Lumbar Spine Conditions Examination and Intervention

Question 1

agency for health care ploy and research has 3 categories for lumbar spine injuries

Answer 1

1. serious spinal pathologies: spinal tumor, infection, fracture, caudal equina (look for loss of ROM in all directions)
2. Sciatcia: back related lower extremity symptoms surgical intervention sometimes required
3. nonspecific low back pain: dysfunction of musculoskeletal symptoms

Question 2

spinal stenosis occurs where and in who more from what?

Answer 2

narrowing of the central canal or lateral intervertebral foramina, more in older males over 60 and congenital or age related degeneration causes anterior slippage

Question 3

the boundaries of the lateral foramen

Answer 3

anteriorly: disc and body
Posteriorly: ligamentum flavum
superiorly: facet joints
pedicle degeneration can cause stenosis

Question 4

neurogenic claudication is what?

Answer 4

neural compromise due to obstructions of blood flow to the nerve or dural sleeve

Question 5

symptoms of stenosis include what; aggravating factors include what and what eases them; do they have a history?

Answer 5

symptoms include localized vague pain, back and leg pain maybe bilateral, presence of N/T and weakness of LE’s
aggravating factors include extension, prolonged standing or walking, walking downhill, lying flat
eased by flexion, sitting or squatting, walking uphill, bike riding
they will have a long history of intermittent back pain

Question 6

Objectively stenosis pts will have what posture, pain with what?

Answer 6

flat lumbar posture, painful limited extension, pain with side bend toward the involved side, extension or extension plus rotation classification, altered end feel with OP

Question 7

Objective tests for stenosis include what?

Answer 7

central and unilateral PA, soft tissue changes, neurological exam, treadmill test where they can tolerate uphill but not level or downhill, peripheral pulses will be present, diagnostics need x ray or CT/MRI

Question 8

Goals for stenosis include what?

Answer 8

reduce pain, improve mobility/muscle imbalance, resort stability and movement pattern, improve aerobic fitness

Question 9

Interventions for stenosis include (5)

Answer 9

1. mechanical traction
2. joint mobes (rotation) avoiding prone because of the extension
3. educate pt to keep neutral spine, positioning strategies to encourage flexion
4. lumbar flexion exercises/mobility exercises
5. stretching- HS, hip flexion

Question 10

interventions further for stenosis (6)

Answer 10

address impairments relative flexibility / faulty movement

2. abdominal and gluteal muscle strengthening
3. spinal stabilization
4. no extension exercises only in quadruped
5. medications / epidural steroid injections
6. laminectomy / fusion

Question 11

vascular claudication is caused by what and results in what?

Answer 11

compromised circulatory system due to PVD that is caused by plaque build up along arterial walls causing decrease circulation, the system is unable to meet the increased physiological demands of muscle activity

Question 12

with claudication symptoms do what if walking downhill, what aggravates it what eases it?

Answer 12

symptoms remain the same walking downhill, flexion doesn’t ease symptoms, rarely have back symptoms, aggravating to walk on level surface or uphill causes buttock or calf pain, ease it by stop walking or lying supine

Question 13

Objectively claudication will present with?

Answer 13

skin color changes, temp changes, hair loss, LE cramping or tightness, mainly in calf muscles, peripheral pulses will be absent, treadmill test will provoke s/s with increased effort

Question 14

lumbar facet joints are for what and are compressed by what?

Answer 14

essential for spinal mobility and stability, has bony locking mechanism to protect disc, distributes forces across the spine, compression caused by lateral flexion and rotation

Question 15

The facets are innervated by the?

Answer 15

medial branch of the dorsal primary rams, it also supplies multifidus

Question 16

cause of acute facet dysfunction

Answer 16

mechanical block from entrapment of meniscoid due to stretch on synovial fold

Question 17

meniscoids are what?

Answer 17

synovial folds that project into joints that limit excessive motion, have the potential to be entrapped during return from flexion, what causes torticollis in CS

Question 18

what will acute facet dysfunction s/s be what kind of history

Answer 18

unilateral pain, sharp over facet
increased pain with stretch compression of joint
limitation in side bend and extension
history of sudden unguarded movement normally flexion with rotation
local tenderness on palpation

Question 19

facet lock or acute facet interventions include?

Answer 19

unilateral PAs, traction, manipulation
mobility exercises
modalities
resolves with time with excellent prognosis

Question 20

Chronic facet syndrome is caused by what, is how prevalent, with pain where, when, and increased with what?

Answer 20

caused by facet joint degeneration/hypertrophy, osteophytes, inflammation, micro fracture
30% prevalent with chronic LBP
unilateral pain less sharp over the joint, stiffness and pain in the AM
increased pain with stretch of the joint

Question 21

Chronic facet problems ache when, is relieved by what, history of what?

Answer 21

aches prolonged by inactivity, improved by activity but a return of s/s after prolonged activity
pain relieved by flexion posture
past acute facet history and are never entirely symptom free history of trauma or degeneration

Question 22

Objective presentation of chronic facet problems will have what kind of pain pattern, what kind of tenderness?

Answer 22

localized pain but can refer to larger area, local tenderness with palpation, stiff, thick skin,
diagnosed with facet joint block or medial branch nerve block

Question 23

intervention for chronic facet includes

Answer 23

manual therapy rotations, unilateral PA’s, traction, manipulation
stretching and muscle re-education
address faulty movement
facet joint injections or nerve block

Question 24

Sciatic conditions: Acute nerve root is what? caused by what?

Answer 24

irritation/inflammation, compression, tension to the nerve root, caused by disc pathologies, degenerative changes, other medical conditions
can happen to young or old, can being proximally and then extend distally.

Question 25

Acute nerve root problems present as?

Answer 25

distal s/s more than proximal, severely limits activity, very limited ROM, neuro exam should be level specific, use slump and SLR tests to diagnose

Question 26

acute nerve root interventions include?

Answer 26

modalities
manual traction supine or side lying
lumbar rotation
careful neural flossing
epidural steroids 
exercise program when pain decreases

Question 27

chronic nerve root problems are what, caused by what, symptoms will be where?

Answer 27

chronic irritation or adhesion caused by disc pathologies, nerve root injury, degenerative changes, spinal surgery, proximal symptoms will be more than distal, minimal limitation of activity

Question 28

chronic nerve root will present how neurally, palpated how, what kind of ROM, neurodynamic tests will be what?

Answer 28

may or may not have neural symptoms, palpation will reveal localized thickness in tissues stiff at segment, ROM may be painful with OP, neurodynamic tests may be + or -, will have movement impairment

Question 29

chronic nerve roots can be treated with?

Answer 29

unilateral PAIVMs, rotation, traction
soft tissue work
mobility exercises
segmental muscle re ed
treatment of movement impairment findings