LBP with Mobility Deficits Flashcards
Pathoanatomy
What is the proposed underlying cause of this condition?
Spondylosis (degeneration)
- Gradual Progression of age-related joint changes
- Adaptive shortening of the joint connective tissue and periarticular soft tissue
Sprain/Strain
- Acute onset sudden awkward movement
- Muscle strain and/or ligament sprain
- Primary/Secondary disk-related condition
- Intra-articular meniscus entrapment
What is the DD that should be considered?
- LBP with cognitive and affective tendencies
- LBP with generalized pain
- LBP with movement coordination impairment
- LBP with radiating pain
- LBP with referred pain
What system, structure, pain mechanism, and Phase of healing is unique to this patient presentation?
System: MSK
Structure: Zygapophyseal joint and periarticular soft tissue
Pain Mechanism: Nociceptive
Phase of Healing: Muscle strain 2-4 weeks, ligament sprain and cartilage injuries 10-12 weeks
Subjective Exam
What are General Sx with Pts with Mobility Deficits?
- Central or Unilateral Sx
- Possible (somatic reffered) UE pain
- Dull ache at rest that becomes sharp with movement
Subjective Exam
What are common subjective reports for Spondylosis?
Gradual onset with progressive loss of motion
Subjective Exam
What are common subjective reports for Sprain/Strain?
- Immediate onset of pain and loss of motion
- Recent unguarded/awkward movemtn or position
Subjective Exam
What are some Agg/Easing Factors for this patient?
Agg
- Dull ache and stiffness with inactivty
- Sx reproduced with active movment
Ease
- Staying active and changing positions
- Progressive lumbar spine movement
Whats the 24hr pain behavior for this patient?
Morning
- May have pain and stiffness that is worse upon waking that eases with activity and movement
Noon to evening
- Sx may vary throughout the day depending on the patients activities, may have increased pain and stiffness after being sedentary
Night
- Sx may disrupt sleep with changing positions depending on sx irritability
Physical Exam
As indicated from the subjective exam, What takes part of the Systems Review?
Cardiopulmonary
- Vitals: BP, HR, Distal pulses
Urogenital/GI
- Assess for mechanical reproduction of Sx and/or adverse response to movement (AROM, PIVM, Compression/Distraction, Neurodynamics tests
Neuromusculoskeletal
- Reflexes/pathological reflexes
- Dermatomes/myotomes
Physical Examination
During the Movement and Provocation Exam, what may you find during AROM and PIVM?
AROM
- Lumbar ROM limitations and Sx provocation consistently reproduce at END RANGE
- Sx provocation with the addition of overpressure and/or combined motions
PIVM
- Hypomobility at the thoracolumbar and lumbosacral spine
- Hypomobility of the involved segment(s) with local and/or somatic referred Sx reporduction
Physcial Exam
With the Movement and Provocation Exam, what is the Lumbar Quadrant Test?
This is a good Screening Assessment for Lumbar Facet Joint Pain which involves active or passive Lumbar extension, ipsilateral sidbending and ipsilateral rotation with the patient standing.
However it does not perform well at ruling in facet joint pain
Physical Exam
During the Movement and Provocation Exam, what should we test at the Hip?
AROM and PROM
- Hip Flexion and Extension
- Hip IR/ER
Limited Hip Flexion and Extension can translate into the lumbar spine during sagittal plane motions and positions.
- Ex. Patients with limited hip extension will require increased lumbar extension in order to become fully upright. Patients with increased pain with lumbar extension benefit with improved hip extension to reduce the amount of lumbar extension that is needed for standing and walkin
During the Movemen and Provocation Exam, what is done before doing the Laslett Provocation Cluster to rule in/out SI issues?
Lumbar Screen:
- AROM => AROM with overpressure
- Combined motions (quadrant)
- Repeaded motions/sustained positions
- PAIM test
- Neurodynamic Testing
This lumbar screen has test that attempt to alleviate or provoke Sx from the thoracolumbar and lumbosacral segments from T10 to L5-S1. Once the lumbar spine is clear, greater confidence in the laslett cluster is achieved. When Sx do not centralize, moving from a small shift to moderate shift that the source of pain is in the sacroiliac joint
After doing the Lumbar Screen and you find that the symptoms Do Not Centralize, you can perform Laslett Provocation Cluster. What takes place in this cluster?
- Thigh Trust (Most Sensitive)
- ASIS Distraction (Most Specific)
- ASIS Compression
- Sacral Thrust
- Gaenslen’s Right (Only in the 6-item test)
- Gaenslen’s Left (Only in the 6-item test)
The first 4 test are part of a 4-item cluster, once there is 2/4 (+) there is no longer need for further testing and SIJ pain is suspected
During the Muscle Performance Exam, what muscles are we MLTing and what may be expected?
- Hamstrings, Piriformis, Iliopsoas, Rectus Femoris, QL
- Limited length of the lembopelvic musculature
