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Clinical Interventions > Lumbar spine interventions > Flashcards

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
Q

Where does piriformis strain pain refer to?

A

Posterior sacroiliac region, buttocks, and (occasionally) the posterolateral thigh

26
Q

What usually aggravates piriformis muscle strain pain (deep ache/sharp pain)?

A

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
Q

Where is a piriformis muscle strain usually TTP?

A

Medial and proximal to the greater trochanter and/or lateral to the PSIS

28
Q

Where is QL strain pain referred to (aching, sharp pain)?

A
  • Flank, lateral back area
  • posterior SI region
  • upper buttocks
29
Q

What aggravates a QL strain?

A
  • moving from sitting to standing
  • standing for long periods
  • coughing
  • sneezing
  • walking
  • SB
  • trunk ROT
  • supine hip hiking
30
Q

QL strain pain is usually (unilateral/bilateral).

A

unilateral

31
Q

Where is a QL muscle strain usually TTP?

A
  • along the lower ribs
  • its insertion on the iliac crest
32
Q

What is the most common sprain that involves the lumbar facet joints?

A

Lumbar facet joint sprains

33
Q

When does a lumbar facet joint sprain usually occur?

A
  • bending forward
  • bend, lift, twist activities
34
Q

Where is lumbar facet joint sprain pain?

A

It’s local to the structure that is injured

35
Q

How do people usually describe lumbar facet joint sprains?

A

sore pain that gets sharper in response to certain movement and/or postures

36
Q

(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.

A

False (pain is provoked)

37
Q

What is the rehabilitation progression for lumbar facet joint sprains?

A
  • RICE
  • ESTIM
  • joint mobilization using PA and ROT glides
38
Q

Spondylolysis and spondylisthesis can contribute to Low back ____.

A

hypermobility

39
Q

definition: degeneration of the vertebrae and a defect in the pars inter-articularis of the articular process of the vertebrae

A

spondylolysis

40
Q

Spondylolysis is often attributed to a _____ with the defect occurring as a ___.

A

congenital weakness, stress fracture

41
Q

(true/false) spondylolysis may produce NO symptoms unless there is a disc herniation or sudden trauma (ex: hyperextension)

A

true

42
Q

Spondylolysis normally starts as (unilateral/bilateral)

A

unilateral… if it extends bilaterally, there may be some slipping of one vertebra on the one below it

43
Q

definition: a complication of spondylolysis often recurring in HYPERmobility of a vertebral segement

A

spondylisthesis

44
Q

Where does spondylisthesis commonly occur?

A

L5/S1

45
Q

What is most likely cause of spondylisthesis?

A

Hyperextension of the spine

46
Q

How do patients describe spondylisthesis/spondylolysis?

A

Ache across the back like a belt

47
Q

When is spondylisthesis/spondylolysis pain worse?

A

When fatigues or after sitting in a slumped posture for an extended period of time

48
Q

(true/false) spondylisthesis/spondylolysis pain interferes with workout performance

A

False (it does not)

49
Q

What IV discs are most often injured? Which IV discs are the second most commonly affected?

A
  • L4/L5
  • L5/S1
50
Q

What is the MOI of disc-related back pain?

A

Same as lumbosacral pain:
- forward bending and twisting

51
Q

How do patients describe disc-related back pain?

A
  • Centrally located pain that radiates unilaterally or across the back
  • tingling or numbness in a dermatomal pattern
  • sciatic radiation
52
Q

Symptoms of disc-related back pain are normally worse in the (morning/night)

A

morning

53
Q

What aggravates disc-related back pain?

A
  • forward bending
  • sitting postures
  • coughing
  • sneezing
54
Q

With disc-related back pain, ____ pressure over the involved segment increases pain.

A

PA pressure

55
Q

What is the clinical presentation of disc-related back pain?

A

hip-shifted, forward-bent posture

56
Q

Passive SLR will increase back or leg pain during the first ___ degrees of hip FLX when disc-related back pain is present.

A

30 degrees

57
Q

(true/false) Neurological testing may be (+) for differences between the R and L side when disc-related back pain is present.

A

true

58
Q

What is rehabilitation progression for disc-related back pain?

A
  1. Address pain (ice, ESTIM, rest, etc)
    -2. lateral shift corrections
    - gentle EXT exercise following
  2. rest and HEP
  3. restore posture
  4. core stabilization
59
Q

What is the pain relieving position for disc-related back pain?

A

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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