lumbar spine Flashcards
TBC Classification
Rehab triage
- Symptom Modulation
- Movement control
- Functional optimization
Only indication for traction
- if symptoms peripheralize with flex/ext
- CROSSED SLR test
TBC treatment progression
Address in this order
- Neural component
- Soft tissue/joint mobility restrictions
- Motor control issues
- Endurance
Flynn CPR for Lumbar manip
- Acute < 16 days onset of pain
- No pain distal to knee
- hip IR > 35 degrees ( in one hip)
- one hypomobile segment
- Low FABQ score < 19
> 4/5 = 92 % success
who not to manip?
< 3/5= 7% chance of success
5 most common sinister pathologies with LBP
- Cancer
- Fracture
- Infection
- Cauda Equina
- Inflammatory arthritis
- AAA
Prolapsed disc
bulge but disc still contained within fibers of AF
Extruded disc
broken through fibers of annulus fibrosis
Sequetered disc
broken through fibers of AF and parts are floating around
treadmill treatment for vascular claudication
- treadmill test more sensitive than bike test
have pt walk on treadmill where symptoms elicited to 1 on claudication scale within 3-5 min
- have pt continue walking until score of 2 (since its vascular, its about the effort and continued muscle use, dont necessarily need increase in resistance)
- then have pt rest to resolve symptoms
- repeat for 35 min of walking
increase 5 min / session to ultimately get to 50 min 3-5x/week for 12 weeks
ABI
ankle brachial index
mean 3 systolic BP of LE/ mean 3 systolic BP of UE
normal ABI 1-1.1
if ABI < .95= significant narrowing of vessels in LE
< .8 may become symptomatic ( intermittent claudication)
Outcome measures
roland morris disability scale- better for low irritability)
ODI best
thrust manipulation
CPR
- Low FABQ score < 19
- IR > 35 on one hip
- hypomobility in one segment
- pain < 16 days
- no pain distal to knee
best for ACUTE LBP, can use with subacute and chronic pain too
- buttock and thigh pain too
Non-thrust mobilization
best for subacute or chronic LBP- NOT indicated for acute
-improves hip/spine mobility
Trunk coordination and endurance exercises
SUBACUTE AND CHRONIC LBP with movement coordination deficits and s/p lumbar discectomy
Directional preference
ALL
- acute, subacute, chronic
Tx for chronic LBP without generalized pain
- moderate to high intensity exercises
Tx for chronic LBP with generalized pain
- progressive low to submax fitness. Pain management and health promotion
Appendicitis
(+) Mcburneys point tenderness (halfway bw belly button and ASIS on R
Abdominal pain
fever, nausea
Retro cecal appendicitis- pain referred to thigh and R testicle
(+) SLR
radicular pain > 40 degrees of hip flexion
crossed SLR
(+) for contralateral LBP may be indicative of large posterior hernaition or SPACE OCCUPYING LESION
indications for imagining
progressive neurological symptoms, fall/trauma or other red flag symptoms
SI jt cluster CPR
- (+) Gaenslans
- Sacral thrust
- thigh thrust
- compression
- distraction
Spinal stenosis tx
CHOOSE boDYWEIGHT SUPPORT TREADMILL WALKING and manual therapy
spondylolisthesis
pain worse with hyperextension and rotation
- pain with palpation to L5
- palpable step off
Tx: rest to decrease sx, then core stability, low impact aerobic exercise
Scoliosis
angle > 30: brace immediately
> 20-29 degrees, monitor to see if curve increases > 5 degrees over next 12 months for bracing
< 20 brace not recommended
Thoracic clinical diagnostic rule for fx
4 S’s
She (woman)
Seventy (70 age)
Significant trauma
Steroids
Pregancy and LBP
- EDUCATION AND EXERCISE
Indications for lumbar traction
- in prone
- (+) crossed SLR
- peripheralization of symptoms
Acute LBP painful range
early-mid range of motion (more pain, dont want to move more)
subacute and chronic painful range
mid-end range
When is MRI indicated?
Progressive neuro signs or presence of red flags
Best outcome measures
(with clinical change)
ODI 10 pts (out of 100, 30%)
Roland Morris 5 points (out of 24, 30%)
FABQ- >29 suggested cutoff score in nonworking, 22 in working
Anteriorly tilted innominate
leg appears LONGER in supine, sit up and long leg becomes shorter
Posterior tilted innominate
leg appears SHORTER in supine, long sit and short leg becomes LONGER
Posterior pelvis pain provocation test
detects patients with spinal instability
STaRT scale
the psychosocial questions
< 4 high risk
>3 med risk
<3 low risk
9 item screen, agree or disagree
Flexion Exercises and Nerve mobilizations
Level C evidence
Traction parameters
QIW x 12 min, with 40-60% of their body weight
Spinal stenosis walking program
on BWS system
Increased activation to which muscle after manip
lumbar multifidi
pelvic girdle outcome measure
pelvic girdle questionnaire
