Lumbar test 2 part 2 Flashcards
What are the three components of lumbar stability?
structure, musculature, brain (motor control)
A significant decrease in the capacity of the Stabilizing System of the spine to maintain the intervertebral neutral zones within physiological limits which results in pain and disability defines
clinical instability
Lumbar stability is provided by
the neutral and elastic zone
Dysfunction in one of the stabilizing systems leads to
a. a decrease in the elastic zone
b. an increase in the elastic zone
c. an increase in the neutral zone
d. a decrease in the neutral zone
an increase in the neutral zone
This is described as a fracture on one side or both of the pars interarticularis
a. osteoporosis
b. spondylolisthesis
c. spondylolysis
d. disc lesion
spondylolysis
What structures can be limited due to lumbar instability?
ligamentous laxity osteoporosis spondylolysis spondylolisthesis chronic disc lesions SIJ dysfunction
Which motion irritates osteoporosis, spondylolysis, spondylolisthesis?
a. flexion
b. extension
c. side bending
d. rotation
extension
Fracture but no slippage
a. osteoporosis
b. spondylolisthesis
c. spondylolysis
d. disc lesion
spondylolysis
Spondylolysis is rare (true/false)
false
This is classified based on the ratio of the overhanging part of the superior vertebral body to anterior-posterior length of the adjacent inferior vertebral body
a. osteoporosis
b. spondylolisthesis
c. spondylolysis
d. disc lesion
spondylolisthesis
a slippage of 0-25% is classified as
a. grade IV
b. grade I
c. grade II
d. grade V
grade I
a slippage of 26-50% is classified as
a. grade IV
b. grade I
c. grade II
d. grade V
grade II
a slippage of 51-75% is classified as
a. grade IV
b. grade III
c. grade II
d. grade V
grade III
a slippage of 76-100% is classified as
a. grade IV
b. grade III
c. grade II
d. grade V
grade IV
a slippage of >100% is classified as
a. grade IV
b. grade III
c. grade II
d. grade V
grade V
The most common slippage is at
a. L1/L2
b. L2/L3
c. L4/L5
d. L3/L4
L4/L5
Compression and/or stretching of the inflamed neural elements causes
a. increased disc motion
b. decreased intervertebral motion
c. increased laxity
d. decreased stability
e. increased intervertebral motion
increased intervertebral motion
Abnormal deformations of ligaments, joint capsules, annular fibers, and end-plates causes
a. increased disc motion
b. decreased intervertebral motion
c. increased laxity
d. decreased stability
e. increased intervertebral motion
increased intervertebral motion
Ligaments, joint capsules, annular fibers, and end plates do not have nociceptors (true/false)
false
What changes happen to the disc with aging?
loss of fluids and proteoglycans, matrix and bone changes, disc space height is lost
Chronic disc lesion is associated with an
increased micro “shear” of the intervertebral level
An increase in fear causes more problems with _
a. motor control
b. memory
c. sequencing
d. firing of TA
motor control
Which treatment is best to improve inhibited muscles?
a. mobilization
b. manual therapy
c. stabilization
d. modalities
manual therapy
What could be the muscle/motor cause of poor lumbar stability?
altered sequencing
endurance
fatigue
inhibition
What could be the neural cause of poor lumbar stability?
fear avoidance
pain catastrophization
pain
memory
What is the difference between motor sequencing in a healthy patient vs a patient with LBP?
a. LBP shows more fatigue
b. LBP does not contract TA first when they lift their arm
c. LBP shows slowed timing
d. LBP disengages the muscles at the wrong time
LBP does not contract TA first when they lift their arm
LBP patients show increased fatigue of the
a. TA
b. MF
c. lats
d. inner unit
MF
Increase in the size of the neutral zone leads to
increased movement
less control
irritation of various innervated structures
induces pain
Recovery of MF size is not spontaneous with pain relief (true/false)
true
Which of the following irritates spondylolysis or spondylolisthesis?
a. flexion
b. extension
c. supine
d. lateral shift
extension
Which of the following irritates spondylolysis or spondylolisthesis?
a. running or walking
b. rest
c. supine
d. flexion
running or walking
List the aggs of spondylolysis or spondylolisthesis
extension walking running standing flexion to extension prone lifting heavy objects in flexion
List the eases of spondylolysis or spondylolisthesis
flexion
sitting
supine
Patients with spondylolysis or spondylolisthesis will objectively show
lateral shift aberrant motion limited or apprehensive extension prone instability test PA pain provocation palpation of MF shut down problems with corset action
What needs to be measured with spondylolysis or spondylolisthesis?
ability to contract TA and MF ability to not overactive other muscles endurance maintain corset action while using UE and LE abdominal draw in test leg loading test palpation
How should you exercise the spine for a patient with stenosis?
a. extension for disc nutrition
b. walking on treadmill on a down incline
c. neural mobilization
d. aerobic or aquatic exercise
aerobic or aquatic exercise
What are the different types of exercise you can do with stenosis patients?
treadmill walking cycling aerobic aquatic stabilization stretching flexion
Treadmill walking for stenosis patients can include
with body weight supported
without body weight supported
incline for flexion
How can you use exercise to treat the SIJ that moves too much?
a. strengthen the joint capsule
b. prone stretch
c. stabilization
d. cycling
stabilization
What can inhibit muscle contraction?
pain
swelling
How can you treat a patient to get their pain under control to return to life?
mobilization manipulation modalities PNE trigger point
Local, specific segmental spinal stabilization should be used for what type of patients
a. general population for function
b. patients that need conditioning
c. athletes
d. those who want detail
those who want detail
Global spinal stabilization is focused on
function
Global spinal stabilization is used for patients needing
a. detail
b. advanced stabilization
c. function
d. closed chain activities
function
There is sufficient evidence to support stabilization in treating LBP (true/false)
false
How do you progress stabilization?
local segmental control
closed chain segmental
open chain segmental
This phase of stabilization is the initiating stage of getting the TA to activate
a. phase II
b. phase I
c. phase IV
d. phase III
phase I
This phase of progressing stabilization is loading
a. phase II
b. phase I
c. phase IV
d. phase III
phase II
This phase of progressing stabilization activities is in non-weight bearing
a. phase II
b. phase I
c. phase IV
d. phase III
phase III
The evidence supports the idea that stabilization can prevent LBP (true/false)
false
List the clinical prediction rules for stabilization
SLR > 90 degrees laxity positive prone instability test younger pts aberrant motion low fear-avoidance lumbar hypermobility
Exercise is not proven to prevent LBP (true/false)
true
Why exercise the low back?
homuncular refreshment
improve motor and premotor patterns
improve tissue tolerance
What is the biggest predictor of lumbar spine surgery?
a. age
b. pain
c. insurance
d. zip code
zip code
What is the current diagnosis and indication for lumbar spinal surgery?
a. severe scoliosis
b. fractures and tuberculosis
c. spinal degeneration and disc degeneration
d. all of the above
spinal degeneration and disc degeneration
What do patients care about with regard to lumbar spinal surgery?
loss of pain, improved function, no complications
Which surgery is indicated for the neurological deficit?
a. discectomy
b. disc replacement
c. fusion
d. laminectomy
laminectomy
Which surgery shows significant complications with blood transfusion and post op mortality?
a. discectomy
b. disc replacement
c. fusion
d. laminectomy
fusion
Lumbar disc replacement research shows it is better than fusion (true/false)
false
What does the research say about kypho/vertebroplasty?
no significant evidence over conservative care or placebo
What is the risk with kypho/vertebroplasty?
cemented fractures
Patients persistently have pain and disability post lumbar surgery (true/false)
true
Postop rehab has not shown the ability to decrease pain and disability (true/false)
true
What is the positive effect of preop education?
preop anxiety levels
patient knowledge
Viewing surgery images prior to lumbar surgery is helpful for the patient (true/false)
false
What do you address reop lumbar surgery?
PNE GMI sensory discrimination walking programs frequent rest positions
What treatment should be done immediately post op?
a. mobilization
b. manual therapy
c. ROM
d. GMI
GMI
What disabilities will patients have after surgery?
pain disability/function ROM psychological issues muscle and motor control
What kind of pain will patients have after surgery?
original pre op pain back pain scar pain radiculopathy spreading pain nerve sensitization pain from altered mechanics/stress on adjacent joints
It is important to tell your patients after surgery that pain is normal (true/false)
true
Injections are a stand-alone cure for low back pain (true/false)
false
What are the three approaches for injections?
translaminar
transforaminal
caudal
All of the following are conditions associated with radicular symptoms EXCEPT
a. bulging disc with annular tear
b. spinal stenosis
c. facet or nerve root cyst
d. SIJ
e. postlaminectomy
SIJ
What conditions are associated with radicular symptoms?
bulging disc with annular tear spinal stenosis compression fracture facet or nerve root cyst postlaminectomy pain tumors
How do injections help stenosis?
a. expand the canal
b. get rid of nerve pain
c. reduce inflammation
d. help increase movement
reduce inflammation
radicular pain is the result of
nerve root inflammation
_ compression can cause motor deficits and altered sensation
mechanical
Compression of a nerve causes
a. pain
b. motor deficits or altered sensation
c. referred pain
d. inflammation
motor deficits or altered sensation
Inhibition of normal nerve root vascular flow
a. radicular pain
b. stenosis
c. DRG compression
d. facet cyst
stenosis
nucleus pulposis contains high levels of
PLA2
PLA2 is (proinflammatory/inflammatory)
proinflammatory
Injections can be used for radicular pain (true/false)
true
What can be compressed with radicular symptoms causing pain?
DRG
How do epidural steroids help low back pain?
a. it opens the space
b. inhibition of inflammation, PLA2
c. inhibition of neural transmission of nociceptive fibers
d. B and C
e. inhibition of B fibers
inhibition of inflammation, PLA2 and neural transmission of nociceptive fibers
How many injections are usually given in a series?
a. 2
b. 3
c. 5
d. 4
3
The route of injection admission depends on
a. location of pain
b. type of pain
c. volume and dose
d. frequency of injection
volume and dose
Typically patients should not have therapy within _ after ESI
a. 1 day
b. 24 hours
c. 48 hours
d. 5 days
48 hours
If you’ve slipped a disk, you must have surgery. Surgeons agree about exactly who should have surgery (true/false)
false
If your back hurts, you should take it easy until the pain goes away (true/false)
false
Back pain is caused by injuries or heavy lifting (true/false)
false
Back pain is disabling (true/false)
false
Low Back Pain is now as prevalent as it has always been and always will be (true/false)
true
Age changes are synonymous with back pain (true/false)
false
Posture and pain is correlated (true/false)
false
Obesity is related to LBP (true/false)
false
What do we want from a classification system?
exhaustive
mutually exclusive
reliable
What is the first level of the classification system?
a. what is the level of acuity?
b. is the patient appropriate for PT management?
c. what treatment should be used?
is the patient appropriate for PT management?
What is the second level of the classification system?
a. what is the level of acuity?
b. is the patient appropriate for PT management?
c. what treatment should be used?
what is the level of acuity?
What is the third level of the classification system?
a. what is the level of acuity?
b. is the patient appropriate for PT management?
c. what treatment should be used?
what treatment should be used?
What are the three categories in the first level?
appropriate for PT
PT and consultation
requires referral
What allows you to move to the next classification level?
no red flags
primarily mechanical MSK
Acuteness is determined by the nature of the
presenting symptoms
goals of treatment
What classifies a patient under stage I?
oswestry score > 30
unable to sit > 30 mins
unable to stand > 15 mins
unable to walk > 1/4 mile
What are the treatment goals for stage I patient?
control pain
improve ability to perform basic mechanical functions
reduce disability
A patient presents with an Oswestry score > 30 and are unable to sit more than 30 minutes, what stage would you classify them under?
a. stage II
b. stage III
c. stage I
d. none
stage I
A patient is unable to walk more than a quarter of a mile and cannot stand for more than 15 mins, what stage would you classify them under?
a. stage II
b. stage III
c. stage I
d. none
stage I
Which of the following would be the best treatment goal for a stage I patient?
a. correct physical impairments
b. improve ability to perform demanding activities
c. control pain
d. reduce disability
e. c and d
control pain
reduce disability
What classifies a patient under stage II?
oswestry score ~ 15-30
able to sit, stand, walk
unable to perform complex task
no stage I findings
What are treatment goals for a stage II patient?
further reduce disability
correct physical impairments
A patient presents with an oswestry score of 20, is able to stand and walk but cannot perform complex tasks. Which stage are they classified as?
a. stage II
b. stage III
c. stage I
d. none
stage II
Which of the following goals is the best to treat a stage II patient?
a. reduce pain
b. control inflammation
c. correct physical impairments
d. improve ability to perform demanding activities
correct physical impairments
What classified a patient as a stage III?
oswestry score <15
able to perform complex tasks
unable to perform demanding tasks
What are treatment goals for a stage III patient?
improve ability to perform demanding activities
What are the types of treatment?
manipulation
specific exercise
stabilization
traction
A patient presents with closing and SI special tests are positive, what treatment is the best?
a. traction
b. stabilization
c. activities for centralization
d. manipulation
manipulation
A patient presents with centralization phenomonen favoring flexion more, what treatment is the best?
a. traction
b. stabilization
c. activities for centralization
d. manipulation
activities to promote centralization
A patient presents with hypermobility and has frequent episodes of prior back pain, which treatment is the best approach?
a. traction
b. stabilization
c. activities for centralization
d. manipulation
stabilization
A patient presents with leg pain and neurological signs, which treatment is the best approach?
a. traction
b. stabilization
c. activities for centralization
d. manipulation
traction
A patient has no symptoms below the knee, symptoms are recent, hypomobility, low fear avoidance and more hip IR. Which treatment bucket do they fit?
a. stabilization
b. traction
c. manipulation
d. specific exercise
manipulation
A patient shows they prefer extension more during a movement examination and prefer sitting over standing. which treatment classification do they fit under?
a. stabilization
b. traction
c. manipulation
d. specific exercise
specific exercise
A patient shows aberrant motions, hypermobility, younger, positive prone instability test, greater SLR ROM and their pain lasts longer and is more frequent. Which treatment classification do they fit under?
a. stabilization
b. traction
c. manipulation
d. specific exercise
stabilization
A patient shows has neurological signs, leg symptoms, no centralization during movement testing and are in a lateral shift. Which treatment classification do they fit under?
a. stabilization
b. traction
c. manipulation
d. specific exercise
traction
What are neurological signs?
dermatomes
myotomes
reflexes
What is important to test if you think your patient is into the stage II?
muscle length tests
strength tests
How do you treat a stage II classified patient?
treat according to higher-level dysfunctions
break complex task down into components and work on then progress
Patients may move from one classification to another within a session (true/false)
true
What do you need to incorporate in your treatment?
exercise
What is a stress response to extension?
extra bone formation
What motion causes the inferior articular process to put pressure onto the pars interarticularis with bone on bone contact?
extension
What pathologies affect lumbar stability?
ligamentous laxity SIJ dysfunction spondylolysis spondylolisthesis chronic disc lesion osteoporosis
An alteration in stability for the lumbar spine can be due too?
neural components
muscle/motor
What is the primary indication for injection?
radicular pain
