Lumbar Spine Flashcards
What are some criteria that a patient needs to meet to be put into the manipulation classification?
No sxm below knees
Recent sxm
Hypomobility
Low Fear avoidance
More Hip IR
If someone belongs in the manipulation treatment are performed?
Manipulation & exercise
What are some criteria someone must meet to be put into the specific exercise classification?
Centralization during movement exam
Postural/directional preference
If someone belongs in the specific exercise classification what treatment route is done?
Activities to promote centralization
If someone belongs in the stabilization classification what criteria must be met?
Prone instability test
Aberrant motions
Hypermobility
Younger age
Greater SLR ROM
If someone belongs in stabilization classification what treatment route is done?
Stabilization exercises
If someone belongs in the traction classification what criteria must be met?
Neurological signs
Leg Sxm
No centralization during movement testing
If you determine someone to be in the traction classification what treatment options?
Mechanical traction
For acute back pain what treatment should you use based on research?
Thrust or non thrust joint mobilization
For acute back pain what treatment may you use for the patient if they have leg pain?
Muscle strengthening & endurance
Specific trunk activation
What are some other treatments for acute back pain that you may use?
Soft tissue mobilization
Massage
Treatment based classification
Active education
Biopsychosocial contribute to pain
Self management techniques
Favorable natural history
In regards to patient education what should therapist not do?
Recommend or promote bed rest/activity avoidance
Give detailed anatomical explanation
In regards to patient education what should a therapist do?
Structural strength of spine
Pain perception
Favorable prognosis of LBP
Active approach (activity modification)
As activity level improve, pain goes away
What is a derangement syndrome?
Presence of directional preference with rapid change in sxm
Can the body repair disc derangements without surgery?
Yes they can get smaller over time, takes awhile 3-6 months
What is the treatment for a herniated disc/ lumbar radiculopathy?
- Education
- Specific Ex (likely ext)
- May use targeted manual therapy (CVP)
- Eventually prescribe stabilization ex (promote ext)
- General fitness activity/ RTW
- Traction
What are 3 ways that the canal of the vertebrae can narrow?
- Ligamentum Flavum thicken
- Facet joints thicken
- Herniated disc
What is the treatment for lumbar stenosis?
- Education
- Specific ex (flexion)
- May use targeted manual therapy to address lumbar & hip immobility (regain hip ext)
- Address hip flexor tightness (stretching & mobs)
- Ensure to prescribe stabilization ex
- General fitness (cycling, treadmill on incline)
What is the clinical predication rule for manipulation of the lumbar spine?
- Duration of Sxm < 16 days
- Fear avoidance belief questionnaire work subscale score <19
- At least one hip w/ >35° of IR
- Hypomobility in lumbar spine
- No sxm distal to knee
If 4 or more are present from the clinical predication rule what is percentage that manipulation will be successful?
95%
What is the amplitude/resistance & treatment goal of Grade I mobs?
Small amplitude out of resistance
Pain reduction
What is the amplitude/resistance & treatment goal of Grade 2 mobs?
Large amplitude out of resistance
Pain reduction
What is the amplitude/resistance & treatment goal of Grade 3 mobs?
Large amplitude into resistance
Reduce joint stiffness
What is the amplitude/resistance & treatment goal of Grade 4 mobs?
Small amplitude into resistance
Reduce joint stiffness
What is the clinical prediction rule for success with stabilization?
- Prone instability test
- Aberrant trunk motion
- SLR > 90°
- Age <40
What pathology causes the most amount of disability?
Fatty infiltration into muscles
What is avoidance behavior perceived as & associated with?
- Maladaptive response to LBP
- Associated w/ chronic disability
What does avoidance behavior result in?
Physical disuse, reconditioning, & guarded movements
What is the gold standard questionnaire to look at function?
Revised Oswestry Disability Index
in regards to scoring the Oswestry, lower scores = what in regards to disability & high scores?
Lower Scores = lower disability
Higher Scores = Higher disability
In regards to scoring the Oswestry, 0-20% indicates what?
minimal disability
What are some common patterns of herniated disc?
- Insidious onset or related to trauma
- May start w/pain in lumbar region & progress to LE
- Worse w/ flexion activités
- Morning & evening worse
- 95% occur at lower lumbar spine (L4/5 & L5/S1)
- 30-50 y/o (men>women)
- Result of (trauma, poor posture, rep trauma)
- Smokers, sedentary life, obese
What are some common patterns of lumbar radiculopathy?
- Initially back pain presents as leg pain
- Pain/parasthesia presents
- SXM vary depending on activity & position but usually worse w/ flexion
- Better with standing or walking
- Pt may report weakness or difficulty w/ gait
- Neuro exam mandatory
How are herniated disc/ lumbar radic diagnosis?
- MRI
- Electrodiagnostic testing (EMG/NCV test)
- Neuro Exam ( DTR, myotomes, dermatomes, SLR/slump)
- Progressive neurologic decline noted, surgical consult indicated
What is an Adherent Nerve Root (ANR)?
- Episode of back pain w/radic or h/o of surgery
- Leg sxm never completely go away
- Sitting not an issue & walking may be painful at 1st but then improves
- Reports episodes of burning & aching
- Unable to bend forward or SB away
- Neuro exam
What way will people with ANR deviate?
To side of DNR
What are some treatment options for chronic lumbar radiculopathy?
- Education
- Carefully address neural tension
- May use targeted manual therapy to address local lumbar impairments
- Ensure to eventually prescribe stabilization ex
- General fitness activity
What are some common patterns of lumbar stenosis?
- Complains of cramping, aching & or N/T in one or both legs cramping w/ walking
- Worse with standing & walking
- Intermittent sx in back (stiffness)
- Older
- Sitting always relieve leg pain
- Standing tall or extending spine aggravates leg pain
- Slouched position when sit or stand
What will the physical exam be of someone with lumbar stenosis?
- AROM may be decrease w or w/o pain
- Hypomobilty with CVP/UVP
- Limited hip ext
- Normal neuro exam at rest but may have neurological signs after walking
- Asess slump/SLR
What is the clinical prediction rule for lumbar stenosis?
- Bilateral sxm
- Leg pain > back pain
- Pain during walking/standing
- Pain relief upon sitting
- > 48 y/o
What are some common patterns for spondylosis?
- Degeneration of IVD
- Age > 50
- Symmetrial or asymetrical localized LBP
- Episodic; usually time b/w episode decreases
- C/o stiffness & pain
- Normal neuro exam
- Dx w/ radiographs/ CT/ MRI
What is the treatment for spondylosis?
- Education
- Specific exercise from TBC if there is a directional preference
- Acute assess mania CPR from TBC
- May use targeted manual therapy to address lumbar & hip immobility
- Address hip muscle tightness
- Ensure to eventually prescribe stabilization ex
- General fitness activity
What is the common patterns for spondylolysis?
- Defect in pars (L5)
- Men> women
- Common in athletes w/ lumbar ext dominant sports
- Result of repeated micro trauma
- Results in localized back pain
- Ok with stationary task like sitting or standing
- Extending or side- bending/ rotating to painful side is an issue
- Decrease & painful extension (not flexion)
What is the common patterns for spondylolisthesis?
- Most common cause of LBP
- Males > women
- Common in kids w growth spurts
- General back ache to increase stabbing
- Catching or aberrant movements
- Flex activates ok compared to ones involving ext
- Transitioning in to and out of positions is painful
- C/o difficulty with standing
What are the common patterns for sprain/ strains?
- Result of trauma/overuse
- Local pain in lumbar spine (uni or bilateral)
- Stiff & tentative ROM w/ pain
- Decrease trunk rotation w/ ambulation
- Pain w/ MMT of trunk
- Passive ext usually not an issue
- May see local muscle spasm & TTP
What is the treatment for sprain/ strains?
- Education
- Assess manipulation CPR from TBC
- Consider modalities
- Ensure to eventually prescribe stabilization ex
- RTW education/training
- General fitness activity
What is the common patterns for facet joint arthropathy?
- Result of trauma/overuse
- Local pain (unilateal)
- Standing & walking more painful than sitting
- Pain ext/SB/rot ROM
- Passive ext will be painful
- May see local muscle spasm & TTP over facet region
- ## Normal neuro exam
What is the treatment for facet jp
