Lumbar Spine

Question 1

Spine Cancer SPecificity

Answer 1

Older Age
Night Pain (can’t improve it)
Pain at Rest
History of Cancer + Unexplained weight loss (best way to determine)

Question 2

Cauda Equina Syndrome

Answer 2

-disrupts motor & sensory function to the lower extremities & bladder
-LMN syndrome
-Rapid symptoms within 24 hrs
-urinary retention
-history of back pain
-loss of sphincter tone/sacral sensation loss (saddle paresthesia)

Question 3

Vertebral Facture Specificity Cluster

Answer 3

-Older age + trauma (most specific)
-Osteoporosis
-Corticosteroid use

Question 4

Myelopathy

Answer 4

-UMN signs (hypermobile, non-dermatomal, (+) pathological reflexes)
-originates from compression of spinal cord
-bowel/bladder dysfunction
-Dysphagia (difficulty swallowing)/Dysarthria (difficulty talking)
-Ataxic Gait

Question 5

Myelopathy Clinical Diagnosis/Prediction Rule

Answer 5

Gait Deviation (ataxic)
(+) Hoffman’s
(+) Inverted Supinator
(+) Babinski
Age > 45 years

*3 of 5 is .99 specificity

Question 6

Stages to a Disc Herniation

Answer 6

Normal
Degeneration
Prolapse
Extrusion
Sequestration

Question 7

Pain Rating Outcome Measures

Answer 7

0 - 10 scale
Visual Analog Scale or Numeric Pain Rating Scale

*MCID is 2.4 for LBP

Question 8

STarT Back Screening Tool

Answer 8

Helps stratify those patients who need less care and those who need more cognitive-behavioral based care

classified as low, medium or high risk of poor outcome

Question 9

Modified Oswestry Disability Index

Answer 9

Rates level of disability
0-20% minimal disability
21-40% moderate disability
41-60% severe disability
61-80% crippled
81-100% either bed-bound or exaggerating

*MCID is 12%

Question 10

Fear Avoidance Beliefs Questionnaire (FABQ)

Answer 10

2 Subscales: Physical Activity & Work
W-Score higher than 29 indicates poor return to work status
PA-score higher than 14 indicates poor treatment outcomes

Question 11

Tampa Scale of Kinesiophobia (TSK)

Answer 11

quantifies patient’s fear of movement
>37 indicates clinically relevant kinesiophobia

Question 12

Pain Catastrophizing Scale

Answer 12

maladaptive pain response characterized by
-Rumination (i can’t stop thinking about how bad it hurts)
-Magnification (i’m afraid something serious may happen)
-Helplessness (there is nothing I can do to reduce my pain)

> 30 means they’re catastrophizing

Question 13

Short Form 36

Answer 13

questions regarding patient’s perceived health, activity limitations, physical and emotional health problems, social activity, pain, energy & emotions

Question 14

2 item Depression Screen

Answer 14

“During the past month, have you often been bothered by feeling down, depressed or hopeless?”
“During the past month, have you often been bothered by little interest or pleasure in doing things?”

Question 15

Lower Cross Syndrome

Answer 15

Long & Weak abdominals + glutes
Short & Tight hip flexors + spinal extensors
Increased Lumbar Lordosis

Question 16

Pathological Reflexes UMN

Answer 16

spasticity of affected muscles
hyperreflexive DTR, clonus
Babinski

Question 17

Pathological Reflexes LMN

Answer 17

flaccidity of affected muscles
hyporeflexive or absent DTR
muscle atrophy
no pathological reflexes

Question 18

Flexor Endurance Test

Answer 18

Raise trunk off table until scapulae clear
Useful in determining excessive anterior/posterior muscle strength/endurance ratios

Question 19

Double Straight Leg Lowering Test

Answer 19

Notice when lumbar spine begins to arch, ASIS rotates anteriorly or patient fails to keep legs lifted

Question 20

Tests for muscle tightness

Answer 20

Thomas Test (psoas tightness)
Rectus Femoris Test/Kendall (rectus femoris tightness in supine)
Ely’s Test (rectus femoris tightness in prone)

Question 21

Thomas Test

Answer 21

LE can be supported because Psoas only crosses the hip
(+) = straight leg raises off the table & stretch is felt in anterior hip

Question 22

Kendall Test

Answer 22

LE is unsupported because rectus femoris crosses hip & knee

(+) = extension of knee on the side being tested when opposite hip is flexed

Question 23

Ely’s Test

Answer 23

(+) = hip on same side flexes

Question 24

Crossed (Well) SLR Test

Answer 24

Performed on uninvolved leg and if (+) neurological symptoms will reproduce on involved leg (LE flat on table)
(+) indicates potential for large disc herniation

Question 25

Anterior Instability Test

Answer 25

(+) test = palpated segment shifts forward or rapid onset of muscle spasms

Question 26

Posterior Instability Test

Answer 26

(+) test = excessive posterior translation of superior segment

Question 27

Passive Lumbar Extension Test

Answer 27

(+) test = patient complaint of strong lower back pain, back & leg heaviness, or feeling of back “coming off”

Question 28

Prone Instability Test

Answer 28

examiner applies pressure to posterior aspect of most painful segments
(+) = reduction in pain when legs are lifted from floor indicating that muscular recruitment reduces segmental instability

Question 29

Rehabilitation Approaches

Answer 29

Symptoms Modulation
Movement Control
Functional Optimization

Question 30

Symptoms Modulation (acute phase)

Answer 30

Prioritize Symptom reduction first
- Directional Preference Exercises
-Mobilizations/Manipulations
-Traction
-Modalities

Question 31

Movement Control (subacute)

Answer 31

Focus on Local Mobility and Global Stability
-Motor Control Exercises
-Flexibility Exercises
-Stability Exercises

Question 32

Functional Optimization

Answer 32

Patient should be relatively asymptomatic & able to perform ADLs
Interventions should optimize performance in job/sport, endurance, & strength/conditioning

Question 33

Treatment based classification groups

Answer 33

Manual Therapy
Specific Exercise
Stabilization Exercise
Traction

Question 34

Clinical Prediction Rules for Manual Therapy Treatment Group

Answer 34

-symptoms for less than 16 days
-one hip > 35 deg IR
-lumbar hypomobility
-no symptoms distal to knee
-FABQ-W score < 19

Question 35

Clinical Prediction Rules for Specific Exercise Treatment Group

Answer 35

symptoms centralize with a certain movement & perhaps peripheralize in opposite
“McKenzie Method”

Question 36

Clinical Prediction Rules for Stabilization Exercise Treatment Group

Answer 36

3 of the following:
-SLR > 91 deg
- (+) prone instability test
- (+) aberrant movements
- age < 40

Question 37

Clinical Prediction Rules for Traction Treatment Group

Answer 37

-Signs/Symptoms of Nerve root compression
- (+) cross straight leg raise
- no movement centralize symptoms

Question 38

Local Stabilization Exercises

Answer 38

focus is on control of deep, local muscle groups (TA, multifidi) to correct motor control/timing deficits of stabilizer muscles