Lecture 2 Flashcards

1
Q

disc pain patient presentation

A
  • muscle guarding
    slightly flexed posture and
  • deviate away from the symptomatic side
  • neuro (derm and myo) but that’s severe.
  • more symptoms with sitting, flexed posture, transition from STS, cough, strain
  • SLR at 30-60 degrees
  • “peripheralization” of sx with repeated forward bending
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2
Q

disc pain vs facet pain?

A

disc- first- “on and off”
facet- “used to be on and off but now it’s just on”

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3
Q

facet pain patient presentaion

A
  • acute: mm guarding
  • subacute and chronic: immobility or excessive activity
  • posture impaired
  • impaired extension
  • any prolonged flexibility exercises or rep of trunk motion may exacerbate sx
  • pain worse in am/pm
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4
Q

2015 TBC update

A

medical management: for red flags, med comorbidities, neurologic deficits

rehab management: med to high psychosocial and minor/controlled medical

self-car management: low psychosocial; predominately axial LBP

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5
Q

patient with nerve root impairment

A

early on, SLR = SLUMP ; pain increasing with flexed posture

later: stenosis

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6
Q

stabilitiy is visualized as a three-legged stool

A
  1. active mm function
  2. passive osteoligamentous structures
  3. neural control from CNS

NEED ALL 3 FOR STABILITY

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7
Q

factors favoring manipulation

A

acute (< 16 days)
no peripheralizaiton
hypomobile
low FABQ (< 19)
Hip medial rotation >35

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8
Q

factors against manipulation

A

Sx below knee
more episodes
peripheralization with motion
no pain w spring testing

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9
Q

factors favoring stabilization

A
  • hypermobile
  • younger
  • SLR > 90
  • Aberrant motion (catches)
  • post partum
  • tender over long dorsal lig
  • pubic symph tender
  • increased episode 3 or more
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10
Q

factors favoring traction

A

S&S of nerve root compressing;

NO MOVEMENT HELPS CENTRALIZE. always peripheralized

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11
Q

flexion preference exercises

A

 Supine with knees flexed
 Single knee to chest
 Double knee to chest
 Posterior pelvic tilt
 Quadruped Cat/camel
 Quadruped rocking backward
 Hamstring stretching
 Trunk curls
 Progression: restore extension in prone or prone over
pillows
 Prone knee bends to stretch hip flexors and quads
 Stabilization exercises in neutral spine

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12
Q

Flexion preference
ADL/Education

A

 Avoid overhead activities & extension
 Standing with one leg on stool/shopping cart
 Sitting with knees above hips
 Endurance/CV training – bike, water aerobics
 Lumbar corset for acute phase?

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13
Q

“flattened spine” =

A

flexion prefernce
(and lordosis/kyphosis posture)

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14
Q

Extension Preference
exercises: Acute

A

Prone lying
 Over pillows
 Lie flat
 Pillow under chest
 Lateral shift correction Prone
 Standing
 Prone on elbows Prone press up Watch
closely! Lumbar ext or posterior pelvic tilt? Decrease
range or stabilize pelvis as needed.
 Standing extension

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15
Q

ideas to increase rotation

A

sidelying thoracic rotaiton (open books)
supine with knees flexed then legs side to side for rotation

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16
Q

exercises to increase SB

A

prone reaches
quadruped SB
sidelying over bolster
stand sidebends

17
Q

respond to external loads and controls orientation

A

global muscle function

18
Q

dynamic support of individual segements

A

deep, segmental muscles

19
Q

name the global muscles

A

Rectus abdominis, EO, ES

20
Q

name the deep muscles

A

TA
IO
Multifidus

21
Q

Volitional Pre-emptive Abdominal
Contraction (VPAC) Strategies

A

Abdominal Draw In Maneuver (ADIM)
Multifidus Activation (MF)
Pelvic Floor Muscle Activation (PFM)
Abdominal Bracing Maneuver (ABM)

turning on the “core”

22
Q

POOR activaiton signs

A

Posterior pelvic tilt
Pull upper abdominals under ribs
Quick contraction
Pulling ribs down (this activates EO; not what we want)

23
Q

multifidus poor activation signs

A

posterior pelvic tilt
erector spinae activation

24
Q

fundamaental 6 pack

A

 Transversus Abdominis/Internal Oblique
 Multifidus
 Pelvic Floor
 Gluteus Maximus
 Latissimus Dorsi
 Diaphragm

25
Q

3 muscles work together for spinal stability

A

TA
diaphragm
pelvic floor

26
Q

____contributes to increase IAP with both isometric and active trunk flx and ext via EMG

A

TA

27
Q

Abdominal Bracing
Progression

A

Limb loading
 Leg perturbations
 Add arm raises
 Quadruped
 Arm raises
 Leg raises
 Alternate arm/leg raises
 Add rod for balance
 Side Planks – QL & Obliques

28
Q

cue for TrA / IO
ADIM

A

Pull headlights together (ASIS)
Hold pee
Pull stomach away from pants
Blowing out a candle
Verbal cues: Draw belly in; belly button to spine
Breathing cue: slowly exhale completely
Activate the pelvic floor musculature

29
Q

how to progress ADIM?

A

Dissociation
(bend knee fall out)
supine march
SLR

30
Q

posterior pelvic tilts are good for activating?
also best for ____ bias pain modulation

A

RA
Flexion bias pain modulation

31
Q

is posterior pelvic tilt flexion or extension lumbar bias?

A

flexion bias
less lumbar lordosis and promotes flatness which is flexion

32
Q

learning to hold neutral spine position

A

ASIS slightly lower PSIS
mid-range
Sx free position

33
Q

always begin spine stabilization with

A

awareness

34
Q
A