Lumbar Spine Part 3

Question 1

Treatment-Based Classification

Answer 1

Lumbar Manipulation
Lumbar Instability
Lumbar Traction
Specific Exercise

Question 2

Lumbar Manipulation for Acute LBP Predictor Variables

Answer 2

1. Pain does not travel below the knee
2. Onset less than 16 days ago
3. Lumbar hypomobility
4. Either hip has > 35° of internal rotation
5. FABQ - Work subscale score < 19

Question 3

High score on FABQ

Answer 3

suggest indication for active exercise–based approach in which feared activities gradually introduced to patient in controlled environment to assist patient in overcoming fears

Question 4

Low scores on FABQ

Answer 4

improved likelihood to succeed with lumbopelvic spinal manipulation

Question 5

FABQ work subscale

Answer 5

6, 7, 9, 11, 12, and 15

Question 6

FABQ physical activity

Answer 6

2, 3, 4, and 5

Question 7

Absolute Contraindications to Manipulation

Answer 7

Osteomyelitis
Vertebral basilar insufficiency (cervical spine)
Rheumatoid arthritis (upper cervical spine)
Use of anticoagulant medication
Lack of indications
Poor integrity of ligamentous or bony structures from recent injury or disease process
Unstable fracture
Bone tumors
Infectious disease

Question 8

Lumbar Stabilization for Low Back Pain Predictor of success

Answer 8

SLR > 91°
< 40 years old
Aberrant motion present with forward bending
Positive prone instability test

Question 9

Lumbar Stabilization for Low Back Pain Predictor of non-success

Answer 9

FABQ – Physical Activity < 8
Aberrant movement absent
No hypermobility during PA spring testing
Negative prone stability test

Question 10

Absolute Contraindications to Manipulation

Answer 10

Osteomyelitis
Vertebral basilar insufficiency (cervical spine)
Rheumatoid arthritis (upper cervical spine)
Use of anticoagulant medication
Lack of indications
Poor integrity of ligamentous or bony structures from recent injury or disease process
Unstable fracture
Bone tumors
Infectious disease

Question 11

Aberrant motions

Answer 11

Painful arc in flexion
Painful arc on return from flexion
Instability catch
Reversal lumbopelvic rhythm
Gower’s sign

Question 12

Treatment for positive instability test:

Answer 12

Exercise including focus on RA, TrA, IO, ES, multifidus, and QL
2x a week for 8 weeks

Question 13

Big three in low back rehabilitation:

Answer 13

curl up for rectus abdominis
side bridge for obliques, TA and quadratus
birddog for back extensors

Question 14

Definition of success:

Answer 14

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

Non-success defined as < 6-point improvement on ODI

Question 15

Prone Mechanical Traction with Signs of Nerve Root Compression Predictor variables:

Answer 15

Peripheralization with repeated lumbar extension

Positive crossed SLR

Question 16

Supine Mechanical Traction for LBP predictor variables:

Answer 16

FABQ – Work subscale < 21
No neurological deficits
> 30 years old
Non-manual work job status

Question 17

Specific Exercise: Extension Predictor Variables:

Answer 17

Symptoms distal to the buttock
Symptoms centralize with lumbar extension
Symptoms peripheralize with lumbar flexion
Directional preference for extension

Question 18

Specific Exercise: Flexion Predictor Variables:

Answer 18

Older age (> 50 years)
Directional preference for flexion
Imaging evidence lumbar spinal stenosis

Question 19

Extension Exercise group criteria:

Answer 19

Symptoms centralize with lumbar extension
Symptoms peripheralize with lumbar flexion
Directional preference for extension

Question 20

Extension Treatment Approach:

Answer 20

End-range extension exercises
Mobilization to promote extension
Avoidance of flexion activities

Question 21

Flexion exercise group criteria:

Answer 21

Older age (>50 years)
Directional preference for flexion
Imaging evidence of lumbar spine stenosis

Question 22

Flexion Treatment Approach:

Answer 22

End-range flexion exercises
Mobilization or manipulation of the spine and/or lower extremities
Exercise to address impairments of strength or flexibility
Body weight-supported ambulation

Question 23

Stabilization exercise group criteria:

Answer 23

Age (<40 years)
Average SLR (>91°)
Aberrant movement present
Positive prone instability test

Question 24

Stabilization treatment approach:

Answer 24

Exercises to strengthen large spinal muscles (erector spinae, oblique abdominals)
Exercises to promote contraction of deep spinal muscles (multifidus, transversus abdominis)

Question 25

Manipulation exercise group criteria:

Answer 25

• No symptoms distal to nee
• Duration of symptoms <16 days
• Lumbar hypomobility
• FABQW <19
• Hip internal rotation ROM >35°

Question 26

Manipulation treatment approach:

Answer 26

Manipulation techniques for the lumbopelvic region

Active lumbar range of motion exercises

Question 27

Traction exercise group criteria:

Answer 27

Symptoms extent distal to the buttock(s)
Signs of nerve root compression are present
Peripheralization occurs with extension movement or positive contralateral SLR test is present

Question 28

Traction treatment approach:

Answer 28

Prone mechanical traction

Extension specific exercise activities