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Lumbar spine interventions Flashcards

1
Q

What is the 5th most common reason for MD visits?

A

LBP

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2
Q

___% of individuals report LBP within the last 3 months

A

25%

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3
Q

definition: An examination approach for acute LBP that leads to a classification that specifically directs management

A

Treatment based classification (TBC)

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4
Q

(true/false) With TBC, patients can change categories as they improve and progress.

A

true

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5
Q

In what level of TBC staging is a patient assigned a syndrome?

A

Stage 3

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6
Q

What is the syndrome described by the following?
- Merges EXT, FLX, and lateral shift syndromes
- centralization and peripheralization with specific motions

A

Specific exercise syndrome

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7
Q

What is the criteria for Specific Exercise Syndrome for EXT?

A
  • symptoms distal to the buttock
  • symptoms centralize with lumbar EXT
  • symptoms peripheralize with lumbar FLX
  • Directional Preference for EXT
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8
Q

What is the criteria for Specific Exercise Syndrome for FLX?

A
  • > 50 y/o
  • directional preference for FLX
  • imaging evidence for spinal stenosis
  • symptoms centralize with lumbar FLX
  • symptoms peripheralize with lumbar EXT
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9
Q

What is the criteria for Specific Exercise Syndrome for Lateral Shift?

A
  • 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
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10
Q

What is the syndrome that is characterized by the following:
- PMH of trauma and frequent manipulations
- generalized laxity of ligaments
- instability “catch” during motion

A

Immobilization syndrome (hypermobility group)

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11
Q

What are the classification criteria for immobilization syndrome?

A
  • 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
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12
Q

What syndrome is characterized by the following:
- signs and symptoms of nerve root compression
- inability to centralize symptoms w/ movement

A

Traction Syndrome

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13
Q

What interventions should be used the treat mobilization syndrome?

A
  • joint mob/manipulation
  • ROM exercises
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14
Q

What interventions should be used to treat specific exercise syndrome?

A
  • direction of preference exercise with avoidance of the opposing direction
  • manual correction
  • self shift correction
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15
Q

What interventions should be used to treat immobilization/hypermobility syndrome?

A
  • dynamic stabilization
  • use of External support
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16
Q

What interventions should be used to treat traction syndrome?

A
  • manual traction
  • mechanical traction
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17
Q

Where does LBP often arise from?

A

soft tissue structures

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18
Q

Acute LBP lasting no longer than _______ is most common.

A

3 weeks

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19
Q

90% of people with LBP get resolution within __-___ weeks regardless of the care administered

A

6-8 weeks

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20
Q

What is the form of treatment during stage one (acute stage) for LBP?

A
  • modalities (for modulating pain)
  • pain-relieving exercises
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21
Q

What is the form of treatment during stage 2 (re-injury/chronic stage) for LBP?

A
  • treatment plan goes beyond symptom mgmt
  • strengthening, stretching, and mobilization
  • trunk stabilization and functional movement training
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22
Q

definition: history of sudden or chronic stress that initiates pain in a muscular area

A

muscle strain

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23
Q

What is the clinical presentation of muscular strains?

A
  • TTP
  • pain provokes with contraction and stretching
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24
Q

What is the rehab progression for muscular strains?

A
  • RICE
  • Stim
  • mobilization
  • core stabilization
  • stretching
25
Where does piriformis strain pain refer to?
Posterior sacroiliac region, buttocks, and (occasionally) the posterolateral thigh
26
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
27
Where is a piriformis muscle strain usually TTP?
Medial and proximal to the greater trochanter and/or lateral to the PSIS
28
Where is QL strain pain referred to (aching, sharp pain)?
- Flank, lateral back area - posterior SI region - upper buttocks
29
What aggravates a QL strain?
- moving from sitting to standing - standing for long periods - coughing - sneezing - walking - SB - trunk ROT - supine hip hiking
30
QL strain pain is usually (unilateral/bilateral).
unilateral
31
Where is a QL muscle strain usually TTP?
- along the lower ribs - its insertion on the iliac crest
32
What is the most common sprain that involves the lumbar facet joints?
Lumbar facet joint sprains
33
When does a lumbar facet joint sprain usually occur?
- bending forward - bend, lift, twist activities
34
Where is lumbar facet joint sprain pain?
It's local to the structure that is injured
35
How do people usually describe lumbar facet joint sprains?
sore pain that gets sharper in response to certain movement and/or postures
36
(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)
37
What is the rehabilitation progression for lumbar facet joint sprains?
- RICE - ESTIM - joint mobilization using PA and ROT glides
38
Spondylolysis and spondylisthesis can contribute to Low back ____.
hypermobility
39
definition: degeneration of the vertebrae and a defect in the pars inter-articularis of the articular process of the vertebrae
spondylolysis
40
Spondylolysis is often attributed to a _____ with the defect occurring as a ___.
congenital weakness, stress fracture
41
(true/false) spondylolysis may produce NO symptoms unless there is a disc herniation or sudden trauma (ex: hyperextension)
true
42
Spondylolysis normally starts as (unilateral/bilateral)
unilateral... if it extends bilaterally, there may be some slipping of one vertebra on the one below it
43
definition: a complication of spondylolysis often recurring in HYPERmobility of a vertebral segement
spondylisthesis
44
Where does spondylisthesis commonly occur?
L5/S1
45
What is most likely cause of spondylisthesis?
Hyperextension of the spine
46
How do patients describe spondylisthesis/spondylolysis?
Ache across the back like a belt
47
When is spondylisthesis/spondylolysis pain worse?
When fatigues or after sitting in a slumped posture for an extended period of time
48
(true/false) spondylisthesis/spondylolysis pain interferes with workout performance
False (it does not)
49
What IV discs are most often injured? Which IV discs are the second most commonly affected?
- L4/L5 - L5/S1
50
What is the MOI of disc-related back pain?
Same as lumbosacral pain: - forward bending and twisting
51
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
52
Symptoms of disc-related back pain are normally worse in the (morning/night)
morning
53
What aggravates disc-related back pain?
- forward bending - sitting postures - coughing - sneezing
54
With disc-related back pain, ____ pressure over the involved segment increases pain.
PA pressure
55
What is the clinical presentation of disc-related back pain?
hip-shifted, forward-bent posture
56
Passive SLR will increase back or leg pain during the first ___ degrees of hip FLX when disc-related back pain is present.
30 degrees
57
(true/false) Neurological testing may be (+) for differences between the R and L side when disc-related back pain is present.
true
58
What is rehabilitation progression for disc-related back pain?
1. Address pain (ice, ESTIM, rest, etc) -2. lateral shift corrections - gentle EXT exercise following 3. rest and HEP 4. restore posture 5. core stabilization
59
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

Clinical Interventions (25 decks)

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