Lumbar Spine Flashcards
S&S of nociplastic pain (4)
Disproportionate, unpredictable pattern of symptoms
Present > 3 mo.
Multi-site/widespread pain
Diffuse, non-anatomical areas of pain and tenderness
24 hour pattern of pain/symptoms - worse in morning, better midday, worse in evening
Inflammation
24 hour pain/symptoms - severe morning stiffness >30 min
Systemic inflammatory conditions (RA, Ankylosing spondylitis)
24 hour pain/symptoms - night pain that disturbs sleep
Cancer, tumor, bad inflammatory condition
“Special questions” (system screen?) (7)
Unexplained weight change
Night pain no associated with movement
Change in B&B
Saddle paresthesia
Pain w/ cough/sneeze
Fever, chills, night sweats, malaise
Perception of leg weakness
Characteristics of cauda equina syndrome (percentages)
96% reported back pain
93% reported sciatica
83% B&B changes
81% saddle paresthesia
Avg age 42-46
Inspection (5)
Changes in muscle size/tone (atrophy, hypertrophy, bracing)
Changes in spinal curve
Lateral shift
Leg length
How do they load LE (symmetrical? Knee position/structure? Foot structure?)
Functional Screening tests
Squat
Single leg balance
Single leg squat
Functional screening tests - squat: what are we looking at?
Flexibility and function of hips, knees, ankles
Strength assessment
Lumbar flexion
Functional screening tests - single leg balance: what are we looking at?
Positional control/proprioception
Lateral hip strength
Functional screening tests - single leg squat: what are we looking at?
Hip control and leg strength/muscle coordination
What else, aside from quantity of motion, are we looking at when assessing AROM? (4)
Symptom response
Movement deviations
Distribution of movement in the spine
Guarding behavior
SLR is testing which nerve roots?
L4-S1
Prone knee bend is testing which nerve roots?
L1-L3 (femoral nerve)
L2-L4??
Treatment recommendation for pt with directional preference that causes symptoms to centralize
Repeated movements - classic dose is 1-2 sets of 10-12 reps every 1-2 hours
Mobilization/manipulation subgroup of LBP - characteristics (4)
Recent onset <16 days
No radicular pain/symptoms
Pain/stiffness w/ prone PA testing
Low fear avoidance
Stabilization - characteristics (4)
Recurrent episodes
Aberrant movement patterns (e.g., Gower’s sign)
Greater SLR ROM (>90*)
Positive prone instability test
Classification system does not work well for pts w/ symptoms for greater than…
90 days
4 broad classifications of MDT or McKenzie model
Posture
Dysfunction
Derangement
Chronic pain
McKenzie model largely based on?
Use of repeated movements to establish a directional preference
Key points of postural syndrome
Pain arises w/ static positioning of spine
Pain disappears when moved out of position/doesn’t arise when pt is moving
Key points of dysfunction syndrome (3)
Pain is always intermittent and arises at end range of restricted motion (due to structurally impaired tissues/adaptively shortened tissue)
Symptoms present for 8-12 weeks (time needed for tissue to deform)
Repeated movement in direction of pain to remodel tissue
Derangement syndrome key points
Directional preference and inconsistency in symptoms/provocation of symptoms is hallmark
Classic pattern for stenosis
Radiating pain, numbness, paresthesia to leg w/ standing and walking
Relief w/ sitting, squatting, fwd bending “neurogenic claudication”
Positive shopping cart sign
Neurogenic claudication
Leg pain, heaviness, weakness w/ walking due to cord compression
In management of spondylosis/spondylolisthesis, it’s important to not allow…
ANY symptoms in treatment
Radiculopathy vs Radiculitis
Radiculopathy - any painful process that occurs in spinal cord // loss of nerve function
Radiculitis - inflammation of spinal nerve root // type of neuropathic pain