leture 2: Therapeutic Interventions for Pain Modulation, Lumbar Mobility, and Trunk Stabilization Flashcards
what is the posture for someone with a disc impairment
slightly flexed and deviated away from the symptomatic side
what is the neurological symptoms for a disc impairments
in dermatome and possible myotome of affected nerves roots
when do people with disc impairments have increase symptoms
with sitting , prolonged flexed postures , transition from sit to stand , coughing and straining
disc patients will have peripheralization of symptoms with what
repeated forward bending tests
when is disc pain worse ? and does it ever get better?
worse in the morning and gets better as the day goes on bc it is dehydrating thru out the day
how would u describe facet joint pain
pain that comes and doesn’t go away
how is pain in the acute and subacute/chronic phase of facet joint pain
when acute , there is pain and mm guarding with all motions
when subacute/chronic , pain is related to periods of immobility or excessive activity
how is the mobility in patients with facet joint problems
usually HYPOMOBILE and decrease joint play in affected joints
but there may be hypermobility or instability during early stages
how may spinal extension affect people w facet joint problems
may cause or increase neurological symptoms due to foramina stenosis … which can lead to unable to sustain or perform repetitive extension activities without exacerbating symptoms
what functional activity may exacerbate symptoms for facet joint impairment
activities that requires flexibility or prolonged trunk motions, such as repetitive lifting and
carrying of heavy objects, repetitions of
for early nerve root impairment : disc protrusion which neurodynamic test is positive and when does pain increase
SLR and slump are both positive and pain increases with flexed postures
for later nerve root impairment: stenosis … what is compressing the nerve? when is the pain better and worse ? what pain comes with prolonged wlaking /stnading ? what AROM causes patients to have pain ? and what neurodynamic test are done
bony growth is causeing compression
pain is better in the morning and worse at the end of the day
leg pain w prolonged walking
pain w extension and ipsilaterla SB
SLR more positive than SLUMP
what disease is it if the paitent is hyperkyphotic , between 12-17 y/o and has a anterior wedding of >5° at 3 consecutive places
scheurmann’s disease
stability is visualized as a 3 legged stool.. waht are the 3 legs
- Active muscle function
- Passive osteoligamentous structures
- Neural control from the CNS
all 3 legs of stability is require to be stable … what causes instability
when at least one of the legs does not function properly
what is the difference between functional and structural instability
functional instability can use pain despite the absence of any radiological anomoly
structural instability is damage of passive stabilizers which limit ROM
what is gower sign and what kind of instability is it
pt stabilizes on legs to help them stand back up bc the feeling of instability … this is structural instability
what factors are favoring manipulation treatment based classification for LBP
recent onset
-no ss distal to the knee
- low FABQ (<19)
- hip IR > 35° in one leg
- hypo mobility of lumbar spine w spring testing
what factors are favoring stabilization treatment based classification for LBP
- younger age (<40)
- SLR > 91°
- positive prone instability test
- post partum
if a patient has low back pain with some LE pain and it is there at rest or produced with initial to mid range spinal movements what could it be and what is the primary intervention streategie
spinal instability and do NM re ed
if a painted has lumbar ROM limitations , restricted lower lumbar mobility with some back pain what could it be and what would be the primary intervention for this
mobility deficits and do manual therapy , therapeutic exercises and patient education
if a Patient spinal presentation may vary –
flattened, esp in older pts; lordotic, esp in younger
pts or older pts with lordotic/kyphotic posture.. what preference would they like
flexion
for a flexion preference patient ____ maneuvers would decrease or centralize symptoms and ____ activities worsen symptoms … what ROM is limited
flexion and extension
flexion is limited
Patient presents in flexion or flattened
lordosis.
Extension maneuvers decrease or centralize
symptoms. Flexion activities worsen
symptoms.
Limited extension ROM
these indications would make us think the patient has a ____ preference
extension
