Lumbar Spine (Part 3) Flashcards
What are the 4 lumbar spine treatment-based classifications?
1) Lumbar Manipulation
2) Lumbar Instability
3) Lumbar Traction
4) Specific Exercise
What are the 5 predictor variables for lumbar manipulation?
- 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
If - criteria are present then patients have a 95% chance of responding well to lumbar manual therapy
3-4
How is the FABQ scored?
16 statements patient rates on a scale from 0 (completely disagree) to 6 (completely agree)
What are the 2 FABQ subscales?
Work and Physical Activity
_____ FABQ scores (work subscale less than 19) are associated with improved likelihood to succeed with lumbar manipulation
Lower
What are the absolute contraindications to lumbar spine manipulation?
- 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
What are the 5 predictor variables of success for lumbar instability?
- SLR > 91°
- greater than 40 years old
- aberrant motion present with forward bending
- positive prone instability test
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
3
What are the 5 predictor variables of non-success for lumbar instability?
- FABQ physical activity subscale less than 8
- aberrant movement absent with forward bending
- no hypermobility during PA spring test
- negative prone stability test
Presence of a least _ non-success predictor variables indicates a moderate shift in probability patient will not improve with lumbar stabilization
2
Aberrant motion can also be called _____ sign
Gower’s
What motions are aberrant with Gower’s sign?
- Painful arc in flexion
- Painful arc on return from flexion
- Instability catch
- Reversal lumbopelvic rhythm
What is considered a positive prone instability test?
when there is pain in the relaxed position, but not in the contracted position
What should the intervention plan be for lumbar stability?
2 times a week for 8 weeks
What 6 muscles should be the focus of a lumbar stability program?
- RA
- TrA
- IO
- ES
- multifidus
- QL
According to Dr. Bond’s article what are the “big three” stabilization exercise for simple low back pain?
1) curl-ups for rectus abdomins
2) side bridge for the obliques, TA, and quadratus
3) birddogs for the back extensors
What is the definition of a successful lumbar stability program?
> 50% change on modified Oswestry Disability Index (ODI)
What is the definition of an unsuccessful lumbar stability program?
< 6-point improvement on ODI
What is another instability test (other than the prone instability test)?
active SLR
What patients is the active SLR tested in?
post-partum patients
How is the active SLR scored?
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
What is considered a positive test?
Any score rom 1-10 (anything other than not difficult at all)
What are the 2 predictor variables for PRONE lumbar traction?
- peripheralization with repeated extension
- positive crossed SLR
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.
1
Describe the parameters for a prone traction intervention
Static traction at 40-60% of body-weight for maximum 12 minutes
What should be done if a patient is unable to tolerate extended traction position initially?
Reposition after 3 minutes of traction to more tolerable position with goal of reaching neutral or extended spine
What are the requirements of the patient after prone traction?
Remain prone for 2 minutes after traction completed, followed by 10 press-ups prior to standing
What are the 4 predictor variables for SUPINE lumbar traction?
- FABQ work subscale less than 21
- no neurological deficits
- older than 30
- patient has non-manual job status
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.
all 4
Describe the parameters for a supine traction intervention
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
What is the definition of success for both prone and supine traction treatment?
> 50% change on modified Oswestry Disability Index (ODI)
What are the 4 predictor variables for EXTENSION exercises?
- symptoms distal to the buttock
- symptoms centralize with extension
- symptoms peripheralize with flexion
- directional preference for extension
What are the 3 predictor variables for FLEXION exercises?
- age older than 50
- directional preference for flexion
- imaging reveals lumbar spinal stenosis
In what positions should patients perform extension exercises?
in prone, using prone on elbows or prone press-up activities
In what positions should patients perform flexion exercises?
- sitting
- supine
- quadruped
