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MS II > Lumbar test 2 part 2 > Flashcards

Lumbar test 2 part 2 Flashcards

1
Q

What are the three components of lumbar stability?

A

structure, musculature, brain (motor control)

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2
Q

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

A

clinical instability

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3
Q

Lumbar stability is provided by

A

the neutral and elastic zone

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4
Q

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

A

an increase in the neutral zone

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5
Q

This is described as a fracture on one side or both of the pars interarticularis

a. osteoporosis
b. spondylolisthesis
c. spondylolysis
d. disc lesion

A

spondylolysis

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6
Q

What structures can be limited due to lumbar instability?

A 
ligamentous laxity
osteoporosis 
spondylolysis
spondylolisthesis 
chronic disc lesions 
SIJ dysfunction
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7
Q

Which motion irritates osteoporosis, spondylolysis, spondylolisthesis?

a. flexion
b. extension
c. side bending
d. rotation

A

extension

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8
Q

Fracture but no slippage

a. osteoporosis
b. spondylolisthesis
c. spondylolysis
d. disc lesion

A

spondylolysis

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9
Q

Spondylolysis is rare (true/false)

A

false

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10
Q

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

A

spondylolisthesis

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11
Q

a slippage of 0-25% is classified as

a. grade IV
b. grade I
c. grade II
d. grade V

A

grade I

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12
Q

a slippage of 26-50% is classified as

a. grade IV
b. grade I
c. grade II
d. grade V

A

grade II

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13
Q

a slippage of 51-75% is classified as

a. grade IV
b. grade III
c. grade II
d. grade V

A

grade III

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14
Q

a slippage of 76-100% is classified as

a. grade IV
b. grade III
c. grade II
d. grade V

A

grade IV

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15
Q

a slippage of >100% is classified as

a. grade IV
b. grade III
c. grade II
d. grade V

A

grade V

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16
Q

The most common slippage is at

a. L1/L2
b. L2/L3
c. L4/L5
d. L3/L4

A

L4/L5

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17
Q

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

A

increased intervertebral motion

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18
Q

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

A

increased intervertebral motion

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19
Q

Ligaments, joint capsules, annular fibers, and end plates do not have nociceptors (true/false)

A

false

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20
Q

What changes happen to the disc with aging?

A

loss of fluids and proteoglycans, matrix and bone changes, disc space height is lost

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21
Q

Chronic disc lesion is associated with an

A

increased micro “shear” of the intervertebral level

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22
Q

An increase in fear causes more problems with _

a. motor control
b. memory
c. sequencing
d. firing of TA

A

motor control

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23
Q

Which treatment is best to improve inhibited muscles?

a. mobilization
b. manual therapy
c. stabilization
d. modalities

A

manual therapy

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24
Q

What could be the muscle/motor cause of poor lumbar stability?

A

altered sequencing
endurance
fatigue
inhibition

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25
Q

What could be the neural cause of poor lumbar stability?

A

fear avoidance
pain catastrophization
pain
memory

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26
Q

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

A

LBP does not contract TA first when they lift their arm

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27
Q

LBP patients show increased fatigue of the

a. TA
b. MF
c. lats
d. inner unit

A

MF

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28
Q

Increase in the size of the neutral zone leads to

A

increased movement
less control
irritation of various innervated structures
induces pain

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29
Q

Recovery of MF size is not spontaneous with pain relief (true/false)

A

true

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30
Q

Which of the following irritates spondylolysis or spondylolisthesis?

a. flexion
b. extension
c. supine
d. lateral shift

A

extension

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31
Q

Which of the following irritates spondylolysis or spondylolisthesis?

a. running or walking
b. rest
c. supine
d. flexion

A

running or walking

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32
Q

List the aggs of spondylolysis or spondylolisthesis

A 
extension
walking 
running
standing
flexion to extension
prone
lifting heavy objects in flexion
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33
Q

List the eases of spondylolysis or spondylolisthesis

A

flexion
sitting
supine

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34
Q

Patients with spondylolysis or spondylolisthesis will objectively show

A 
lateral shift
aberrant motion
limited or apprehensive extension
prone instability test 
PA pain provocation
palpation of MF shut down
problems with corset action
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35
Q

What needs to be measured with spondylolysis or spondylolisthesis?

A 
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
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36
Q

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

A

aerobic or aquatic exercise

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37
Q

What are the different types of exercise you can do with stenosis patients?

A 
treadmill walking
cycling
aerobic 
aquatic 
stabilization
stretching
flexion
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38
Q

Treadmill walking for stenosis patients can include

A

with body weight supported
without body weight supported
incline for flexion

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39
Q

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

A

stabilization

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40
Q

What can inhibit muscle contraction?

A

pain

swelling

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41
Q

How can you treat a patient to get their pain under control to return to life?

A 
mobilization
manipulation
modalities
PNE
trigger point
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42
Q

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

A

those who want detail

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43
Q

Global spinal stabilization is focused on

A

function

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44
Q

Global spinal stabilization is used for patients needing

a. detail
b. advanced stabilization
c. function
d. closed chain activities

A

function

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45
Q

There is sufficient evidence to support stabilization in treating LBP (true/false)

A

false

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46
Q

How do you progress stabilization?

A

local segmental control
closed chain segmental
open chain segmental

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47
Q

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

A

phase I

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48
Q

This phase of progressing stabilization is loading

a. phase II
b. phase I
c. phase IV
d. phase III

A

phase II

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49
Q

This phase of progressing stabilization activities is in non-weight bearing

a. phase II
b. phase I
c. phase IV
d. phase III

A

phase III

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50
Q

The evidence supports the idea that stabilization can prevent LBP (true/false)

A

false

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51
Q

List the clinical prediction rules for stabilization

A 
SLR > 90 degrees
laxity 
positive prone instability test 
younger pts 
aberrant motion
low fear-avoidance 
lumbar hypermobility
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52
Q

Exercise is not proven to prevent LBP (true/false)

A

true

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53
Q

Why exercise the low back?

A

homuncular refreshment
improve motor and premotor patterns
improve tissue tolerance

54
Q

What is the biggest predictor of lumbar spine surgery?

a. age
b. pain
c. insurance
d. zip code

A

zip code

55
Q

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

A

spinal degeneration and disc degeneration

56
Q

What do patients care about with regard to lumbar spinal surgery?

A

loss of pain, improved function, no complications

57
Q

Which surgery is indicated for the neurological deficit?

a. discectomy
b. disc replacement
c. fusion
d. laminectomy

A

laminectomy

58
Q

Which surgery shows significant complications with blood transfusion and post op mortality?

a. discectomy
b. disc replacement
c. fusion
d. laminectomy

A

fusion

59
Q

Lumbar disc replacement research shows it is better than fusion (true/false)

A

false

60
Q

What does the research say about kypho/vertebroplasty?

A

no significant evidence over conservative care or placebo

61
Q

What is the risk with kypho/vertebroplasty?

A

cemented fractures

62
Q

Patients persistently have pain and disability post lumbar surgery (true/false)

A

true

63
Q

Postop rehab has not shown the ability to decrease pain and disability (true/false)

A

true

64
Q

What is the positive effect of preop education?

A

preop anxiety levels

patient knowledge

65
Q

Viewing surgery images prior to lumbar surgery is helpful for the patient (true/false)

A

false

66
Q

What do you address reop lumbar surgery?

A 
PNE 
GMI 
sensory discrimination
walking programs 
frequent rest 
positions
67
Q

What treatment should be done immediately post op?

a. mobilization
b. manual therapy
c. ROM
d. GMI

A

GMI

68
Q

What disabilities will patients have after surgery?

A 
pain
disability/function 
ROM
psychological issues
muscle and motor control
69
Q

What kind of pain will patients have after surgery?

A 
original pre op pain
back pain
scar pain
radiculopathy
spreading pain
nerve sensitization
pain from altered mechanics/stress on adjacent joints
70
Q

It is important to tell your patients after surgery that pain is normal (true/false)

A

true

71
Q

Injections are a stand-alone cure for low back pain (true/false)

A

false

72
Q

What are the three approaches for injections?

A

translaminar
transforaminal
caudal

73
Q

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

A

SIJ

74
Q

What conditions are associated with radicular symptoms?

A 
bulging disc with annular tear 
spinal stenosis 
compression fracture 
facet or nerve root cyst 
postlaminectomy pain
tumors
75
Q

How do injections help stenosis?

a. expand the canal
b. get rid of nerve pain
c. reduce inflammation
d. help increase movement

A

reduce inflammation

76
Q

radicular pain is the result of

A

nerve root inflammation

77
Q

_ compression can cause motor deficits and altered sensation

A

mechanical

78
Q

Compression of a nerve causes

a. pain
b. motor deficits or altered sensation
c. referred pain
d. inflammation

A

motor deficits or altered sensation

79
Q

Inhibition of normal nerve root vascular flow

a. radicular pain
b. stenosis
c. DRG compression
d. facet cyst

A

stenosis

80
Q

nucleus pulposis contains high levels of

A

PLA2

81
Q

PLA2 is (proinflammatory/inflammatory)

A

proinflammatory

82
Q

Injections can be used for radicular pain (true/false)

A

true

83
Q

What can be compressed with radicular symptoms causing pain?

A

DRG

84
Q

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

A

inhibition of inflammation, PLA2 and neural transmission of nociceptive fibers

85
Q

How many injections are usually given in a series?

a. 2
b. 3
c. 5
d. 4

A

3

86
Q

The route of injection admission depends on

a. location of pain
b. type of pain
c. volume and dose
d. frequency of injection

A

volume and dose

87
Q

Typically patients should not have therapy within _ after ESI

a. 1 day
b. 24 hours
c. 48 hours
d. 5 days

A

48 hours

88
Q

If you’ve slipped a disk, you must have surgery. Surgeons agree about exactly who should have surgery (true/false)

A

false

89
Q

If your back hurts, you should take it easy until the pain goes away (true/false)

A

false

90
Q

Back pain is caused by injuries or heavy lifting (true/false)

A

false

91
Q

Back pain is disabling (true/false)

A

false

92
Q

Low Back Pain is now as prevalent as it has always been and always will be (true/false)

A

true

93
Q

Age changes are synonymous with back pain (true/false)

A

false

94
Q

Posture and pain is correlated (true/false)

A

false

95
Q

Obesity is related to LBP (true/false)

A

false

96
Q

What do we want from a classification system?

A

exhaustive
mutually exclusive
reliable

97
Q

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?

A

is the patient appropriate for PT management?

98
Q

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?

A

what is the level of acuity?

99
Q

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?

A

what treatment should be used?

100
Q

What are the three categories in the first level?

A

appropriate for PT
PT and consultation
requires referral

101
Q

What allows you to move to the next classification level?

A

no red flags

primarily mechanical MSK

102
Q

Acuteness is determined by the nature of the

A

presenting symptoms

goals of treatment

103
Q

What classifies a patient under stage I?

A

oswestry score > 30
unable to sit > 30 mins
unable to stand > 15 mins
unable to walk > 1/4 mile

104
Q

What are the treatment goals for stage I patient?

A

control pain
improve ability to perform basic mechanical functions
reduce disability

105
Q

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

A

stage I

106
Q

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

A

stage I

107
Q

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

A

control pain

reduce disability

108
Q

What classifies a patient under stage II?

A

oswestry score ~ 15-30
able to sit, stand, walk
unable to perform complex task
no stage I findings

109
Q

What are treatment goals for a stage II patient?

A

further reduce disability

correct physical impairments

110
Q

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

A

stage II

111
Q

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

A

correct physical impairments

112
Q

What classified a patient as a stage III?

A

oswestry score <15
able to perform complex tasks
unable to perform demanding tasks

113
Q

What are treatment goals for a stage III patient?

A

improve ability to perform demanding activities

114
Q

What are the types of treatment?

A

manipulation
specific exercise
stabilization
traction

115
Q

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

A

manipulation

116
Q

A patient presents with centralization phenomonen favoring flexion more, what treatment is the best?

a. traction
b. stabilization
c. activities for centralization
d. manipulation

A

activities to promote centralization

117
Q

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

A

stabilization

118
Q

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

A

traction

119
Q

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

A

manipulation

120
Q

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

A

specific exercise

121
Q

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

A

stabilization

122
Q

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

A

traction

123
Q

What are neurological signs?

A

dermatomes
myotomes
reflexes

124
Q

What is important to test if you think your patient is into the stage II?

A

muscle length tests

strength tests

125
Q

How do you treat a stage II classified patient?

A

treat according to higher-level dysfunctions

break complex task down into components and work on then progress

126
Q

Patients may move from one classification to another within a session (true/false)

A

true

127
Q

What do you need to incorporate in your treatment?

A

exercise

128
Q

What is a stress response to extension?

A

extra bone formation

129
Q

What motion causes the inferior articular process to put pressure onto the pars interarticularis with bone on bone contact?

A

extension

130
Q

What pathologies affect lumbar stability?

A 
ligamentous laxity
SIJ dysfunction
spondylolysis
spondylolisthesis
chronic disc lesion 
osteoporosis
131
Q

An alteration in stability for the lumbar spine can be due too?

A

neural components

muscle/motor

132
Q

What is the primary indication for injection?

A

radicular pain

MS II (17 decks)

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