Lumbar Mobility & Stability

Question 1

what factors indicates manipulation as a treatment for low back pain?

Answer 1

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

Question 2

what factors indicates stabilization as a treatment for low back pain?

Answer 2

younger age (<40)
SLR >91 deg
aberrant motion (instability catch)
positive prone instability test

Question 3

which should be addresses 1st: stability or mobility?

Answer 3

mobility

Question 4

what factors indicates stabilization postpartum as a treatment for low back pain?

Answer 4

positive ASLR
tenderness over long dorsal ligament
tenderness over pubic symphysis

Question 5

which muscles comprise the fundamental 6-pack?

Answer 5

transverse abdominis/internal oblique
multifidus
pelvic floor
gluteus maximus
latissimus dorsi
diaphragm

Question 6

what are the goals of stabilization in order?

Answer 6

develop NM control
strength and endurance
functional stability in stable and unstable positions and activities

Question 7

which muscles commonly turn off with pain?

Answer 7

multifidus and transverse abdominis (+internal obliques)

Question 8

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

Answer 8

disc impairment

Question 9

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

Answer 9

facet impairment

Question 10

which impairment is suspected:
20-30s yo
equal SLR and slump
pain increased with flexion

Answer 10

early stages of nerve root impairment - disc protrusion

Question 11

which impairment is suspected:
pain better in AM, worse in PM
pain with extension and ipsi SB
SLR more + than slump

Answer 11

later stages of nerve root impairment - stenosis

Question 12

which motion should be avoided with a compression fracture?

Answer 12

flexion

Question 13

what is Scheurmann’s Disease?

Answer 13

anterior wedging of >5 deg of vertebrae at 3 consecutive levels

Question 14

how can QL compress the facet joints?

Answer 14

it is a global stabilizer so when shortened it compresses the facet joints

Question 15

all 3 legs of the stool are necessary for instability. what are they?

Answer 15

active muscle function
passive osteoligamentous structures
neural control from the CNS

Question 16

which hip motion is a common causes back issues?

Answer 16

lack of hip rotation

Question 17

which direction does spinal stenosis prefer?

Answer 17

flexion

Question 18

which direction does disc pathology prefer?

Answer 18

extension (younger pts)

Question 19

when is traction indicated?

Answer 19

nerve root compression
no movement centralizes the symptoms

Question 20

what is the 3 legged stool of spinal stability?

Answer 20

passive
active
neural control

Question 21

which part of ROM does passive stability support?

Answer 21

end range

Question 22

which part of ROM does active stability support?

Answer 22

midrange

Question 23

how does neural control help stability?

Answer 23

integrates passive and active systems

Question 24

global muscles respond to ___ loads

Answer 24

external

Question 25

which type of muscles/stabilizers put less stress on the facet joints?

Answer 25

deep/segmental

Question 26

which abdominal muscles are global?

Answer 26

rectus abdominis
external obliques
erector spinae

Question 27

which abdominal muscles are deep?

Answer 27

transverse abdominis
internal obliques
multifidus

Question 28

which structure can tighten the L spine without putting stress on it?

Answer 28

TL fascia

Question 29

what are the VPAC startegies

Answer 29

abdominal draw in maneuver
multifidus activation
pelvic floor muscle activation
abdominal bracing

Question 30

which position is better for multifidus activation?

Answer 30

sidelying

Question 31

posterior pelvic tilt facilitates _____ activation and is best for ____ bias PAIN MODULATION

Answer 31

rectus abdominis
flexion

Question 32

transverse abdominis contributes to increased _____

Answer 32

intra-abdominal pressure

Question 33

ASISs should be slightly _____ than the PSISs

Answer 33

lower

Question 34

guidelines for stabilization exercises

Answer 34

start with 5 mins / day
start 30-60 sec then 3 mins
20-30 reps with 4-8 sec holds