lumber spine and neurodynamic Flashcards
common findings on MRI of spine
facet arthropathy, disc bulge, disc protrusion
may not always be a problem= conditions become normal ageing
if condition is persistent, and involves yellow/red flags then should scan quickly
causes for LBP
cancer, infection, trauma, inflammatory disease, cauda equina
red flags
cauda equina signs, motor weakness (age <20 >55, violent trauma, long term steroid use, new Tx pain), constant pain= night pain/bilateral pain, history cancer, drugs/HIV, weight loss, widespread neurology
current treatment for LBP
combining MT with exercise=better responses
classification based- CFT
specific or NS LBP, maladaptive or adaptive (can be useful) behavior, movt impairments (joint/stiffness) vs control behaviour (contractile but in this instance neural control)
disorders associated with motor control
adaptive/protective altered motor responses to an underlying disorder- inflammatory disorders, centrally mediated pain, sympathetically maintained pain, neurogenic/ neuropathic pain
altered motor response and centrally mediated pain secondary to dominate psychosocial factors
mal-adaptive motor control patterns that drive the pain disorder- movement/control impairment (can result in loss of spinal stability)
classification- movement and control disorder
mvt- loss of movt, control disorder- full ROM but painful so won’t flex
could be stiffness, or can be neural control issue- brain saying not to go further, can get changes in facet joints or space loss in foramina= compression of nerve, spinal stenosis- degenerative condition which causes narrowing of canal
classification- movement and control disorder
mvt- loss of movt, control disorder- full ROM but painful so won’t flex
could be stiffness, or can be neural control issue- brain saying not to go further, can get changes in facet joints or space loss in foramina= compression of nerve, spinal stenosis- degenerative condition which causes narrowing of canal
pathologies
degenerative spines- OA, stenosis, disc degeneration
spondylolysis= vertebra slides forward=reduces space for spinal cord- can be congenital, acquired or trauma
acute disc prolapse
elderly osteoporotic collapse
nerve root entrapment (radiculopathy)
instability
rheumatological
degenerative condition
often pain free for long periods of time, load (and subsequent wear) are greater than repair process, possible lack of load- mechanotransduction, some genetics thrown in effecting cell responsee
canal stenosis
narrowing canal, facet OA- different from spondylosis
the superior foraminal ligament
lumbar degenerative disc disease with facet hypertrophy and osteophyte formation, can thicken and cause compression of nerve roots
lumber stenosis
intermittent claudication, lef pain (buttock/thigh/;eg), aggs with activity and eased with rest, spinal position influence, how to differentiate with PVD- movement of lumber region will be good and exercise on bike will not hurt as they are in flex spine position or walking brings on symptoms= less space for nerve
presentation= lumber stenosis
sudden or gradual onset, local pain mechanical pattern, limited ROM of lumber spine, stiffness (capsular pattern)
objective examination
obs, functional demonstration, pain behaviour, A/PROM, accessory, muscle length/strength control, neuro- conduction test and neurodynamic, palpation
after objective
patient feel like they had a through Ax, determined pain mechanism, determined adaptive or maladaptive behaviour, confirmed hypothesis, ?changed function. able to plan treatment and prognosis, close the loop and challenge behaviour, meaningful task= direction of pain, change it, modify beliefs and fear
mechanical function of the nervous system
lengthen, sliding= longitudinal and transverse- nerve slides and flows between tissues, compression- internal or external, angulation- angled around a joint
mechanical interface- neural container
nerve moves through/around/under adjacent tissue, these tissues are refrred to as the mechancial interfacee,
types of mechanical interface and affect on nerve function
bone, muscle, lig, tendon, joint,fascia, fibro-osseous tunnel
affect- fractures, inflammation, tears, adhesions pathodynamics
types of mechanical interface and affect on nerve function
bone, muscle, lig, tendon, joint,fascia, fibro-osseous tunnel
affect- fractures, inflammation, tears, adhesions
pathodynamics
pathological condition can produce symptoms in neural tissue by comprising the neural tissue ability to- conduct an impulse= P and N, motor weakness, generate length- pain/tugging/ pulling, slide through mechanical interface- pain tugging pulling
aim of Ax
determine the nerve is compromised/involved in symptoms, determine severity of compromise, ascertain site of mechanical interface issue, use red flags, monitoring- if nerve gets more and more compromised- surgery needed
aim of Rx
reduce symptoms, improve neural blood supply, mobilize the container, floss the nerve
LL sliders
slumped slider- in slumped position- slide neural tissue distally- ext knee, DF ankle and Ex neck, to slide proximally- PF ankle, Flex knee and flex neck
SLR slider- patient in supine with leg elevated against wall- slide neural tissue distally- DF ankle, proximally- PF and flex Cx
LL tensioners
slumped tensioners- start in upright position, then slump, ext knee, DF ankle and flex Cx, then reverse- lower Irritability
SLR tensioner- same positon as slider, DF ankle and flex neck at same time, then return to resting positon
hybrid sliding technique
place leg on chair with wheels, ext knee, DF ankle and ext knee, then return to starting position whilst flex Cx
