic injury

36
Q

What are 4 characteristics of counter-nutation (sacral unlocking)?

A
  1. Backward motion of base of sacrum out of pelvis
  2. Anterosuperior glide of articular surface of sacrum on illium
  3. Iliac bones separate, ischial tuberosities approximate
  4. Limited by long post sacroiliac ligament and multifidus contraction
37
Q

What are 2 bilateral characteristics of counter nutation?

A
  1. Early trunk flexion
  2. End of trunk extension
38
Q

What is a unilateral characteristics of counter nutation?

A

Hip extension

39
Q

What is the mechanism of injury of counter-nutation?

A

Single leg landing

40
Q

What are 3 characteristics of lumbar flexion?

A
  1. Anterior rotation of innominate bilaterally around HOF (hip flex)
  2. Anterior translation of lumbar spine (L5) on sacrum
  3. Sacral nutation
41
Q

What are 3 characteristics of lumbar extension?

A
  1. Anterior shift of COG Posterior translation of lumbar spine (L5) on sacrum
  2. Sacral nutation slightly through range.
  3. Sacral counternutation at EOR lumbar extension.
42
Q

What are 2 characteristics of lateral flexion, rotation and gait?

A
  1. Intra-pelvic twisting
  2. Sacrum torsions in response to reciprocal AP rotation of innominate
43
Q

What is a characteristic of hip flexion?

A

Posterior rotation of innominate.

44
Q

What is a characteristic of hip extension?

A

Anterior rotation of innominate.

45
Q

What is the normal ROM of SIJ rotation?

A

>4 degrees

46
Q

What is the normal ROM of SIJ translation?

A

=< 1.6 mm

47
Q

What is the definition of form closure?

A

Form closure is a stable situation with closely fitting joint surfaces, where no extra forces are needed to maintain the stability.

48
Q

What are the 5 structures responsible for form closure?

A
  1. Joint surfaces
    • Type of cartilage
    • Ridges and grooves
  2. A/P wedging of the sacrum
  3. Friction co-efficient
  4. Integrity of ligaments
  5. Explain the anatomy to provide reassurance if patient worries about SIJ stability.
49
Q

What is the definition of force closure?

A

Force closure is a stable situation where extra forces are needed to maintain the stability

50
Q

What are 2 structures responsible for force closure?

A
  1. Muscles: No muscles directly attach to SIJ, but many overlie the area. Tendinous origins may blend close to joint line.
    • Posterior oblique system: Gmax, latissimus dorsi, thoracolumbar fascia.
    • Deep longitudinal system: Erector spinae, deep lamina of thoracolumbar fascia, sacrotuberous ligament & biceps femoris (ipsilateral hamstrings).
    • Anterior oblique system: Oblique abdominals, contralateral adductors.
    • Lateral system: Gmed/min, contralateral adductors - important for WB. •Can strengthen these muscles to increase pelvic stability.
  2. Fascial system
51
Q

What are 5 characteristics of muscles of force closure?

A
  1. Posterior oblique system: Gmax, latissimus dorsi, thoracolumbar fascia.
  2. Deep longitudinal system: Erector spinae, deep lamina of thoracolumbar fascia, sacrotuberous ligament & biceps femoris (ipsilateral hamstrings).
  3. Anterior oblique system: Oblique abdominals, contralateral adductors.
  4. Lateral system: Gmed/min, contralateral adductors - important for WB.
  5. Can strengthen these muscles to increase pelvic stability.

PHTY2220 (31 decks)

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