Lumbar Mobility & Stability Flashcards
what factors indicates manipulation as a treatment for low back pain?
recent onset (<16 days)
no sx distal to knee
low FABQ-W (<19)
hip IR >35 deg in 1 leg
hypomobility of lumbar spine with spring testing
what factors indicates stabilization as a treatment for low back pain?
younger age (<40)
SLR >91 deg
aberrant motion (instability catch)
positive prone instability test
which should be addresses 1st: stability or mobility?
mobility
what factors indicates stabilization postpartum as a treatment for low back pain?
positive ASLR
tenderness over long dorsal ligament
tenderness over pubic symphysis
which muscles comprise the fundamental 6-pack?
transverse abdominis/internal oblique
multifidus
pelvic floor
gluteus maximus
latissimus dorsi
diaphragm
what are the goals of stabilization in order?
develop NM control
strength and endurance
functional stability in stable and unstable positions and activities
which muscles commonly turn off with pain?
multifidus and transverse abdominis (+internal obliques)
which impairment is suspected:
slightly flexed posture
lean towards non symptomatic side
SLR b/t 30-60 deg
younger (20-30s)
pain worse in AM
pain decreases with traction
disc impairment
which impairment is suspected:
pain and guarding with all motions
hypomobility (late stage)
hypermobility or instability in early stage
impaired spinal extension
pain is unchanged (worse in AM & PM)
pain worse with extension and prolonged standing
30-50s yo
facet impairment
which impairment is suspected:
20-30s yo
equal SLR and slump
pain increased with flexion
early stages of nerve root impairment - disc protrusion
which impairment is suspected:
pain better in AM, worse in PM
pain with extension and ipsi SB
SLR more + than slump
later stages of nerve root impairment - stenosis
which motion should be avoided with a compression fracture?
flexion
what is Scheurmann’s Disease?
anterior wedging of >5 deg of vertebrae at 3 consecutive levels
how can QL compress the facet joints?
it is a global stabilizer so when shortened it compresses the facet joints
all 3 legs of the stool are necessary for instability. what are they?
active muscle function
passive osteoligamentous structures
neural control from the CNS
which hip motion is a common causes back issues?
lack of hip rotation
which direction does spinal stenosis prefer?
flexion
which direction does disc pathology prefer?
extension (younger pts)
when is traction indicated?
nerve root compression
no movement centralizes the symptoms
what is the 3 legged stool of spinal stability?
passive
active
neural control
which part of ROM does passive stability support?
end range
which part of ROM does active stability support?
midrange
how does neural control help stability?
integrates passive and active systems
global muscles respond to ___ loads
external
