Lumbar Flashcards
Examples of yellow flags
Emotional distress
Hypervigilance
Pain catastrophizing
Elevated fear-avoidance beliefs
Low self efficacy
Misunderstanding about the nature and likely impact of pain
Misunderstanding about the best strategies for long term success
Blue flag
Pt perception of work and work conditions that impair return to work
Black flags
Social and financial issues
Self efficacy
Belief one can achieve future goals
Red flags for metastatic cancer
- hx of cancer
- night pain at rest
- unexplained at loss
- age > 50 or less than 17
Red flags infection within disk or vertebrae
- immunosuppressed
- prolonged fever >100.4 deg F
- hx of intravenous drug use
- hx of UTI, cellulitis, or pneumonia
Red flags suggesting undiagnosed vertebral fx
- prolonged corticosteroids
- mild trauma age >50 yo
- age > 70 yo
- a known hx of osteoporosis
- recent major trauma at any age (MVA or fall from height >5 ft)
Red flags that may indicate a dangerous abdominal aneurysm
- pulsating mass in the abdomen
- hx of atherosclerotic vascular disease
- a throbbing, pulsating back pain at rest or with recumbency
- age >60 yo
Yellow flags
Person’s beliefs about pain and injury
MRI T2 image of disc annulus
High intensity zone is an area of bright signal in annular region of IVD
MRI T2 end plate
Modic sign. Increased signal at end plate.
Motor control exercises by Costas et al stage 1
Train coordinated activity of trunk muscles.
• independent activation of deeper muscles: transversus abdominis and multifidus
• reduce overactivity of superficial muscles in an individualized manner
Motor control exercises by Costas et al stage 2
Implement precision of the desired coordination
• train skills in static tasks
• incorporate the skills into dynamic tasks and functional positions
Clinical prediction rule lumbar spine
Less than 16 days FABQ less than 19 One hypomobile lumbar segment No symptoms below the knee One hip > 35 Deg IR
Stabilization lumbar spine criteria
•Younger age •Greater general flexibility •Instability “catch” •Positive prone instability test
Intervention procedures lumbar stabilization group
•Promoting isolated contraction and co-contraction of deep stabilizing muscles •Strengthening of large spinal stabilizing muscles
Lumbar extension directional preference criteria
•Symptoms distal to buttock that peripheralize with lumbar f lexion and centralize with extension •Directional preference for extension
Lumbar ext intervention procedures
•End-range extension exercises •Mobilization to promote extension •Avoidance of flexion
Flexion criteria for lumbar spine
•Older age •Directional preference for flexion •Imaging evidence of lumbar stenosis
Flex ion intervention procedures lumbar spine
•Mobilization or manipulation of the spine and/or lower extremities •Exercises to address impairment of strength and flexibility •Body-weight supported treadmill ambulation
TBC systems: lateral shift criteria
•Visible frontal plane deviation of shoulders relative to pelvis •Directional preference for lateral translation movements of the pelvis
TBC: lateral shift intervention procedures
•Exercise to correct lateral shift •Mechanical or autotraction
TBC: traction criteria
•Signs and symptoms of nerve root compression •No movements centralize symptoms
TBC: traction intervention procedures
•Mechanical or autotraction
