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OCS - Current Concepts of Ortho PT > Lumbar > Flashcards

Lumbar Flashcards

1
Q

T/F: women and minorities with LBP exhibit greater pain, disability, but better tx

A

False, they exhibit greater pain, disability, and POORER tx

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2
Q

Prognosis of aLBP

A

Generally favorable, HOWEVER.. recurrence rate is high

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3
Q

Those with cLBP typically present with more comorbidities including:

A

Central sensitization, lumbar muscle alterations, changes in the processing of pain in the brain

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4
Q

T/F: vertebral end-plates play a role in getting nutrition to the IVD?

A

True, the end plate has a semi-permeable barrier that allows diffusion of some nutrients to the avascular IVD

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5
Q

Does the high intensity zone (HIZ) have something to do with symptomatic LBP

A

Inconclusive at this point

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6
Q

Most disc herniations/bulges have a spontaneous regression within what time frame?

A

Typically a year, but up to 40 months

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7
Q

T/F: The worse a disc herniation/bulge looks on imaging = the less likely the chance of spontaneous resolution

A

False, actually the worse it is on imaging, the more likely the resolution!!!

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8
Q

Modic changes and types

A

Modic changes describe changes in the endplate and bone marrow

Type I: inflammatory reaction in bone marrow

Type II: fatty infiltration to bone marrow

Type III: sclerotic changes to bone marrow

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9
Q

Which modic type is associated with the presence of LBP?

A

Type I (mixed evidence)

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10
Q

T/F: modic changes occur naturally with age

A

True

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11
Q

T/F: Gray matter volume (GMV) thickness plays a role in LBP

A

True

GMV was reduced in dorsal lateral prefrontal cortex (DLPFC), temporal lobes, insula, and somatosensory cortex (S1 - mixed results)

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12
Q

Does tx have any effect on the GMV thickness?

A

Yes, it’s found that cortical thickness can increase for those who responded positively to tx!!

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13
Q

What percentage of cLBP has no know anatomical cause

A

85-95%

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14
Q

3 possible non-structural changes that contribute to cLBP

A

1) People with LBP move differently

2) People with LBP process nociception differently

3) Somatotopic organization differes in individuals with cLBP

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15
Q

Cortical smudging

A

Loss of discrete organization in the motor cortex in individuals w/ LBP (aka the place that is responsible for TA activation is now reassigned with something else)

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16
Q

T/F: Impaired motor control often observed in cLBP can be linked to cortical reorganization

A

True!!

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17
Q

Is there a true link between cLBP and depression

A

Yes

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18
Q

Is depression linked with poor PT outcomes?

A

Yes, It is often associated with poor recovery

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19
Q

What outcome scale can you use for depression assessment in LBP population?

A

Beck Depression Inventory

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20
Q

What outcome scale can you use for pain catastrophizing assessment in LBP population?

A

Pain Catastrophizing Scale (PCS)

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21
Q

Any relation between pain catastrophizing and GMV?

A

Yes, it has been linked to decreased GMV in the DLPFC

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22
Q

Is disability related to pain intensity?

A

No, psychosocial contributors are MUCH more likely to play a role in disability

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23
Q

Is there a way to predict if aLBP can turn into cLBP

A

Not really, a functional MRI can look at the motivation-valuation circuitry but is not practical to the clinic due to price

aka No way to tell, can use clinical judgement and some outcome measures to help (SBT or OMPQ )

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24
Q

Which 2 outcome measures can possibly help screen for risks of poor prognosis or cLBP?

Which is more superior tool?

A

SBT: STarT Back Screening Tool

OMPQ: Orebro Musculoskeletal Pain Questionnaire

SBT is BETTER!

NOTE: SBT in combo with MDQ (mod oswestry) can adequately predict those who will respond WELL to tx

25
Q

What is considered the mainstay of PT management in LBP?

A

Exercise in combo with education

26
Q

What outcomes questionnaires can be used to screen for red and yellow flags in LBP pathology?

A

OSPRO-ROS and OSPRO-YF

27
Q

Is neurological screening useful in LBP patients?

A

Yes, however use an abundance of caution when trying to make diagnostic conclusions about exact nature and location of pathology

28
Q

Is posture important when treating someone with LBP?

A

Not necessarily… Helping pt’s find a posture that is that is more relaxed and comfortable IN COMBO with education on how their posture is safe = symptom relief

29
Q

Those with LBP tend to display greater (upper/lower) lumbar excursion during the first 20-50° of motion while limiting the amount of concurrent hip flexion during fwd bending

A

Upper

NOTE: increase in early lumbar motion correlated with self-reporting of functional limitations

30
Q

What aspect of a physical exam of LBP is the most related to reproduction of the comparable sign (CS)?

A

ROM assessment

Best is an assessment that looks at both quality and pain reproducibility

31
Q

Treatment-based classification (TBC):
3 rehabilitation approaches

A

1) Symptom modulation
2) Movement control
3) Functional optimization

32
Q

Efficacy of the TBC approach

A

Concerning.. recent studies show that those who receive matched tx care did no better vs those who received unmatched care

33
Q

Surgery vs non-surgical management of LBP (i.e. lumbar stenosis)

A

Same outcome

34
Q

Are graded activity and graded exposure approach helpful for tx of LBP?

A

Yes, they have been proven to reduce pain and disability vs minimal tx

HOWEVER: graded activity/exposure is no better vs generalized exercise

35
Q

Graded activity and graded exposure VS generalized exercise

A

Same in effectiveness

36
Q

Motor control exercises VS generalized exercise

A

Same in effectiveness at restoring proper movement patterns

37
Q

Motor control exercises VS placebo

A

Motor control is BETTER vs placebo

38
Q

MDT (i.e. directional preference) vs placebo

A

MDT was superior to placebo

NOTE: same as generalized exercise though

39
Q

Walking vs non-pharmacological interventions

A

Same, goal 150 mins a week

Helpful if pt’s can’t tolerate PT

40
Q

T/F: motor control, stabilization, graded exposure/activity, and MDT are all equal vs generalized exercise

A

True

41
Q

Dosing of exercise for cLBP

A

Unknown

A study found that increasing the frequency per week was the most likely cause of pain relief for pt’s w/ cLBP

42
Q

Is spinal manipulation and mobilization helpful in treating LBP? Is any superior to the other?

A

Yes, especially in aLBP and also occasionally cLBP

Manip > mobs (as it relates to reducing disability)

43
Q

Clinical prediction rule for who would respond best to spinal manip (4/5 = +LR 24.38)

A

1) No symptoms past knee
2) Pain duration <16 days
3) Score <19 FABQ
4) At least 1 hypomobile segment
5) 1 or both hips at least IR >35°

44
Q

Can spinal manipulative therapy (SMT) be used as a stand alone tx?

A

Unlikely that SMT in isolation will provide optimal benefit so use in CONJUNCTION with other therapies (i.e. exercise)

45
Q

Is dry needling indicated in tx of LBP?

A

Dry needling vs sham was effective in reducing pain and disability

NOTE: Low quality studies

46
Q

Dry needling vs acupuncture in tx for LBP

A

Dry needling better in short-term, however same results long-term

47
Q

Can dry needling be used as stand alone tx?

A

No, best used in conjunction with other therapies

48
Q

Is using a bio-medical educational model indicated in tx of cLBP?

A

No, it may increase fears, anxiety, and stress.

Education going more towards reassuring the pt’s that they have a good prognosis and return to typical activities

49
Q

Is using pain neuroscience education (PNE) indicated in tx of cLBP?

A

Yes!!

Compared to traditional education, PNE demonstrates significant improvements with reduction in healthcare utilization, disability, pain beliefs, pain catastrophizing, and both SLR and fwd bending

50
Q

Can PNE be used as a stand alone tx in cLBP?

A

No, best in combo with exercise and other physical interventions

51
Q

Is using pain neuroscience education (PNE) indicated in tx of aLBP?

A

No, it is no better vs placebo in treating ACUTE LBP. However, primary-care basic advice and reassurance seems to be adequate.

52
Q

Does patient rapport play a role in outcomes for cLBP?

A

Yes, the therapeutic alliance has been shown to be a strong predictor of outcomes for cLBP

53
Q

3 Primary components of a “Therapeutic Alliance”

A

1) agreement on goals
2) agreement on tx
3) affective bond

54
Q

Mindfulness Based Stress Reduction (MBSR)

A

Technique to treat the “psychosocial” aspect of care, 8 wk program

Unknown to tx LBP

55
Q

Mindfulness Based Stress Reduction (MBSR) vs CBT

A

Same outcome, both able to relieve pain to a similar extent

56
Q

Has an app for MBSR been shown to help?

A

Yes, good results

57
Q

Classic red flags for diagnosing spinal fracture (4*)

A

1) Prolonged use of corticosteroids
2) Significant trauma
3) Age >70 y/o
4) Female (variable factor)

NOTE: only first 3 variables have research behind it

2+ factors are positive = +LR >10

58
Q
A

OCS - Current Concepts of Ortho PT (12 decks)

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