lumber spine and neurodynamic

Question 1

common findings on MRI of spine

Answer 1

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

Question 2

causes for LBP

Answer 2

cancer, infection, trauma, inflammatory disease, cauda equina

Question 3

red flags

Answer 3

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

Question 4

current treatment for LBP

Answer 4

combining MT with exercise=better responses

Question 5

classification based- CFT

Answer 5

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)

Question 6

disorders associated with motor control

Answer 6

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)

Question 7

classification- movement and control disorder

Answer 7

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

Question 8

classification- movement and control disorder

Answer 8

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

Question 9

pathologies

Answer 9

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

Question 10

degenerative condition

Answer 10

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

Question 11

canal stenosis

Answer 11

narrowing canal, facet OA- different from spondylosis

Question 12

the superior foraminal ligament

Answer 12

lumbar degenerative disc disease with facet hypertrophy and osteophyte formation, can thicken and cause compression of nerve roots

Question 13

lumber stenosis

Answer 13

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

Question 14

presentation= lumber stenosis

Answer 14

sudden or gradual onset, local pain mechanical pattern, limited ROM of lumber spine, stiffness (capsular pattern)

Question 15

objective examination

Answer 15

obs, functional demonstration, pain behaviour, A/PROM, accessory, muscle length/strength control, neuro- conduction test and neurodynamic, palpation

Question 16

after objective

Answer 16

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

Question 17

mechanical function of the nervous system

Answer 17

lengthen, sliding= longitudinal and transverse- nerve slides and flows between tissues, compression- internal or external, angulation- angled around a joint

Question 18

mechanical interface- neural container

Answer 18

nerve moves through/around/under adjacent tissue, these tissues are refrred to as the mechancial interfacee,

Question 19

types of mechanical interface and affect on nerve function

Answer 19

bone, muscle, lig, tendon, joint,fascia, fibro-osseous tunnel
affect- fractures, inflammation, tears, adhesions pathodynamics

Question 19

types of mechanical interface and affect on nerve function

Answer 19

bone, muscle, lig, tendon, joint,fascia, fibro-osseous tunnel
affect- fractures, inflammation, tears, adhesions

Question 20

pathodynamics

Answer 20

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

Question 21

aim of Ax

Answer 21

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

Question 22

aim of Rx

Answer 22

reduce symptoms, improve neural blood supply, mobilize the container, floss the nerve

Question 23

LL sliders

Answer 23

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

Question 24

LL tensioners

Answer 24

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

Question 25

hybrid sliding technique

Answer 25

place leg on chair with wheels, ext knee, DF ankle and ext knee, then return to starting position whilst flex Cx