Lumbar Spine Evaluation Flashcards
1
Q
AHCPR Red Flags
A
- age >65 or 10 year post menopause
- trauma
- immunosppression
- rest/night pain
- LE neurological deficit
- history of cancer
- saddle anesthesia
- bladder dysfunction
- fever, chills, night sweats
- weight loss
- recent infection
2
Q
Self assessments for lumbar spine
A
- Oswestry Disability Index (ODI)
- Roland-Morris Disability Questionnaire
- Patient Specific Functional Scale
- Fear Avoidance Beliefs Questionnaire (FABQ)
- Pain Catastrophizing Scale (PCS)
3
Q
Neurodynamic testing
A
- SLR
- slump
- femoral nerve test
4
Q
Neuro screen for diagnosing lumbosacral radiculopathy
A
- reflexes
- weakness
- sensory
- +SLR
5
Q
Repeated movement testing
A
- Flexion 10 reps
- Extension 10 reps
Sideglides if lateral shift is present 10 reps - assess for centralization or peripheralization of symptoms
6
Q
Muscle testing
A
- Multifidi: swelling, arm movement, weight shift
- Transverse Abdominus: drawing in maneuver
- Myotomal testing
7
Q
Describe the prone instability test
A
- patient lies on table with hips hanging off and feet on the ground
- PT provides PA pressure to the lumbar spine looking for provocation of pain
- patient lifts legs off of floor
- PT provides PA pressure to lumbar spine looking for provocation of pain
- Positive if pain is reduced in 2nd movement
8
Q
What are the 6 low back pain classifications
A
- LBP w/mobility deficits
- LBP w/movement coordination impairments
- LBP w/referred LE pain
- LBP w/radiating pain
- LBP w/cognitive or affective disorders
- LBP generalized
9
Q
Mobility deficits impairments
A
- reduced ROM
- reduced segmental mobility
- low back & referred pain reproduced with segment provocations
10
Q
Mobility deficits interventions
A
- thrust/non-thrust mobilizations
- exercises for spine mobility
- patient education for return to activity
11
Q
Manipulation test item cluster
A
- duration of symptoms <16 days
- no symptoms distal to knee
- lumbar hypomobility
- at least one hip with greater than 35 degrees IR
- FABQ-W less than 19
- 4/5 predictors and no contraindications = manipulate
12
Q
When to use the neutral gap manipulation technique
A
- for patients that prefer flexion
13
Q
Movement coordination deficits impairments
A
- acute: pain with initial to middle AROM or PROM
- chronic: pain at sustained end range
- referred pain reproduced with lumbar motion or segment provocations
- aberrant movements
- hypermobility may be present
- diminished core muscle activation & endurance
14
Q
Movement coordination deficits interventions
A
- neuromuscular re-education dynamically
- consider external stability
- self care home training
- manual therapy
- exercises to address core muscle activation & endurance
- community or work integration training
15
Q
Coordination impairment/stabilization test item cluster
A
- age<40
- positive prone instability test
- aberrant movement with ROM
- SLR greater than 90 degrees
16
Q
Transverse abdominus training
A
- patient supine in hook lying position
- palpate TA
- have patient lower stomach
- hold for 10 seconds for 10 reps with minimal effort
17
Q
Multifidus training
A
- palpate patients multifidus
- have patient either lift contralateral arm or perform a weight shift
18
Q
Referred LE pain impairments
A
- symptoms centralize with specific positions or repeated motions
- may present with lateral shift
- reduced lumbar lordosis & ROM
- may present with movement coordination impairments also
19
Q
Referred LE pain interventions
A
- exercises, manual procedures, or traction to centralize symptoms
- patient education on positioning
- exercises to address core muscle activation & endurance
- community or work integration training
20
Q
Radiating pain impairments
A
- pain with initial to mid ROM
- aggravated with neurodymanic testing
- may present with LE sensory, strength, & reflex impairments
21
Q
Radiating pain interventions
A
- patient education to reduce stress to nerve root
- manual based treatment to reduced stress to surrounding tissues
- manual traction
- nerve mobility exercises
22
Q
Direction specific exercise flexion category
A
- mainly older patients with spinal stenosis
- LE symptoms come on after standing or walking for certain amount of time
- sitting improves symptoms
- flexion activités improve symptoms
- occasionally a younger patient without stenosis will fit this category
23
Q
Exercises for flexion preference
A
- SKTC
- DKTC
- sitting flexion
- standing flexion
24
Q
Interventions for stenosis
A
- flexion exercises
- manual stretching (hip flexors)
- strengthening
- supported treadmill walking
25
Direction specific exercise extension category
- symptoms distal to the buttock
- symptoms centralize with lumbar extension
- symptoms peripheralize with lumbar flexion
26
Exercises for extension preference
- prone
- prone on elbows
- prone press up
- standing extension
- sideglide against wall
- bridging
- prone leg raise
27
Cognitive or affective tendencies impairments
- one or more
- 2 positive responses to the primary care evaluation of mental disorders (depression)
- high FABQ scores
- High PCS scores
28
Cognitive or affective tendencies interventions
- patient education & counseling to address specific issues exhibited by the patient
- exercise according to pain science research
29
Describe generalized low back pain
- LBP >3 months
- high fear avoidance
- does not meet other classifications
- education (acute injury is healed)
- movement into fearful positions
- fitness
30
Describe symptom modulation stage
- high disability
- volatile symptoms
- high to moderate pain
31
Patient characteristics for symptom modulation stage
- recent or recurrent episodes of LBP that is currently causing significant symptomatic features
- tend to avoid certain postures
- AROM is limited & painful
- increased sensitivity with neurological examination
32
Treatment for symptom modulation stage
- manual therapy (mobilizations/manipulations/soft tissue massage)
- directional preference exercises
- neural mobilization
33
What classifications fall under symptom modulation stage
- LBP with mobility deficits
- LBP with radiating pain
- LBP with referred LE pain
34
Describe movement control stage
- moderate disability
- stable symptoms
- moderate to low pain
35
Patient characteristics for movement control stage
- poor ability to activate individual muscles (TA, multifidus, diaphragm)
- impaired ability to coordinate thoracolumbar & lumbopelvic movements
- poor ability to perform loaded multiplayer movements (squat, lunge, rotation)
36
Treatment for movement control stage
- motor control exercises
- flexibility exercises
- stability exercises
37
What classifications fall under movement control stage
- stabilization/movement coordination deficits
38
Describe functional optimization stage
- low disability
- low to no pain
- symptoms stable
39
Treatment for functional optimization stage
- strength & conditioning
- work tasks
- aerobic exercise
- general fitness
