Lumbar test 2 Flashcards
All of the following include self-help treatments except
a. leaning forward
b. OTC medication
c. exercise
d. positional change
exercise
All of the following include self-help treatments except
a. education
b. injection
c. traction
d. cycling
injection
List the self-help plus treatment options for spinal stenosis
borrowing treadmill cycling traction exercise manual therapy neural tissue mobilization
Only body-weight supported treadmill walking is best for spinal stenosis patients (true/false)
false
either with or without
What type of cycling is the best for stenosis patients?
a. extended backwards
b. upright or forward bent
c. nustep
d. do not have them cycle
upright or forward bent
Lumbar traction is indicated for stenosis patients if there is
presence of leg symptoms
signs of nerve root compression
If a patient with spinal stenosis is showing signs of nerve root compression with peripheralization with extension movements, which treatment should you administer?
a. cycling
b. treadmill
c. manual therapy
d. lumbar traction
lumbar traction
If a patient with spinal stenosis is showing signs of nerve root compression with peripheralization with a crossed straight leg raise, which treatment should you administer?
a. cycling
b. treadmill
c. manual therapy
d. lumbar traction
lumbar traction
What exercises can be done for spinal stenosis patients?
flexion based aerobic stretches aquatic stabilization
Which type of exercise should be done with spinal stenosis patients?
a. extension
b. side bending
c. lateral shifting
d. flexion
flexion
Which grade of mobilization should be performed on patients with spinal stenosis?
a. grade I and II
b. grade II and III
c. grade I and IV
d. grade III and IV
grade II and III
What is the purpose of manual therapy for spinal stenosis patients?
a. increase movement
b. mobilize the nerves
c. increase space and BF
d. open the space
increase space and BF
What exercises promote neural tissue mobilization?
walking
treadmill
aquatic therapy
exercises
Injections with PT are not beneficial (true/false)
false
The purpose of injections with PT for stenosis pts are to
a. improve blood flow
b. increase space
c. prevent surgery
d. provide relief and reduce inflammation
provide relief and reduce inflammation
The surgery rate for spinal stenosis increased _% in the last decade
400%
Which leads to a poorer outcome with spinal stenosis surgery?
a. depression, hypertension, higher income, older
b. poor walking ability, scoliosis, depression, cardiovascular co-morbidity
c. better walking ability, lower income, co-morbidities, scoliosis
d. diabetes, hypertension, male. higher income
poor walking ability, scoliosis, depression, cardiovascular co-morbidity
Which leads to a better outcome with spinal stenosis surgery?
a. less comorbidities, low income, male gender, younger
b. poor walking abilities, diabetes, female, younger
c. scoliosis, better walking abilities, high income, male
d. male, better walking ability, younger, higher income, less co-morbidity, self-rated health
male, better walking ability, younger, higher income, less co-morbidity, self-rated health
We have very little confidence to conclude whether surgical treatment or a conservative approach is better for lumbar spinal stenosis (true/false)
true
No side effects were reported with conservative treatment for spinal stenosis (true/false)
true
The SIJ is what type of joint?
synovial articulation or diarthrosis
The sacroiliac joint serves to _
a. support the spine
b. as an intersection
c. attach to the LE
d. help with lumbar rotation
as an intersection
SI joints are the same in every person and in any type of gender (true/false)
false
What percentage of LBP patients have SIJ issues?
a. 4%
b. 10%
c. 9%
d. 22%
9%
Which part of the SIN contains synovial and hyaline cartilage?
a. lateral
b. medial
c. anterior
d. posterior
anterior
Which area of the SIJ articulates with the PLL?
a. anterior
b. posterior
c. medial
d. lateral
posterior
Which nerve innervates the SIJ?
a. femoral nerve
b. obturator nerve
c. posterior rami
d. sciatic nerve
sciatic nerve
All of the following movements are facilitated in SIJ except
a. shear
b. compression
c. external rotation
d. distraction
e. mutation
external rotation
How much movement is there in the SIJ?
a. 5%
b. 4%
c. 9%
d. 12%
4%
List the ligaments in the SIJ
dorsal sacral ligament
interosseous ligament
anterior sacroiliac ligament
Which system includes the lats, glute max, thoracodorsal fascia?
a. lateral system
b. anterior oblique system
c. deep longitudinal system
d. posterior oblique system
posterior oblique system
Which system includes the external/internal obliques, contralateral hip adductors, intervening abdominal fasica?
a. lateral system
b. anterior oblique system
c. deep longitudinal system
d. posterior oblique system
anterior oblique system
Which system includes the ES, deep layer thoracodorsal fascia, sacrotuberous ligament, and biceps femoris?
a. lateral system
b. anterior oblique system
c. deep longitudinal system
d. posterior oblique system
deep longitudinal system
Which system includes the gluteus medius and contralateral hip adductors?
a. lateral system
b. anterior oblique system
c. deep longitudinal system
d. posterior oblique system
lateral system
The lats, glute max, and thoracodorsal fascia are apart of the
a. outer unit
b. inner unit
c. pelvic floor
d. none of the above
outer unit
The external/internal obliques, contralateral hip adductors, intervening abdominal fasica are apart of the
a. outer unit
b. inner unit
c. pelvic floor
d. none of the above
outer unit
The ES, deep layer thoracodorsal fascia, sacrotuberous ligament, and biceps femoris are apart of the
a. outer unit
b. inner unit
c. pelvic floor
d. none of the above
outer unit
The gluteus medius and contralateral hip adductors are apart of the
a. outer unit
b. inner unit
c. pelvic floor
d. none of the above
outer unit
The levator ani consists of
pubococcygeus, puborectalis and iliococcygeus
The levator ani joins with the coccygeus muscles to complete the
a. outer unit
b. inner unit
c. pelvic floor
d. none of the above
pelvic floor
All of the following are functions of the pelvic floor except
a. help the diaphragm with breathing
b. increase intraabdominal pressure
c. help pelvic organs
d. lumbopelvic stability
e. rectal support
help the diaphragm with breathing
List the pelvic floor functions
increase intrabdomindal pressure provide rectal support inhibit bladder activity support pelvic organs lumbopelvic stability
The multifidus, TA, diaphragm, pelvic floor are part of the
a. outer unit
b. inner unit
c. pelvic floor
d. none of the above
inner unit
The _ portion of the SIJ is innervated from posterior rami L2-S2 roots
a. posterior
b. anterior
c. medial
d. caudal
anterior
The anterior portion of the SIJ is innervated from posterior rami _ roots
a. L1-S5 roots
b. L2-S2 roots
c. L3-S4 roots
d. L1-S2 roots
L2-S2 roots
The innervation of the SIJ is consistent with any joint (true/false)
false
Movement of the pelvis is in the nature of _
deformations
guiding motions of the pelvis move around _ with the pelvic ring deforming in response to _ and _
axes
BW
GRF
This movement of the pelvis can also be called flexion
nutation
This movement of the pelvis can also be called extension
counter-nutation
Motion of the pelvis occurs in which plane?
a. transverse
b. sagittal
c. frontal
d. none of the above
sagittal
Explain the mechanics of the pelvis during climbing or walking
posterior pelvic tilt on one side and anterior pelvic tilt on the other side
What forces help stabilize the pelvis?
form closure
force closure
The pelvis creates a _ for stability
keystone
The pelvis has a _ effect
clutching
Pelvis dysfunction due to aging can be caused by all of the following except
a. shortening of ligaments
b. OA
c. RA
d. ankylosing spondylitis
e. leg length discrepancy
leg length discrepancy
List all the contributing factors to a pelvis that moves too little
OA RA shortening of ligaments decreased function ankylosing spondylitis
A patient demonstrates with a vague, posterior local ache and limited motion of the pelvis, what dysfunction could be causing this?
a. OA
b. intraarticular
c. ligaments
d. ankylosing spondylitis
ligaments
A patient presents with deep, posterior pain and some groin pain, what dysfunction of the SIJ could be causing this?
a. OA
b. intraarticular
c. ligaments
d. ankylosing spondylitis
intraarticular
Which of the following will irritate a patient whos SIJ moves too little?
a. unloading
b. little movement
c. rest
d. loading
loading
Aggs of SIJ that moves too little
strain on joint and ligaments prolonged loading rotational tasks morning pain due to OA sitting, going up steps, standing
All of the following irritate an SIJ that moves too little except
a. loading
b. rotation
c. little movement
d. sitting
little movement
Eases of SIJ that moves too little
little bit of movement
stop straining task
unloading
an SIJ that moves too much can be due to
hormonal pregnancy leg length discrepancy lumbar surgery hip OA ligamentous laxity trauma scoliosis excessive lumbar lordosis lumbar spine degeneration ankylosing spondylitis
A SIJ that moves too much can be due to any of the following except
a. pregnancy
b. leg length
c. OA
d. trauma
e. aging
aging
An SIJ that moves too much can be due to any of the following except
a. lumbar surgery
b. laxity
c. stiffness
d. shortening of ligaments
e. sacroiliitis
shortening of ligaments
What is increased with hormones and pregnancy?
ptosin levels
laxity of SIJ ligaments
lumbar lordosis
Sacroiliitis causes _ _ from adjacent joints
increased stiffness
Which of the following can cause increased stiffness from adjacent joints?
a. increased pstosin levels
b. lumbar degeneration
c. lumbar lordosis
d. leg length
lumbar degeneration
All of the following cause increased stiffness from adjacent joints except?
a. scoliosis
b. lumbar lordosis
c. degeneration
d. OA
e. ankylosing spondylitis
lumbar lordosis
Increased stiffness from adjacent joints can be due to
lumbar surgery hip OA scoliosis lumbar spine degeneration ankylosing spondylitis
Sacroiliitis can be caused by
hormones increased stiffness from adjacent joints bilateral THA/stiffness l-spine aging trauma sport ligament laxity leg length discrepancy
this is defined as the SIJ moving too much
sacroliitis
Aggs of sacroiliitis
loading movement - transitional later in the day after prolonged WB extension cough/sneeze
Which of the following would irritate a patient with sacroiliits?
a. flexion
b. loading
c. side bending
d. prone
loading
All of the following irritate patients with sacroiliits except?
a. loading
b. transitional movements
c. extension
d. flexion
e. cough
flexion
Which of the following would irritate a patient with sacroiliitis?
a. flexion
b. prolonged WB
c. supine
d. rotation
prolonged WB
Eases of sacroiliitis
rest unloading stabilization flexion muscle-energy
What is the gold standard for sacroiliac joint pain?
a. mobilization
b. manual therapy
c. exercise
d. anesthetic block
anesthetic block
The sacroiliac joint is a synovial joint with abundant innervation and capability of being a source of low back pain and referred pain in the lower extremity (true/false)
true
What is the type of symptoms patients experience with SIJ dysfunction?
a. deep, burning ache
b. referring, tingling, numbness
c. localized, sharp, stabbing or dull, throbbing ache
d. localized deep and burning ache
localized, sharp, stabbing or dull, throbbing ache
Symptoms of SIJ dysfunction are (bilateral/unilateral)
unilateral
Referral patterns for the SIJ are most commonly in the
a. lumbar
b. below the knee
c. groin
d. buttock
e. into LE
buttock
SIJ shows neurological symptoms (true/false)
false
Most research indicates none of the provocation tests alone have significant sensitivity or specificity (true/false)
true
Provocation tests can be used with good validity (true/false)
false
A patient demonstrates with a SIJ that moves too much, what is the best treatment?
a. unilateral PA
b. anterior innominate manipulation
c. steroid injection
d. stabilization
stabilization
A patient demonstrates with a SIJ that moves too much, what is the best treatment?
a. central PA
b. taping
c. rotational manipulation
d. rotation mobilization
taping
What treatments can be used for SIJ that moves too much?
mechanics
treat above and below
unstiff
stabilization
What treatments can be used for SIJ that moves too little?
mobilization
manipulation
Which of the following is the best treatment for SIJ that moves too little?
a. stabilization
b. unilateral PA mobs
c. orthotics
d. mobilization to the hip
unilateral PA mobs
Which of the following is the best treatment for SIJ that moves too little?
a. central PA mobs
b. mobs to lumbar spine
c. taping
d. addressing leg length discrepency
central PA mobs
sciatic nerve symptoms are due to
piriformis syndrome
in piriformis syndrome pain is (local/distal)
local
A patient presents with trigger points, deep buttock pain, local pain, and altered neurodynamics. What could they be diagnosed with?
a. SIJ dysfunction
b. facet joint pain
c. stenosis
d. piriformis syndrome
piriformis syndrome
A positive test for seated slump or SLR could indicate
piriformis syndrome
Which of the following treatments is the best for piriformis syndrome?
a. stabilization
b. hip mobilization
c. manipulation
d. trigger point therapy
trigger point therapy
What are some treatment options for piriformis syndrome?
stretches soft tissue treatment trigger point therapy neurodynamics spinal mobilization or spinal manipulation
Symptoms of SIJ can follow a _ dermatome
a. L5 myotome
b. L4 dermatome
c. S1 dermatome
d. S2 dermatome
S2 dermatome
What type of mobilization treatment should be used for SIJ that moves too little?
unilateral PA
central PA
rotation
What type of manipulation should be used for SIJ that moves too little?
anterior innominate
rotational
Mechanical pressure on the sciatic nerve creates _
a. pain
b. tingling
c. numbness
d. ache
numbness
What is indicated for lumbar traction in a stenosis patient?
presence of leg symptoms
signs of nerve root compression
and either peripheralization with extension or crossed SLR
Signs of nerve root compression and either _ with extension or _ SLR is indicated for _ treatment
peripheralization
crossed
stenosis
What makes a patient a good candidate for lumbar traction?
presence of leg symptoms
signs of nerve root compression
and either peripheralization with extension or crossed SLR
Stabilization is indicated for stenosis (true/false)
true
it opens the space
An injection is indicated for stenosis (true/false)
true
Which SIJ ligament helps with stability?
a. dorsal sacral ligament
b. interosseous ligament
c. anterior sacroiliac ligament
d. sacrotuberous ligament
sacrotuberous ligament
What type of pain is produced with a referral from SIJ?
diffuse
What absorbs the majority of LE rotation?
SIJ
A vague, posterior local ache is consistent with
ligaments causing SIJ moves too much
Deep, posterior pain and possible groin pain is consistent with
intraarticular causing SIJ moves too much
The synovial joint of the SIJ can be a source of LBP and referred pain in the LE (true/false)
true
Which ligament is weak and thin?
a. dorsal sacral ligament
b. interosseous ligament
c. anterior sacroiliac ligament
d. sacrotuberous ligament
anterior sacroiliac
Which SI ligament is strong, deep and posterior to the SI ligament?
a. dorsal sacral ligament
b. interosseous ligament
c. anterior sacroiliac ligament
d. sacrotuberous ligament
interosseous ligament
Which ligament connects the innominate to the sacrum?
a. dorsal sacral ligament
b. interosseous ligament
c. anterior sacroiliac ligament
d. sacrotuberous ligament
interosseous ligament
Which SI ligament resists anterior and inferior movement?
a. dorsal sacral ligament
b. interosseous ligament
c. anterior sacroiliac ligament
d. sacrotuberous ligament
interosseous ligament
Which SI ligament connects the PSIS to the sacrum?
a. dorsal sacral ligament
b. interosseous ligament
c. anterior sacroiliac ligament
d. sacrotuberous ligament
dorsal sacral ligament
Which SI ligament is tough, strong and feels like a bone?
a. dorsal sacral ligament
b. interosseous ligament
c. anterior sacroiliac ligament
d. sacrotuberous ligament
dorsal sacral ligament
Does smoking and diet affect spinal stenosis?
yes
