lumbar spine

Question 1

TBC Classification

Answer 1

Rehab triage

1. Symptom Modulation
2. Movement control
3. Functional optimization

Question 2

Only indication for traction

Answer 2

• if symptoms peripheralize with flex/ext

- CROSSED SLR test

Question 3

TBC treatment progression

Answer 3

Address in this order

1. Neural component
2. Soft tissue/joint mobility restrictions
3. Motor control issues
4. Endurance

Question 4

Flynn CPR for Lumbar manip

Answer 4

1. Acute < 16 days onset of pain
2. No pain distal to knee
3. hip IR > 35 degrees ( in one hip)
4. one hypomobile segment
5. Low FABQ score < 19

> 4/5 = 92 % success
who not to manip?
< 3/5= 7% chance of success

Question 5

5 most common sinister pathologies with LBP

Answer 5

1. Cancer
2. Fracture
3. Infection
4. Cauda Equina
5. Inflammatory arthritis
6. AAA

Question 6

Prolapsed disc

Answer 6

bulge but disc still contained within fibers of AF

Question 7

Extruded disc

Answer 7

broken through fibers of annulus fibrosis

Question 8

Sequetered disc

Answer 8

broken through fibers of AF and parts are floating around

Question 9

treadmill treatment for vascular claudication

Answer 9

• 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

Question 10

ABI

Answer 10

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)

Question 11

Outcome measures

Answer 11

roland morris disability scale- better for low irritability)

ODI best

Question 12

thrust manipulation

Answer 12

CPR

1. Low FABQ score < 19
2. IR > 35 on one hip
3. hypomobility in one segment
4. pain < 16 days
5. no pain distal to knee

best for ACUTE LBP, can use with subacute and chronic pain too
- buttock and thigh pain too

Question 13

Non-thrust mobilization

Answer 13

best for subacute or chronic LBP- NOT indicated for acute

-improves hip/spine mobility

Question 14

Trunk coordination and endurance exercises

Answer 14

SUBACUTE AND CHRONIC LBP with movement coordination deficits and s/p lumbar discectomy

Question 15

Directional preference

Answer 15

ALL

- acute, subacute, chronic

Question 16

Tx for chronic LBP without generalized pain

Answer 16

• moderate to high intensity exercises

Question 17

Tx for chronic LBP with generalized pain

Answer 17

• progressive low to submax fitness. Pain management and health promotion

Question 18

Appendicitis

Answer 18

(+) 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

Question 19

(+) SLR

Answer 19

radicular pain > 40 degrees of hip flexion

Question 20

crossed SLR

Answer 20

(+) for contralateral LBP may be indicative of large posterior hernaition or SPACE OCCUPYING LESION

Question 21

indications for imagining

Answer 21

progressive neurological symptoms, fall/trauma or other red flag symptoms

Question 22

SI jt cluster CPR

Answer 22

1. (+) Gaenslans
2. Sacral thrust
3. thigh thrust
4. compression
5. distraction

Question 23

Spinal stenosis tx

Answer 23

CHOOSE boDYWEIGHT SUPPORT TREADMILL WALKING and manual therapy

Question 24

spondylolisthesis

Answer 24

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

Question 25

Scoliosis

Answer 25

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

Question 26

Thoracic clinical diagnostic rule for fx

Answer 26

4 S’s

She (woman)
Seventy (70 age)
Significant trauma
Steroids

Question 27

Pregancy and LBP

Answer 27

• EDUCATION AND EXERCISE

Question 28

Indications for lumbar traction

Answer 28

• in prone
• (+) crossed SLR
• peripheralization of symptoms

Question 29

Acute LBP painful range

Answer 29

early-mid range of motion (more pain, dont want to move more)

Question 30

subacute and chronic painful range

Answer 30

mid-end range

Question 31

When is MRI indicated?

Answer 31

Progressive neuro signs or presence of red flags

Question 32

Best outcome measures

Answer 32

(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

Question 33

Anteriorly tilted innominate

Answer 33

leg appears LONGER in supine, sit up and long leg becomes shorter

Question 34

Posterior tilted innominate

Answer 34

leg appears SHORTER in supine, long sit and short leg becomes LONGER

Question 35

Posterior pelvis pain provocation test

Answer 35

detects patients with spinal instability

Question 36

STaRT scale

Answer 36

the psychosocial questions
< 4 high risk
>3 med risk
<3 low risk

9 item screen, agree or disagree

Question 37

Flexion Exercises and Nerve mobilizations

Answer 37

Level C evidence

Question 38

Traction parameters

Answer 38

QIW x 12 min, with 40-60% of their body weight

Question 39

Spinal stenosis walking program

Answer 39

on BWS system

Question 40

Increased activation to which muscle after manip

Answer 40

lumbar multifidi

Question 41

pelvic girdle outcome measure

Answer 41

pelvic girdle questionnaire