Lumbar Spine Flashcards
What are normal expectations when observing LQ movement screen?
Normal Expectations:
-Touches toes?
-Reversal of Lumbar Lordosis
-Hip to Spine flexion ratios about 50% each
-Posterior hip sway
What are two constructs for scoring the Keele STARTBack Screen Tool?
1) Overall Score – if 3 or more = Medium or High Risk to develop Chronic LBP – depending on how the scores for the Psychological Items are
2) Psychological Score
Psych score 2 or less = Medium Risk
Psych score 3 or more = High Risk
Medium or High RISK = Refer to PT
What are signs of pathologic motion when observing LQ movement screen?
Non-reversal of L-Lordosis
Hinge Points
Judder and deviations
Gower’s sign (climbing up the legs to stand back up)
What are the 5 criteria for Lumbar Manipulation CPR?
Duration of Symptoms < 16 days
At least one hip > 35 of IR
Lumbar Hypo-mobility
No symptoms distal to knee
FABQ-W <19
What is the four criteria for Lumbar Stabilization Intervention CPR?
Age < 40
Avg SLR > 91
POS Prone instability test (PIT)
Aberrant movement present (instability catch, painful arc, thigh climbing, reversal of lumbo-pelvic rhythm)
Grade 1 Spondylolithesis
<25% slippage, usually not symptomatic
Grade 2 Spondylolithesis
25%-50% slippage, education to avoid extension and begin spinal stabilization. May use casting to reduce anterior shear forces and allow healing
Grade 3 Spondylolithesis
50%-75% slippage, conservative treatment may be attempted. May need surgery
Grade 4 Spondylolithesis
> 75% slippage, surgery due to neurological involvement
What 3 exercises are included in the McGill Big 3?
The Curl Up
Side Plank
Bird dog
What is the lumbar spinal stenosis CPR?
Bilat Symptoms
Leg Pain > Back Pain
Pain during walking or standing
Pain relief upon sitting
Age > 48 years
Who is more likely to experience Pelvic Girdle / SIJ Pain?
Females > Males
What is a common mechanism of injury (MOI) for Pelvic Girdle / SIJ Pain?
Recent Fall onto buttock or knee, pregnancy/childbirth (post partum or monthly cycle)
What should be ruled out (R/O) when assessing Pelvic Girdle / SIJ Pain?
Fractures – Trauma vs. Insufficiency (Osteoporosis)
How does Pelvic Girdle / SIJ Pain present in the early stages?
Hurts with Everything!
How does Pelvic Girdle / SIJ Pain present later?
Inconsistent Onset vs. Specific Motions…Movement Control
What type of pain is commonly reported in the SIJ / PSIS region?
Sharp Pain
What physical signs may indicate Pelvic Girdle / SIJ Pain?
Guarded Gait, Any Pelvic Motion, Any Lifting the LE (into the bathtub)
What sleeping issue is commonly associated with Pelvic Girdle / SIJ Pain?
Sleeping difficult, Any Rolling / Supine-Sit aggravates
What is the initial focus of physical therapy management for Pelvic Girdle / SIJ Pain when everything hurts?
Symptom Moderation – Belting to stabilize
What is the focus of physical therapy management for Pelvic Girdle / SIJ Pain with inconsistent onset?
Movement Control
What is the criteria for SIJ CPR - Provocation Test Cluster(s) ?
Distraction
Compression
Thigh Thrust
Ganslen’s
Sacral Thrust (Laslett’s)
What 3 criteria are involved in the LQ algorithm for pelvic girdle (Pelvic alignment)?
Need 2 of 3 POSITIVE for these for the Pelvic Girdle:
Motion Testing (March/Gillet and Forward bending tests)
Positional Testing – Ant/Post illia, inflare/outflares
Ligamentous Palpation Provocation Testing – Long & Short SI, Sacrospinous & Sacrotuberous ligaments
What is the forward bend PSIS test?
Left Hand on Sacral Base, R hand on PSIS; Patient FB’s watch for WHEN PSIS moves. Compare to C/L side. POS= Side that moves 1st or moves MOST w/ FB as it is more restricted or “sticking” to the spine longer. (Sacrum on Ilium)
What is the March/Gillet Test?
Ilium on sacrum. POS for side that moves the LEAST (L to R on March). Also view for trendelenberg and or pelvic elevation (Movement Control)
What is the Active SLR Test (AKA “Mens” Test)?
Laxity with inflammation trauma vs. ligamentous laxity
Original Article tested in Post Partum Population
Stabilize the Pelvis and Repeat Active SLR; POS if pain abolished with stabilization
What does it mean if you have a short to long leg in supine to long sit test?
Short to long leg = Posterior Ilial rotation
What does it mean if you have a long to short leg in supine to long sit test?
Long to Short leg = Anterior Ilial rotation
What does it mean if you have a short leg with no change in supine to long sit test?
Short leg with no change = Leg Length Discrepancy
Lumbar strain/sprain symptoms
Diffuse pain in lumbar muscles; some radiation to buttocks
Degenerative disk or facet process symptoms
Localized lumbar pain; similar findings to lumbar strain
Herniated disk symptoms
Leg pain often worse than back pain; pain radiating below knee
Osteoporotic compression fracture symptoms
Spine tenderness; often history of trauma
Spinal stenosis symptoms
Pain better when spine is flexed or when seated, aggravated by walking downhill more than uphill; symptoms often bilateral
Spondylolisthesis
Pain with activity, usually better with rest; usually detected with imaging; controversial as cause of significant pain
What is derangement?
Obstruction within spinal motion segment
Time: Instant
Variable Pain within the motion segment
What is dysfunction?
Structural scar & shortened tissue
Time to develop 6-8 weeks after injury
Consistent, ERP always On/Off
