Lumbar random

Question 1

Clinical prediction rule for lumbar manipulation

Answer 1

Recent onset (>16 days)

Low FABQW (< 19)

No symptoms below the knee

Lumbar stiffness

Good hip IR (>35 deg)

Question 2

Red flags that refer pain from the low back

Answer 2

Pathologic fx

Sacral stress fx

Acute spondylolisthesis

Cancer

Infection

Cauda equina syndrome

Ankylosing spondylitis

Question 3

Red flags that refer pain to the low back

Answer 3

Aneurysm

Vascular claudication

Kidney stone

Genital pathologies

GI pathologies

Question 4

Fear avoidance beliefs questionnaire (FABQ)

Answer 4

FABQW: 42 points possible
- clinical suggestion: >/=30

FABQPA: 24 points possible
- clinical suggestion: >/=14

Modify patient education if above cutoff.

Question 5

Patient health questionnaire (PHQ-4)

Answer 5

4 points possible

Cutoff: >/=2

Refer if score is above cutoff.

Question 6

SINSS: severity

Answer 6

Intensity of pain, impact of pain on ADLs, amount of medication needed to control pain.

Mild: 0-3/10
Moderate: 4-7/10
Severe: 8/10

Measure of functional impact

Question 7

SINSS: irritability

Answer 7

Relationship between the amount of activity required to worsen symptoms, magnitude of symptoms once provoked, time for symptoms to ease or subside

Mild: symptoms ease quickly
Moderate: 1:1 ratio provoke to ease
Irritable: takes a long time to ease

Question 8

SINSS: stage

Answer 8

Acute: less than 3 weeks
Subacute: >3 weeks, <6 weeks
Chronic: >6 weeks

Acute on chronic

Question 9

Symptom modulation

clinical findings

Answer 9

Disability: high
Symptom status: volatile
Pain: high to moderate

Question 10

Symptom modulation

treatment

Answer 10

directional preference exercises
manipulation/mobilization
traction
active rest

Question 11

Movement control

clinical findings

Answer 11

Disability: moderate
Symptom status: stable
Pain: moderate to low

Question 12

Movement control

treatment

Answer 12

sensorimotor exercises
stabilization exercises
flexibility exercises

Question 13

Functional optimization

clinical findings

Answer 13

Disability: low
Symptom status: controlled
Pain: low to absent

Question 14

Functional optimization

treatment

Answer 14

strength and conditioning exercises
work or sport specific tasks
aerobic exercises
general fitness exercises

Question 15

Reintroduction to opposite direction (DP)

Answer 15

When: 5-7 days after no PER; SINSS improvement

How: start unloaded, end sessions with CEN manuever