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OCS > Lumbar > Flashcards

Lumbar Flashcards

1
Q

Keele STarTBack Screening tool

A
  • combines key items from several previously validated screening questionnaires
  • addresses pain location, function, avoidance beliefs, depression, and catastrophizing
  • easily adminitered and scored
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2
Q

Red flags

A
  • single red flag may not be predictive of serious disease

- metastatic lesions involving lumbar vertebrae are likely to be the most serious pathology that may present as LBP

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3
Q

Red flags that may increase likelihood of metastatic cancer

A

1) hx of cancer
2) night pain or pain at rest
3) unexplained weight loss
4) age > 50 or < 17
5) failure to improve over the predicted time interval following treatment

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4
Q

red flags that may suggest presence of an infection within the disk or vertebrae

A

1) patient is immunosuppressed
2) prolonged fever with a temp over 100.4
3) hx of intravenous drug abuse
4) recent UTI, cellulitis, pneumonia

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5
Q

Red flags suggesting undiagnosed vertebral fracture

A

1) prolonged use of steroids
2) mild trauma > 50 yrs old
3) age >70 yrs old
4) known hx of osteoporosis
5) recent major trauma at any age
6) bruising over spine following trauma

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6
Q

Red flags that may indicate AAA

A

1) pulsating mass in the abdomen
2) hx of atherosclerotic vascular disease
3) throbbing, pulsing back pain at rest or with recumbency
4) age > 60yrs

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7
Q

MRI and LBP

A
  • sensitivity to detect subtle fractures, abnormal tissue growth, local and diffuse inflammatory issues, hemorrhage is extremely high
  • also good at detecting serious compression of spinal cord
  • 99% of patients presenting with acute or chronic LBP DO NOT HAVE THESE ISSUES!
  • negative emotional impact with MRIs
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8
Q

Yellow flags

A
  • 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
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9
Q

Blue flags

A
  • describe a patient’s perception of work and work conditions that may impair return to work
  • ex. low job satisfaction and personal conflicts with employers or fellow workers
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10
Q

Black flags

A
  • social and financial issues

ex. reimbursement incentives to remain disabled

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11
Q

Best questionnaires for LBP

A
  • roland-morris back pain disability questionnaire

- odi

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12
Q

Spinal manipulative therapy

A
  • typically better for acute patients

- significant lower pain and disability compared to those who receive placebo

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13
Q

SMT CPR

A

1) no symptoms distal to knee
2) less than 16 days
3) FABQ-work subscale less than 19
4) at least 1 hypomobile lumbar segment
5) at least 1 hip with greater than 35* IR

4/5 = + LR of 24

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14
Q

Treatment for subacute and chronic LBP

A
  • motor control exercises are superior to minimal intervention at short and long term follow up
  • graded activity and dgraded exposure incorporate cognitive approaches to improve activity tolerance
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15
Q

Graded exposure

A

-patients with LBP generate a hierarchy of feared activities and then gradually progress through these in an attempt to reduce activity-related anxiety

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16
Q

Graded activity

A

-uses operant conditioning to reinforce healthy behaviors and progress the patient through different levels of functional activity

17
Q

Lumbar extension strengthening exercises

A

-not adequately investigated

18
Q

Aerobic fitness and chronic LBP

A

-are helpful to reduce pain and increase function
-help to reduce increased awareness of neural stimulus (central sensitization)
-

19
Q

Centralization exercises

A
  • likely to reduce pain and increase mobility in patients with acute, subacute and chronic LBP
  • likely to lead to better outcomes than passive treatments for patients with acute lbP, but efficacy and effectiveness of mckenzie approach for patients with cLBP was not clear
20
Q

Patient education for back pain

A
  • valuable to educate regarding maintaining a physically active lifestyle
  • educate on the difference between “good pain” (post exertional soreness) and “bad pain”
21
Q

Modern neuroscience approach

A
  • literature demonstrates that changes in motor control are often coupled with substantial changes in brain structure and function in patients with cLBP
  • no data to support yet
22
Q

Dry needling

A
  • evidence that trigger points are an important pain generator, but the mechanism is under debate
  • evidence is inconclusive
23
Q

Intervertebral disk

A
  • annulus fibrosus
  • nucleus pulposus

4 layers;

1) outer most annulus
2) inner portion of the annulus
3) transitional zone
4) vertebral end plate

24
Q

Outer most annulus

A
  • resistance to tensile loads
  • dense, well oriented type 1 collagen
  • virtually all the neurovascular structure is here
  • loaded under flexion and/or SB
25
Q

inner portion of annulus

A
  • type I collagen

- lack the organization found in the outer most annulus

26
Q

Transitional zone

A
  • thin, fibrous tissues that surround and encompass the fourth and deepest layer
  • gel like region composed primarily of water
27
Q

Vertebral end plate

A
  • borders the IVD
  • large, flate cartilage covers the central portions of the superior and inferior vertebral bodies creating a semi-permeable barrier between subchondral bone and IVD
  • this area is the “weak link” where IVDs are exposed to trauma
28
Q

Cauda equina

A

1) urine retention
2) fecal incontinence
3) saddle anesthesia
4) sensory or motor deficits in teh feet (L4-S1 areas)

29
Q

Thrust and non-thrust manipulation

A
  • is effective for subgroups of patients and as a component of a comprehensive treatment plan
  • grade I
  • clinicians should consider utilizing thrust manips to reduce pain and disability
  • can also be used to improve spine and hip mobility and reduce pain with subacute and chronic
  • grade A
30
Q

Top 2 factors of manip CPR

A

1) duration less than 16 days
2) symptoms distal to the knee

+ LR of 7.2

31
Q

Trunk coordination and strengthening

A

-grade a recommendation for patients with subacute and chronicn LBP

32
Q

Centralization

A

-grade A - for acute, subacute and chronic

33
Q

Nerve mobilization

A

-grade C

34
Q

Traction

A

-grade D - conflicting evidence

35
Q

Stenosis CPR

A
  1. (B) symptoms
  2. leg pain more than back pain
  3. pain with walking/standing
  4. pain relief upon sitting
  5. age > 48 years

3 tests positive sp=0.88
4 tests positive = 0.98
5 tests positive = 1.0.

sn is poor if > 3 tests positive

OCS (13 decks)

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