Lumbar spine interventions Flashcards
What is the 5th most common reason for MD visits?
LBP
___% of individuals report LBP within the last 3 months
25%
definition: An examination approach for acute LBP that leads to a classification that specifically directs management
Treatment based classification (TBC)
(true/false) With TBC, patients can change categories as they improve and progress.
true
In what level of TBC staging is a patient assigned a syndrome?
Stage 3
What is the syndrome described by the following?
- Merges EXT, FLX, and lateral shift syndromes
- centralization and peripheralization with specific motions
Specific exercise syndrome
What is the criteria for Specific Exercise Syndrome for EXT?
- symptoms distal to the buttock
- symptoms centralize with lumbar EXT
- symptoms peripheralize with lumbar FLX
- Directional Preference for EXT
What is the criteria for Specific Exercise Syndrome for FLX?
- > 50 y/o
- directional preference for FLX
- imaging evidence for spinal stenosis
- symptoms centralize with lumbar FLX
- symptoms peripheralize with lumbar EXT
What is the criteria for Specific Exercise Syndrome for Lateral Shift?
- Visible frontal plane deviation of the shoulders relative to the pelvis
- asymmetrical SB during AROM
- painful and restricted EXT in AROM
- directional preference for lateral translation movements of the pelvis
What is the syndrome that is characterized by the following:
- PMH of trauma and frequent manipulations
- generalized laxity of ligaments
- instability “catch” during motion
Immobilization syndrome (hypermobility group)
What are the classification criteria for immobilization syndrome?
- frequent recurrent episodes of LBP w/ minimal perturbation
- hypermobility of L-spine
- PMH of lateral shift deformity w/ alt. sides
- frequent prior use of manipulation w/ dramatic but short-term results
- trauma
- pregnancy/ postpartum patients
- use of oral contraceptives
- relief with immobilization
- < 40 y/o
- (+) prone instability test
What syndrome is characterized by the following:
- signs and symptoms of nerve root compression
- inability to centralize symptoms w/ movement
Traction Syndrome
What interventions should be used the treat mobilization syndrome?
- joint mob/manipulation
- ROM exercises
What interventions should be used to treat specific exercise syndrome?
- direction of preference exercise with avoidance of the opposing direction
- manual correction
- self shift correction
What interventions should be used to treat immobilization/hypermobility syndrome?
- dynamic stabilization
- use of External support
What interventions should be used to treat traction syndrome?
- manual traction
- mechanical traction
Where does LBP often arise from?
soft tissue structures
Acute LBP lasting no longer than _______ is most common.
3 weeks
90% of people with LBP get resolution within __-___ weeks regardless of the care administered
6-8 weeks
What is the form of treatment during stage one (acute stage) for LBP?
- modalities (for modulating pain)
- pain-relieving exercises
What is the form of treatment during stage 2 (re-injury/chronic stage) for LBP?
- treatment plan goes beyond symptom mgmt
- strengthening, stretching, and mobilization
- trunk stabilization and functional movement training
definition: history of sudden or chronic stress that initiates pain in a muscular area
muscle strain
What is the clinical presentation of muscular strains?
- TTP
- pain provokes with contraction and stretching
What is the rehab progression for muscular strains?
- RICE
- Stim
- mobilization
- core stabilization
- stretching
Where does piriformis strain pain refer to?
Posterior sacroiliac region, buttocks, and (occasionally) the posterolateral thigh
What usually aggravates piriformis muscle strain pain (deep ache/sharp pain)?
Deep ache
- sitting with hip FLX, ADD, and medial ROT
- exercise
Sharp pain
- deceleration of the medial hip
- leg ROT during WB
Posterior hip and buttock pain
- passive hip IR
- isometric ABD
Where is a piriformis muscle strain usually TTP?
Medial and proximal to the greater trochanter and/or lateral to the PSIS
Where is QL strain pain referred to (aching, sharp pain)?
- Flank, lateral back area
- posterior SI region
- upper buttocks
What aggravates a QL strain?
- moving from sitting to standing
- standing for long periods
- coughing
- sneezing
- walking
- SB
- trunk ROT
- supine hip hiking
QL strain pain is usually (unilateral/bilateral).
unilateral
Where is a QL muscle strain usually TTP?
- along the lower ribs
- its insertion on the iliac crest
What is the most common sprain that involves the lumbar facet joints?
Lumbar facet joint sprains
When does a lumbar facet joint sprain usually occur?
- bending forward
- bend, lift, twist activities
Where is lumbar facet joint sprain pain?
It’s local to the structure that is injured
How do people usually describe lumbar facet joint sprains?
sore pain that gets sharper in response to certain movement and/or postures
(true/false) Pain from a lumbar facet joint sprain becomes better if the vertebra affected is moved passively with PA or ROT pressure through the spinous process.
False (pain is provoked)
What is the rehabilitation progression for lumbar facet joint sprains?
- RICE
- ESTIM
- joint mobilization using PA and ROT glides
Spondylolysis and spondylisthesis can contribute to Low back ____.
hypermobility
definition: degeneration of the vertebrae and a defect in the pars inter-articularis of the articular process of the vertebrae
spondylolysis
Spondylolysis is often attributed to a _____ with the defect occurring as a ___.
congenital weakness, stress fracture
(true/false) spondylolysis may produce NO symptoms unless there is a disc herniation or sudden trauma (ex: hyperextension)
true
Spondylolysis normally starts as (unilateral/bilateral)
unilateral… if it extends bilaterally, there may be some slipping of one vertebra on the one below it
definition: a complication of spondylolysis often recurring in HYPERmobility of a vertebral segement
spondylisthesis
Where does spondylisthesis commonly occur?
L5/S1
What is most likely cause of spondylisthesis?
Hyperextension of the spine
How do patients describe spondylisthesis/spondylolysis?
Ache across the back like a belt
When is spondylisthesis/spondylolysis pain worse?
When fatigues or after sitting in a slumped posture for an extended period of time
(true/false) spondylisthesis/spondylolysis pain interferes with workout performance
False (it does not)
What IV discs are most often injured? Which IV discs are the second most commonly affected?
- L4/L5
- L5/S1
What is the MOI of disc-related back pain?
Same as lumbosacral pain:
- forward bending and twisting
How do patients describe disc-related back pain?
- Centrally located pain that radiates unilaterally or across the back
- tingling or numbness in a dermatomal pattern
- sciatic radiation
Symptoms of disc-related back pain are normally worse in the (morning/night)
morning
What aggravates disc-related back pain?
- forward bending
- sitting postures
- coughing
- sneezing
With disc-related back pain, ____ pressure over the involved segment increases pain.
PA pressure
What is the clinical presentation of disc-related back pain?
hip-shifted, forward-bent posture
Passive SLR will increase back or leg pain during the first ___ degrees of hip FLX when disc-related back pain is present.
30 degrees
(true/false) Neurological testing may be (+) for differences between the R and L side when disc-related back pain is present.
true
What is rehabilitation progression for disc-related back pain?
- Address pain (ice, ESTIM, rest, etc)
-2. lateral shift corrections
- gentle EXT exercise following - rest and HEP
- restore posture
- core stabilization
What is the pain relieving position for disc-related back pain?
90/90 position: 90 degrees of hip FLX and 90 degrees of knee FLX
–> provides a mild lumbar traction
