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Clinical Medicine > Lumbar Spine > Flashcards

Lumbar Spine Flashcards

1
Q

What are some criteria that a patient needs to meet to be put into the manipulation classification?

A

No sxm below knees
Recent sxm
Hypomobility
Low Fear avoidance
More Hip IR

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2
Q

If someone belongs in the manipulation treatment are performed?

A

Manipulation & exercise

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3
Q

What are some criteria someone must meet to be put into the specific exercise classification?

A

Centralization during movement exam

Postural/directional preference

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4
Q

If someone belongs in the specific exercise classification what treatment route is done?

A

Activities to promote centralization

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5
Q

If someone belongs in the stabilization classification what criteria must be met?

A

Prone instability test
Aberrant motions
Hypermobility
Younger age
Greater SLR ROM

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6
Q

If someone belongs in stabilization classification what treatment route is done?

A

Stabilization exercises

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7
Q

If someone belongs in the traction classification what criteria must be met?

A

Neurological signs
Leg Sxm
No centralization during movement testing

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8
Q

If you determine someone to be in the traction classification what treatment options?

A

Mechanical traction

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9
Q

For acute back pain what treatment should you use based on research?

A

Thrust or non thrust joint mobilization

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10
Q

For acute back pain what treatment may you use for the patient if they have leg pain?

A

Muscle strengthening & endurance
Specific trunk activation

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11
Q

What are some other treatments for acute back pain that you may use?

A

Soft tissue mobilization
Massage
Treatment based classification
Active education
Biopsychosocial contribute to pain
Self management techniques
Favorable natural history

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12
Q

In regards to patient education what should therapist not do?

A

Recommend or promote bed rest/activity avoidance
Give detailed anatomical explanation

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13
Q

In regards to patient education what should a therapist do?

A

Structural strength of spine
Pain perception
Favorable prognosis of LBP
Active approach (activity modification)
As activity level improve, pain goes away

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14
Q

What is a derangement syndrome?

A

Presence of directional preference with rapid change in sxm

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15
Q

Can the body repair disc derangements without surgery?

A

Yes they can get smaller over time, takes awhile 3-6 months

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16
Q

What is the treatment for a herniated disc/ lumbar radiculopathy?

A
  • Education
  • Specific Ex (likely ext)
  • May use targeted manual therapy (CVP)
  • Eventually prescribe stabilization ex (promote ext)
  • General fitness activity/ RTW
  • Traction
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17
Q

What are 3 ways that the canal of the vertebrae can narrow?

A
  • Ligamentum Flavum thicken
  • Facet joints thicken
  • Herniated disc
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18
Q

What is the treatment for lumbar stenosis?

A
  • 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)
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19
Q

What is the clinical predication rule for manipulation of the lumbar spine?

A
  • 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
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20
Q

If 4 or more are present from the clinical predication rule what is percentage that manipulation will be successful?

A

95%

21
Q

What is the amplitude/resistance & treatment goal of Grade I mobs?

A

Small amplitude out of resistance
Pain reduction

22
Q

What is the amplitude/resistance & treatment goal of Grade 2 mobs?

A

Large amplitude out of resistance
Pain reduction

23
Q

What is the amplitude/resistance & treatment goal of Grade 3 mobs?

A

Large amplitude into resistance
Reduce joint stiffness

24
Q

What is the amplitude/resistance & treatment goal of Grade 4 mobs?

A

Small amplitude into resistance
Reduce joint stiffness

25
Q

What is the clinical prediction rule for success with stabilization?

A
  • Prone instability test
  • Aberrant trunk motion
  • SLR > 90°
  • Age <40
26
Q

What pathology causes the most amount of disability?

A

Fatty infiltration into muscles

27
Q

What is avoidance behavior perceived as & associated with?

A
  • Maladaptive response to LBP
  • Associated w/ chronic disability
28
Q

What does avoidance behavior result in?

A

Physical disuse, reconditioning, & guarded movements

29
Q

What is the gold standard questionnaire to look at function?

A

Revised Oswestry Disability Index

30
Q

in regards to scoring the Oswestry, lower scores = what in regards to disability & high scores?

A

Lower Scores = lower disability
Higher Scores = Higher disability

31
Q

In regards to scoring the Oswestry, 0-20% indicates what?

A

minimal disability

32
Q

What are some common patterns of herniated disc?

A
  • 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
33
Q

What are some common patterns of lumbar radiculopathy?

A
  • 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
34
Q

How are herniated disc/ lumbar radic diagnosis?

A
  • MRI
  • Electrodiagnostic testing (EMG/NCV test)
  • Neuro Exam ( DTR, myotomes, dermatomes, SLR/slump)
  • Progressive neurologic decline noted, surgical consult indicated
35
Q

What is an Adherent Nerve Root (ANR)?

A
  • 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
36
Q

What way will people with ANR deviate?

A

To side of DNR

37
Q

What are some treatment options for chronic lumbar radiculopathy?

A
  • Education
  • Carefully address neural tension
  • May use targeted manual therapy to address local lumbar impairments
  • Ensure to eventually prescribe stabilization ex
  • General fitness activity
38
Q

What are some common patterns of lumbar stenosis?

A
  • 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
39
Q

What will the physical exam be of someone with lumbar stenosis?

A
  • 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
40
Q

What is the clinical prediction rule for lumbar stenosis?

A
  • Bilateral sxm
  • Leg pain > back pain
  • Pain during walking/standing
  • Pain relief upon sitting
  • > 48 y/o
41
Q

What are some common patterns for spondylosis?

A
  • 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
42
Q

What is the treatment for spondylosis?

A
  • 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
43
Q

What is the common patterns for spondylolysis?

A
  • 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)
44
Q

What is the common patterns for spondylolisthesis?

A
  • 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
45
Q

What are the common patterns for sprain/ strains?

A
  • 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
46
Q

What is the treatment for sprain/ strains?

A
  • Education
  • Assess manipulation CPR from TBC
  • Consider modalities
  • Ensure to eventually prescribe stabilization ex
  • RTW education/training
  • General fitness activity
47
Q

What is the common patterns for facet joint arthropathy?

A
  • 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
48
Q

What is the treatment for facet jp

A

Clinical Medicine (12 decks)

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