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MSK: LQ > lecture 3: lumbar spine interventions > Flashcards

lecture 3: lumbar spine interventions Flashcards

1
Q

what are the 2 main objectives to LBP interventions

A
  • relieve acute pain
    -attempt to prevent transition to chronicity
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2
Q

individuals w LBP are ___ in nature

A

heterogenous

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3
Q

what are the acute phase intervention goals (6)

A
  • decrease pain
    -promote tissue healing
  • increase pain free ROM
  • regain soft tissue extensibility
    -regain NM control
    -allow progression to subacute functional phase
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4
Q

what is the great initial choice for Tx for acute phase LBP

A

walking

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5
Q

what is the most beneficial if used early in pts what presents w/o radiating leg pain for LBP

A

manual therapy

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6
Q

what is highly encouraged in the acute phase of LBP

A

early motion

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7
Q

what is teh subacute /fucntinal phase intervention goals

A

-achieve significant decrease of pain
- restoration of full and pain free ROM
- full integration of upper and lower kinetic chains
- complete restoration of respiratory function
- restoration of t spine and UQ/LQ strength and NM contrl

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8
Q

research suggest that sub acute phase for LBP is CRITICAL in what

A

preventing chronicity and disability

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9
Q

what are the 3 major protocols for LBP that have been studied over the past 40 years

A
  • williams flexion ex’s
    -McKenzies ex’s
  • spinal stabilization ex’s
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10
Q

what are chronic phase intervention goals for LBP

A

-maximize function and encourage exercise
-use multimodal approach tailed to pt needs (aeordib ex’s , meds , etc)

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11
Q

what is the difference between chronic phase and chronic pain

A

chronic phase has no tissue damage just pain

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12
Q

what is primary hyperalgesia (primary sensitization)

A

normal hyperalgesia that is a protective mechanism

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13
Q

what is secondary hyperalgesia

A

adaptations in CNS
- increase responsiveness to stimuli from periphery

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14
Q

what is the hallmark to chronic pain

A

central sensitization

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15
Q

what is central sensitization

A

fucntinal changes in the CNS what include altered sensory processing in the brain, malfunctioning of descending anti nocicpetive mechanisms , increased activity or pain pathways

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16
Q

What are the clinical prediction rule (CPR’s) for manual therapy

A
  • no ss distal to the knees
  • less than 16 days of when pain started
  • score of less than 19 on FABQ
  • at least 1 hypo mobile segment in L spine
  • at least 1 hip w > 35 ° of IR (bc then we know its not coming from the hip bc normla ROM)
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17
Q

what are the CPR’s for stabilization

A
  • less than 40 years
  • post partum , average SLR > 91°
  • visible instability catch or aberrant movements during lumbar flexion/extenion ROM
  • (+) prone instability test
  • (+) postieor pelvic pain provaction , ASLR< modified tredeneleburg test ORRRRR pain w palpation of long dorsal SI ligament or pubic symphysis
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18
Q

what is the CPR’s for direction specific extension criteria

A
  • ss distal to buttock (radiating pain)
  • symptoms centeralize w lumbar ex
    symptoms peripheralize w lumbar flex
  • directional preference for extension
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19
Q

what is the CPR’S for direction specific flexion criteria

A
  • greater than 50 years
  • directional preference for flexion
    -lumbar spinal stenosis
20
Q

what is the clinical prediction rules for direction specific (lateral shift) criteria for LBP

A
  • visible frontal plane shift of shoulders relative to pelvis
  • directional preference for lateral translation movements of pelvic
21
Q

what is the McKenzie exercise

A

directional specific exercise for LBP , technique makes NO attempt at being tissue specific

22
Q

what are the 3 direction specific exercise (McKenzie) terms and which is sent here most

A
  1. postural
  2. dysfunction
  3. derangement

3 is seen the most

23
Q

what does the dysfucntion term for direction specific exercises mean

A
  • pain only produced at end range
  • fixed name pattern (always the same)
  • radiate a little
  • condition unchanged after testing
24
Q

what is the derangement term for the direction specific exercises (McKenzie) mean

A
  • symptoms produces/ altered w mid range movements
  • painful arc may occur
  • variable pain patterns
  • progressive increase and decrease during test
  • rapid and lasting changes after testing
25
Q

if a pateint has a lateral shift and extension direction superficial problems which one would u fix first

A

lateral shift always !!!

26
Q

how many times a day does a patient do flexion direction specific exercises for LBP

A

6-10 times/hr while awak

supine > kness to chest > seated flexion > standing flexion

27
Q

what are the clinical prediciton rules for traction for LBP

A

symptoms decrease w manual or autotraction

28
Q

what is traction clinically useful w?

A
  • peripheralization of symptoms w extension
  • (+) crossed SLR
29
Q

what is the definition of a positive test for adverse neural tension

A

symptoms reproduction
differences side to side testing
changed w distant component

30
Q

what are examples of neuro dynamic test

A
  • (+) slump test
  • (+) SLR
    -(+) prone/sidelying knee bend
31
Q

what is the proposed progresssion for Tx session for LBP

A

1.manual techniques
2. mobility ex’s
3. NM re ed
4. strength traingin ex’s
5. functional/ therapeutic activity tolerance

32
Q

what is manual techniques used for in LBP patients

A

to decrease pain and increase mobility

33
Q

what is mobility ex’s used for in LBP patients

A

use new ROM to help maintain it

34
Q

what kind of manual therapy techniques should u used to acute LBP

A

use thrust manipulative techniques for acute LBP

35
Q

what are contraindications for joint manipulations

A
  • presence of serious pathology
  • relative to skill and experience
  • fx
  • ligament rupture
  • no working hypothesis
  • worsening neurological function
  • unremitting night pain
  • severe multi directional spasm
  • UMN lesions
36
Q

what kind of progressive exercises with chronic LBP w/o generalized pain

A

moderate to high intensity exercises

37
Q

what kind of progressive exercises with chronic LBP w/ generalized pain

A

low intensity exercise

38
Q

how do i know which exercise to prescribe

A
  • check posture
    -address movement dysfunctions
  • regional interdependence
39
Q

is there clear evidence for dry needling

A

no

40
Q

what may dry needling help with for chronic LBP

A

decrease pain and disability for pts w chronic LBP
short term effects only

41
Q

is dry needling better than other treatments for ACUTE LBP

A

noooo

42
Q

what are minor amd major side effects for spinal mainupulation

A

minor : temp soreness/faitgue
major: Fx, ischemia , cauda equina

43
Q

what is a laminectomy

A

sx that removes the lamina of the vertebrae

44
Q

what is a laminectomy

A

sx that removes the lamina of the vertebrae

45
Q

what is a discectomy

A

removing disc material

46
Q

what are 3 decompression techniques for LBP

A

laminectomy
discectomy
foraminectomy

47
Q

what are 5 stabilization techniques for sx for LBP

A
  • anterior lumbar interbody fusion
  • posterior lumbar interbody fusion
    -scoliotic curve reduction
  • kyphopasty
    -disc replacement

MSK: LQ (10 decks)

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