Lumbar Spine

Question 1

S&S of nociplastic pain (4)

Answer 1

Disproportionate, unpredictable pattern of symptoms

Present > 3 mo.

Multi-site/widespread pain

Diffuse, non-anatomical areas of pain and tenderness

Question 2

24 hour pattern of pain/symptoms - worse in morning, better midday, worse in evening

Answer 2

Inflammation

Question 3

24 hour pain/symptoms - severe morning stiffness >30 min

Answer 3

Systemic inflammatory conditions (RA, Ankylosing spondylitis)

Question 4

24 hour pain/symptoms - night pain that disturbs sleep

Answer 4

Cancer, tumor, bad inflammatory condition

Question 5

“Special questions” (system screen?) (7)

Answer 5

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

Question 6

Characteristics of cauda equina syndrome (percentages)

Answer 6

96% reported back pain
93% reported sciatica
83% B&B changes
81% saddle paresthesia

Avg age 42-46

Question 7

Inspection (5)

Answer 7

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?)

Question 8

Functional Screening tests

Answer 8

Squat
Single leg balance
Single leg squat

Question 9

Functional screening tests - squat: what are we looking at?

Answer 9

Flexibility and function of hips, knees, ankles

Strength assessment

Lumbar flexion

Question 10

Functional screening tests - single leg balance: what are we looking at?

Answer 10

Positional control/proprioception

Lateral hip strength

Question 11

Functional screening tests - single leg squat: what are we looking at?

Answer 11

Hip control and leg strength/muscle coordination

Question 12

What else, aside from quantity of motion, are we looking at when assessing AROM? (4)

Answer 12

Symptom response
Movement deviations
Distribution of movement in the spine
Guarding behavior

Question 13

SLR is testing which nerve roots?

Answer 13

L4-S1

Question 14

Prone knee bend is testing which nerve roots?

Answer 14

L1-L3 (femoral nerve)

L2-L4??

Question 15

Treatment recommendation for pt with directional preference that causes symptoms to centralize

Answer 15

Repeated movements - classic dose is 1-2 sets of 10-12 reps every 1-2 hours

Question 16

Mobilization/manipulation subgroup of LBP - characteristics (4)

Answer 16

Recent onset <16 days

No radicular pain/symptoms

Pain/stiffness w/ prone PA testing

Low fear avoidance

Question 17

Stabilization - characteristics (4)

Answer 17

Recurrent episodes

Aberrant movement patterns (e.g., Gower’s sign)

Greater SLR ROM (>90*)

Positive prone instability test

Question 18

Classification system does not work well for pts w/ symptoms for greater than…

Answer 18

90 days

Question 19

4 broad classifications of MDT or McKenzie model

Answer 19

Posture
Dysfunction
Derangement
Chronic pain

Question 20

McKenzie model largely based on?

Answer 20

Use of repeated movements to establish a directional preference

Question 21

Key points of postural syndrome

Answer 21

Pain arises w/ static positioning of spine

Pain disappears when moved out of position/doesn’t arise when pt is moving

Question 22

Key points of dysfunction syndrome (3)

Answer 22

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

Question 23

Derangement syndrome key points

Answer 23

Directional preference and inconsistency in symptoms/provocation of symptoms is hallmark

Question 24

Classic pattern for stenosis

Answer 24

Radiating pain, numbness, paresthesia to leg w/ standing and walking

Relief w/ sitting, squatting, fwd bending “neurogenic claudication”

Positive shopping cart sign

Question 25

Neurogenic claudication

Answer 25

Leg pain, heaviness, weakness w/ walking due to cord compression

Question 26

In management of spondylosis/spondylolisthesis, it’s important to not allow…

Answer 26

ANY symptoms in treatment

Question 27

Radiculopathy vs Radiculitis

Answer 27

Radiculopathy - any painful process that occurs in spinal cord // loss of nerve function

Radiculitis - inflammation of spinal nerve root // type of neuropathic pain