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722: Clinical Management of the Musculoskeletal System II > Lumbar Spine (Part 3) > Flashcards

Lumbar Spine (Part 3) Flashcards

1
Q

What are the 4 lumbar spine treatment-based classifications?

A

1) Lumbar Manipulation
2) Lumbar Instability
3) Lumbar Traction
4) Specific Exercise

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2
Q

What are the 5 predictor variables for lumbar manipulation?

A
  • Pain does not travel below the knee
  • Onset ≤ 16 days ago
  • Lumbar hypomobility
  • Either hip has > 35° of internal rotation
  • FABQ - Work subscale score < 19
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3
Q

If - criteria are present then patients have a 95% chance of responding well to lumbar manual therapy

A

3-4

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4
Q

How is the FABQ scored?

A

16 statements patient rates on a scale from 0 (completely disagree) to 6 (completely agree)

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5
Q

What are the 2 FABQ subscales?

A

Work and Physical Activity

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6
Q

_____ FABQ scores (work subscale less than 19) are associated with improved likelihood to succeed with lumbar manipulation

A

Lower

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7
Q

What are the absolute contraindications to lumbar spine manipulation?

A
  • Lack of indications
  • Poor integrity of ligamentous or bony structures from recent injury or disease process
  • Unstable fracture
  • Bone tumors
  • Infectious disease
  • Osteomyelitis
  • Use of anticoagulant medication
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8
Q

What are the 5 predictor variables of success for lumbar instability?

A
  • SLR > 91°
  • greater than 40 years old
  • aberrant motion present with forward bending
  • positive prone instability test
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9
Q

The presence of at least _ success predictor variables indicates a small, meaningful shift in probability of at least 50% improvement in function after 8 weeks of lumbar stabilization

A

3

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10
Q

What are the 5 predictor variables of non-success for lumbar instability?

A
  • FABQ physical activity subscale less than 8
  • aberrant movement absent with forward bending
  • no hypermobility during PA spring test
  • negative prone stability test
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11
Q

Presence of a least _ non-success predictor variables indicates a moderate shift in probability patient will not improve with lumbar stabilization

A

2

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12
Q

Aberrant motion can also be called _____ sign

A

Gower’s

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13
Q

What motions are aberrant with Gower’s sign?

A
  • Painful arc in flexion
  • Painful arc on return from flexion
  • Instability catch
  • Reversal lumbopelvic rhythm
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14
Q

What is considered a positive prone instability test?

A

when there is pain in the relaxed position, but not in the contracted position

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15
Q

What should the intervention plan be for lumbar stability?

A

2 times a week for 8 weeks

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16
Q

What 6 muscles should be the focus of a lumbar stability program?

A
  • RA
  • TrA
  • IO
  • ES
  • multifidus
  • QL
17
Q

According to Dr. Bond’s article what are the “big three” stabilization exercise for simple low back pain?

A

1) curl-ups for rectus abdomins
2) side bridge for the obliques, TA, and quadratus
3) birddogs for the back extensors

18
Q

What is the definition of a successful lumbar stability program?

A

> 50% change on modified Oswestry Disability Index (ODI)

19
Q

What is the definition of an unsuccessful lumbar stability program?

A

< 6-point improvement on ODI

20
Q

What is another instability test (other than the prone instability test)?

A

active SLR

21
Q

What patients is the active SLR tested in?

A

post-partum patients

22
Q

How is the active SLR scored?

A

Scores of both sides added so summed score ranges 0-10

0 = not difficult at all
1 = minimally difficult
2 = somewhat difficult
3 = fairly difficult
4 = very difficult
5 = unable to perform
23
Q

What is considered a positive test?

A

Any score rom 1-10 (anything other than not difficult at all)

24
Q

What are the 2 predictor variables for PRONE lumbar traction?

A
  • peripheralization with repeated extension

- positive crossed SLR

25
Q

The presence of _ or more prone predictor variables helps identify patients with signs of nerve root compression who have higher likelihood of experiencing 50% reduction in disability after 6 weeks (12 sessions) of manual therapy, extension exercises, lumbar traction, and education.

A

1

26
Q

Describe the parameters for a prone traction intervention

A

Static traction at 40-60% of body-weight for maximum 12 minutes

27
Q

What should be done if a patient is unable to tolerate extended traction position initially?

A

Reposition after 3 minutes of traction to more tolerable position with goal of reaching neutral or extended spine

28
Q

What are the requirements of the patient after prone traction?

A

Remain prone for 2 minutes after traction completed, followed by 10 press-ups prior to standing

29
Q

What are the 4 predictor variables for SUPINE lumbar traction?

A
  • FABQ work subscale less than 21
  • no neurological deficits
  • older than 30
  • patient has non-manual job status
30
Q

The presence of _____ predictor variables indicates patients with LBP that have a higher likelihood of experiencing a 50% reduction in disability after three sessions of intermittent, mechanical lumbar traction in supine.

A

all 4

31
Q

Describe the parameters for a supine traction intervention

A

Patient positioned in supine with hips and knees supported and flexed at 90°

30-40% of body-weight intermittent traction with 30-second hold and 10-second relaxation phase 15 minutes

32
Q

What is the definition of success for both prone and supine traction treatment?

A

> 50% change on modified Oswestry Disability Index (ODI)

33
Q

What are the 4 predictor variables for EXTENSION exercises?

A
  • symptoms distal to the buttock
  • symptoms centralize with extension
  • symptoms peripheralize with flexion
  • directional preference for extension
34
Q

What are the 3 predictor variables for FLEXION exercises?

A
  • age older than 50
  • directional preference for flexion
  • imaging reveals lumbar spinal stenosis
35
Q

In what positions should patients perform extension exercises?

A

in prone, using prone on elbows or prone press-up activities

36
Q

In what positions should patients perform flexion exercises?

A
  • sitting
  • supine
  • quadruped

722: Clinical Management of the Musculoskeletal System II (12 decks)

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