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Intervention techniques > LBP > Flashcards

LBP Flashcards

1
Q

Pain generators of LBP

A

any structure that is innervated can produce symptoms

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2
Q

Radicular pain is described as
Somatic pain in described as
Nerve root compression typically …

A

sharp and well defined
poorly localized aching pain
does not cause pain

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3
Q

a range of symptoms produced by the pinching of a nerve root in the spinal column

causes?

A

radiculopathy

radiating paresthesia, numbness, weakness, combination

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4
Q

Parasthesia

A

Tingling or prickling, “pins-and-needles” sensation

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5
Q

a form of low back pain, caused by chemically or mechanically damaged intervertebral discs.

A

discogenic

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6
Q

Systemic sources of LBP (4)

The patient may have a

A

Kidney stones
Prostatitis
Tuberculosis
UTI

history of recent trauma
or a past medical history or urinary tract infections - alert the clinician

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7
Q

Red flags for LBP (4)

Yellow flag

A

Cancer
Kidney disorders
Cauda equina syndrome
Liver disease

Depression

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8
Q

a new and abnormal growth of tissue in some part of the body, especially as a characteristic of cancer

A

neoplasms

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9
Q

Diagnosis for a young individual with LBP

old?

30-50?

A
  • neoplasms, atypical disk lesions, spondylolithesis
  • vertebral metastasis, prostate cancer, stenosis, osteoporosis
  • disk herniation, degenerative spondylolithesis, facet joint dysfunction
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10
Q

Spinal stenosis

A

when the spaces in the spine narrow and create pressure on the spinal cord and nerve roots

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11
Q

Factors that may impact outcomes of treating LBP (4)

A

smoking
obesity
age greater than 40
sciatic pain

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11
Q

Things to consider for questioning a patient with LBP (7)

A

location
onset
prior history/ treatment
medications
progression
symptoms
severity

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12
Q

Systematic back pain is not relieved by …
People with systemic back pain tend to …
Almost all clients with regional or non-specific backache …

A

lying down
move
seek the most comfortable position and stay there

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13
Q

In particular ______ diseases, such as (3) often present with a systemic backache that causes the patient to curl up and sleep in a chair, or to pace at night

A

visceral diseases such as pancreatic neoplasm, pancreatitis and posterior
perforating ulcers

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14
Q

People with this lesion try to sleep in a chair and often pace at
night.

A

Cauda equina tumor

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15
Q

to move or proceed with twists and turns

A

writhe

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16
Q

Back pain that is unrelieved by rest or change in position,
or pain that does not fit the expected mechanical or neuromuscular pattern should serve as

A

a red flag

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17
Q

When the symptoms cannot be reproduced, aggravated, or altered in any what during the examination

A

additional questions to screen for medical disease are indicated

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18
Q

long standing night pain unaltered by position changes suggests a space occupying lesion such as

A

a tumor

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19
Q

the risk of certain diseases associated with back pain increases with advancing age such as

A

systemic disease and neoplastic disorders

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20
Q

A possible sign of lumbar metastases (often in an elderly patient)

It is unusual for someone younger than _____ to have a disk herniation

A

a month or two of increasing backache

mid 20s

21
Q

When back pain is ______________ referral to a physician is necessary.

A

severe or chronic pain
and fever

22
Q

Back pain may be localized _________. The
stronger the pain stimulus …
The area should be identified
on …

A

centrally, unilaterally, or bilaterally.
the larger the area of pain.
on a pain diagram.

23
Q

Discogenic low back pain is the primary cause of ….
characteristics?

A

-chronic low back pain (lasting more than 3 months)
-often dull and achy (may be sharp), shooting leg pain, numbness, and weakness are NOT, often tight hamtrings and hip flexors

24
Q

An anterior displacement of one vertebra over another

A

Spondylolithesis

25
Q

Cushing’s syndrome results from ….
this causes

A

from overactivity of the adrenal gland,
with consequent hypersecretion of glucocorticoids.

demineralization of bone, and in severe cases, may lead to pathological fractures, bone pain, kyphosis

26
Q

It is essential to review the medial history regarding ________ when
assessing back pain, especially back pain of an insidious onset, whether gradual or sudden

A

previous cancer

27
Q

The most common malignant primary bone tumor

A

Multiple myeloma

28
Q

Skeletal metastasis – usually from the (5) are much
more common that primary bone cancer.

A

usually from the breast, thyroid, lung, kidney, or prostate

29
Q

Oswestry Low Back Pain Disability questionnaire

A

The questionnaire contains 10 sections related to activities of
daily living and pain on the day the person is seen in the clinic. Each section has a statement that is scored on a 0 – 5 scale. The higher the score, the more impact the low back pain has on the patient’s activities. A higher percentage suggests a greater perceived
level of disability.

29
Q

Different indications of pain:
bony source
muscle or fascia source
nerve source
vascular source
visceral source

A

b: deep ache
m: dull achy, sore, burning/cramping
n: sharp, shooting, tinging, burning
vas: burning, stabbing, tingling
vis: deep pain, cramping, stabbing

30
Q

Centralization of symptoms?

centralization is considered to be …? it typically indicates

A

the progressive centralizing of the symptoms toward the midline in response to standardize movement testing

a positive sign for discogenic symptoms, disc involvement

31
Q

Peripheralization

A

the symptoms are spreading with repeated movements

32
Q

Depression as a yellow flag for low back pain

A

May occur with a patient who presents with only somatic complaints without associated physical impairments or a
patient whose depressive symptoms are severe or extreme

32
Q

Fear avoidance beliefs as a yellow flag of low back pain

A

patients with elevated fear-avoidance beliefs are more likely to use an avoidance response to their low back pain, resulting in the development of an exaggerated pain perception and chronic disability

33
Q

Pain catastrophizing as a yellow flag of low back pain

A

a negative cognition related to the belief that the experienced pain will inevitably result in the worst possible outcome

34
Q

How is a slump test performed
What is considered a positive test (2 ways)

A

seated SLR, neck flexion, and lumbar slumping

If extending the knee causes pain, have the patient extend the neck into neutral. If the patient is still unable to extend the knee due to pain, the test is considered positive

If extending the knee does not cause pain, ask the patient to actively dorsiflex the ankle. If dorsiflexion causes pain, have the patient slightly flex the knee while still dorsiflexing. If the pain is reproduced, the test is considered positive.

35
Q

How is SLR test performed
What should this provoke

A

-The patient is positioned supine with no pillow. The trunk and hip should remain in the neutral position. Each leg is raised individually with the
examiner holding the patient’s heel in neutral until tension is felt. (dorsiflexion and cervical flexion added)
-radicular signs

36
Q

How is a thomas test performed
Positive test?

A

Examiner helps to lay the patient onto the table
Low back and sacrum are flat on the table
The non-test leg is in 90 degrees of hip flexion (perpendicular to the table)
Test leg is being held in the arms of the patient

when extended leg lifts of table, or an extended lower leg

37
Q

If the flexion position or moving into flexion brings relief

A

possible causes are facet joint dysfunction, low back muscle strain, or lateral stenosis

38
Q

If the extension position or moving into extension bring relief

A

possible causes are disc or nerve root irritation

39
Q

If rest provides relief

A

a possible cause is neurogenic claudication

40
Q

Once the relieving motion or position is identified…

A

the patient can be
instructed on strategies using the motion or position

41
Q

3 stages of the second classification of the treatment based classification approach

A

Stage 1: patient is classified into stage one by an inability to perform basic mechanical
functions, such as standing, walking, and sitting. In this stage, intervention is aimed at
symptom relief

Stage 2 : patients are able to perform basic mechanical functions, but lack the ability to perform basic functional activities of daily living. Interventions include pain modulation and techniques to reduce physical impairments.

Stage 3 : patients are planning on returning to an activity that requires a high degree of
physical demand. These individuals are often asymptomatic, but are generally deconditioned due to inactivity.

41
Q

The treatment-based classification approach was proposed by Delitto and provides a guide
for the determination of optimal treatment. The first and second level …

A

first: to determine if the patient is appropriate for physical therapy intervention or should be referred.
second classification has three stages

41
Q

The movement system impairment syndrome approach dictates that

The systematic examination consists of tests of

Treatment is aimed at

A

the clinician performs an examination that identifies the movement direction that most consistently causes pain, the associated movement impairment, and the contributing factors

trunk motion and limb motions performed
in a variety of postures

corrective exercises and modification of functional
activities, a cautious progression of repeated forces and loads is used in this method “corrective mechanical directional movement”

42
Q

Compare and contrast chemical vs mechanical pain

Morning or nocturnal?
When does pain occur?
Does rest relieve it?
Duration of morning stiffness?

A

Chemical: constant or continuous nocturnal, pain is unaffected by rest, night pain may disturb sleep, morning stiffness lasting longer than 2 hours

Mechanical: intermittent, eased by rest, can sleep without waking from pain, morning stiffness lasting less than a few minutes and relieved with appropriate activity

43
Q

Typical ROM for lumbar spine F,E,SB,AR

A

Flexion: 50 – 70 degrees
Extension: 10 – 30 degrees
Side bending: 25 – 35 degrees
Axial rotation: 20 – 40 degrees

44
Q

Midrange isometric resistance test findings

Strong and painful
Weak and painful
Weak and painless
Pain with repeated contractions

A

S&P: a minor contractile lesion, for example, such as a tendinopathy.
A nerve entrapment may also present with this finding.
W&PF: suggests the presence of a major contractile lesion that produces
symptoms and disrupts the force producing capacity of the muscle
W&PL: suggests a neurological deficit, or a full thickness tear of the muscle unit
RC: may indicate the presence of a minor contractile lesion

45
Q

Stages of healing for McKenzie
Week 1
Week 2-4
Weeks 5+

the patient is treated through…

A

Injury and inflammation: decrease inflammation, relative rest, protected movement with little to no stress (pain free range of motion!!)
Repair and healing: work into stiffness, patient in control of forces of pressure to end range, progressive return to normal loads
Remodeling: prevent contracture by increasing tensile load to tissue, return to full ROM and full functional level, overpressure applied to end range of repeated movements by therapist or patient

active extension, posture correction in sitting and standing, and extension mobilization

46
Q

What are the typical ROM and end feels for lumbar motions?

A

Flexion: 70-90 (soft tissue stretch, firm)

Extension: 30-50 (bony or tissue stretch)

Side bending: 30(soft)

Rotation: 35 (tissue stretch)

Intervention techniques (10 decks)

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