Lumbar

Question 1

What is the importance of finding, maintaining, and using neutral spine position in the lumbar spine?

Answer 1

• awareness and control of safe spinal motion -awareness of neutral spinal position in supine, prone, sitting and standing -awareness of effect of ADL’s and extremity motions of spine

Question 2

What happens to your lumbar spine when you move your extremities away from your body?

Answer 2

spinal motion is extension

Question 3

What happens to your lumbar spine when you move your extremities toward your body?

Answer 3

spinal motion is flexion

Question 4

What is the significance of a patients breathing if they are injured?

Answer 4

they will not inhale fully

Question 5

Inhalation facilitates what things in the spine?

Answer 5

-stability of the spine when hips in flexion -spinal extension -scapular elevation and humeral IR

Question 6

Exhalation facilitates what things in the spine?

Answer 6

-stability of the spine when hips in extension -spinal flexion -scapular depression and humeral ER

Question 7

What can inhaling into each (one) lung facilitate?

Answer 7

Side bending

Question 8

In a patient with LBP what muscle is ineffective?

Answer 8

the transverse abdominis

Question 9

What is the primary function of the transverse abdominis?

Answer 9

stabilization

Question 10

What lower ( in lumbar region) muscle precedes trunk movement?

Answer 10

transverse abdominis

Question 11

What other muscles activate with the transverse abdominis?

Answer 11

pelvic floor muscles (synergists)

Question 12

What is the primary role of the multifidus?

Answer 12

stabilization

Question 13

What does the multifidus co-contract with?

Answer 13

with the transverse abdominis

Question 14

What muscles are activated when you do the drawing in maneuver?

Answer 14

the multifidi and the transverse abdominis

Question 15

What position is the drawing in maneuver done in?

Answer 15

quadruped or prone

Question 16

How do you isolate activating the multifidi?

Answer 16

-done in quadruped or prone -draw your navel into your spine and at the same time swell your back into my thumbs

Question 17

What are the global muscles of the lumbar spine?

Answer 17

-rectus abdominis -external and internal obliques -quadratus lumborum (lateral portion) -erector spinae -iliospoas

Question 18

How do you perform the abdominal stabilization with a blood pressure cuff?

Answer 18

-stabilizer in small of back -40mmHg of pressure in the cuff -slowly slide one leg away from the body -gauge should stay at 40mmHg

Question 19

How do you increase and decrease pressure in the abdominal stabilization with a blood pressure cuff?

Answer 19

-increase pressure-posterior pelvic tilt (PPT) -decreased pressure- anterior pelvic tilt (APT)

Question 20

How do you find the neutral spine?

Answer 20

-begin in supine or hooklying -have them move through APT and PPT -find most comfortable position -if not possible=teach imprinting

Question 21

What is imprinting with finding neutral spine?

Answer 21

-in a posterior pelvic tilt, with back imprinted flat on the mat -may need to do passively if active movement and control are not possible for the patient

Question 22

What muscle should also be accompanied by finding pelvic neutral ?

Answer 22

transverse abdominis

Question 23

What is the progression of stability exercises?

Answer 23

-emphasis on endurance -use props (yard stick, pressure cuff biofeedback) -extremity loading (moving all 4 extremities at once, change planes- transverse/diagonal) -external resistance -position changes (sitting, kneeling, standing) -unstable surfaces

Question 24

Examples of dynamic strengthening for the abdominals?

Answer 24

-curl-ups -curl-downs -diagonal curl-up

Question 25

Describe how to progress curl-ups for abdominals?

Answer 25

-arms by side -across chest -behind head -holding weight/med ball (shoulder flex to 90)

Question 26

describe how to do diagonal curl-ups

Answer 26

curl up and reach one hand toward opposite knee, or bring knee toward opposite shoulder

Question 27

How do you progress for dynamic strengthening for trunk flexion?

Answer 27

-resisted in sitting or standing -using resistance secured behind -flex/rotate trunk

Question 28

What muscles does this activate and how do you progress it?

Answer 28

* Activates erector spinae and multifidi * progress by adding weights in hands

Question 29

What is the name of this exercise, what muscles does it work and how do you progress it?

Answer 29

* superman * works the erector spinae and multifidi * increase resistance with shoulder adbuction to 90 or elevating to 180

Question 30

When should you start adding functional activities in the exercise program?

Answer 30

initiate once patient has learned to manage signs and symptoms of inflammation diminish

Question 31

If pateint is unable to do a normal pushup what can they do instead?

Answer 31

Have patient do a wall pushup

Question 32

how do you progress ADLs?

Answer 32

* Lifting with stable spine * Carrying with stable spine * Reaching with stable spine

Question 33

What is the extension bias approach? What does the patient look like? What might be wrong with them (reason for bais)?

Answer 33

* Extension tests decrease or centrilize symptoms * Patient presents with flexed posture (lateral shift present) * IVD lesions, imparied flexed posture, osteoperosis

Question 34

What can you do to help with someone the has extension or flexion bias?

Answer 34

core stabilization exercises and stretching

Question 35

How do you specifically treat extension bias besides doing core stabililzation?

Answer 35

* Treat lateral shift (manual or self correct) * Treat with extension techniques * Isometric activities

Question 36

What exercises do you avoid in the acute phase for extension bias and why?

Answer 36

Lumbar flexion or extension exercises increase intra-disc pressure

Question 37

What happenes after the acute symptoms stabilized?

Answer 37

* decreased pain & neurological signs * imporved posture, increased mobility

Question 38

After acute symptoms stabilize, how do you progress for extension bias?

Answer 38

* have them do flexion exercises or prolonged flexion and then end with extension exercises * NOTE: if symptoms reoccur perform just extension exercises

Question 39

What is osteoporosis?

Answer 39

Loss of bone mineral density

Question 40

What is the standard deviations is osteoperosis and osteropenia?

Answer 40

* osteoporsis: 2.5 SD * Osteopenia: 1 SD

Question 41

What is osteopenia?

Answer 41

mildly reduced bone mineral density

Question 42

What motion MUST you avoid with people with osteoperosis/penia?

Answer 42

Avoid flexion exercises and ADL's

Question 43

What is flexion bias?

Answer 43

* patient is more comfortable in flexed posture * extension tests increase or peripherilize symptoms

Question 44

What could be wrong with the patient if they have a flexion bias approach?

Answer 44

* spondolosis * stenosis * extension load injuries * facet joint irritation

Question 45

What is spondylosis?

Answer 45

Degenerative osteoarthritis of the joints in the spine * descripitve term, not really a diagnosis * You can have pain and degeneration regardless of location

Question 46

What is stenosis?

Answer 46

Narrowing of the neural foramin or narrowing of the spinal canal itself

Question 47

What can cause stenosis?

Answer 47

* Osteoarthritis * Loss of disk height * ligamentous changes

Question 48

What can cause hypermobility and functional instability in the lumbar spine?

Answer 48

* trauma * ligamentous laxity * spondololysis * spondololisthesis

Question 49

how can you fix hypermobility and functional instability ?

Answer 49

core stabilization

Question 50

What is a spondylolysis?

Answer 50

* Defect in the pars interarticularis (pedicle) * pedicle breaks off and tries to heal, but fails (held in place by soft tissue)

Question 51

Where is the most common location for a spondoloysis and who is it most common in?

Answer 51

* usually at L5-S1 * boys who play football (linemen) * girls who are gymnasts * can occur due to changes with ageing

Question 52

If there is pars defect does the scotty dog have a collar?

Answer 52

YES

Question 53

What is a spondylolisthesis?

Answer 53

* Forward displacement of a vertebrae

Question 54

where is the most common location for a spondylolisthesis and what are the grades of severity?

Answer 54

* L5-S1 * grades 1-5 (step off can usually be palpated)

Question 55

What does the patient look like if they have a spondylolisthesis?

Answer 55

Patient presents with decreased lumbar curve and flattening of buttocks

Question 56

If patient presents with gaurded posture or increased muscle tension what could their problem be?

Answer 56

* strains, tear, contusions, and overuse

Question 57

With impairment based diagnostic approach what is the first stage of exercises and how do you progress?

Answer 57

exercise in position of confort and progress to core stabilization

Question 58

What is postural pain syndrome?

Answer 58

* Patient presents with faulty posture * Symptoms increase with sustained position

Question 59

What could be wrong with the patient if they have postural pain syndrome?

Answer 59

* Postural strain * cervicogenic headache * thoracic ourlet syndrome * poor physcial condition

Question 60

How do you treat postural pain syndrome?

Answer 60

movement, posture correction and exercise decrease symptoms

Question 61

For every one Standard deviation away from the mean how much affect does it have for the risk of fracturing (for osteoperosis)?

Answer 61

It doubles