Lecture 3

Question 1

pre-op mgmt

Answer 1

• pain
• ROM (keep it full b/c pre-op ROM will influence post-op ROM)
• educate pt on expectations (swelling, pain, timeline)
• precautions
• AD as needed

Question 2

watch out for these things post op (early and late phases of healing)

Answer 2

local/systemic infection
DVT or PE
delayed healing of wound or bone
mm deficits
nerve entrapped
adhesioin/scarring

Question 3

“immediately after a soft tissue injury, do not harm and let ____ guide your approach”

“after the first days have passed, soft tissues need ____”

Answer 3

PEACE

LOVE

Question 4

PEACE stands for

Answer 4

Protection
Elevation
Avoid anti-inflammatories
Compression
Education

Question 5

LOVE stands for

Answer 5

Load
Optimism
Vascularization
Exercise

Question 6

tissue healing timeline

Answer 6

slide 6

Question 7

MAX protection phase
time frame? things to consider?

Answer 7

right after surgery (days to 6 wks)
be aware of WB status and light loading
tissue inflammation and pain in this phase

Question 8

MOD phase of healing
time frame? things to work on?

Answer 8

less infalmmation, more mobility
4-12 weeks
return to AROM pain free
- restore normal arthorkinematics
- gradually increase strength
**- imporve NMSK control and stability **

Question 9

MIN protection phase
time frame? things to consider?

Answer 9

6 weeks to 12 months
- restore strength
- consider sport / activity training
- be specific w/ patient education

Question 10

progression of post-op phases depends on ability to meet ____.

Answer 10

GOALS
(i.e. can’t strengthen if pt is still swollen)

Question 11

what are indications for surgery?

Answer 11

cauda equina
acute loss of function (rapid foot drop)
failure of 3 months conservative care (PT, Injections)

Question 12

post of precautions

Answer 12

no BLT (bending, lifting, twisting)
log roll
sitting into car

Question 13

extension instantaneous axis of rotaiton : aging of the lumbar spine

decreased segmental control from the ____
increaased stress on the ____ and ____

Answer 13

disc
facet / disc

Question 14

SB instantaneous axis of rotaiton : aging of the lumbar spine

increased ____ and increased ____ chondral load

Answer 14

shearing
facet

Question 15

surgical options

Answer 15

laminectomy
decompression without fusion (microdiscectomy)
posterior lumbar interbody fusion (PLIF)
Transforaminal lumbar interbody fusion (TLIF)
Anterior lumbar interbody fusion (ALIF)

Question 16

long term post op

Answer 16

adjacent segment degeneration
(becomes symptomatic causing pain or numbness)

Question 17

biomechanical effects of surgery:
alters biomechanics of both involved and adjacent segments center of rotaiton

this leads to increased forces and compression on the ____

Answer 17

intervertebral disc

Question 18

decompression with motion preservation (disc replacement) is contraincated when

Answer 18

hypertrophic facets
translational deformity (spondy)
Ankylosing spondylitis
poor bone quality

Question 19

post surgical mgmg stages of recovery

Answer 19

1. disc hydration/dehydration
2. change positions every 15-30 min
3. avoid stretching and rotation of lumbar s
4. avoid prone/flat sleeping
5. think about healing times

Question 20

sacral nutation associated with what type of innominate movement

Answer 20

posterior innominate

Question 21

SIJ counternutation is associated with

Answer 21

innominate anterior rotation

Question 22

sacral nutation increases ____ spine

Answer 22

extension

Question 23

sacral counternutation increases ____ spine

Answer 23

flexion

Question 24

this ligament is a big pain generator in LBP… an issue when lumbar spine flexes and sacrum doesn’t move

Answer 24

posterior SI ligament

Question 25

anterior rotation occurs with hip ____ during open chain

Answer 25

extension

Question 26

posterior rotation occurs with hip ____ during open chian

Answer 26

flexion

Question 27

what type of rotation occurs during SLS in closed chain?

Answer 27

posterior

Question 28

upslip

Answer 28

ASIS and PSIS higher on one side (more common than downslip)

Question 29

inflare/outflare

Answer 29

inflare: hip IR
outflare: hip ER

Question 30

sacral rotation is named by

Answer 30

the side that is more superficial