Lumbopelvic spine intervention: Mobility deficits - Lecture 5

Question 1

What are latearl shifts named for?

Answer 1

The direction of the shoulders

Question 2

If a pt has a directional preference into extension what kind of injury does this mean they have?

Answer 2

Extension feel good flexion feels bad = disc

Question 3

HNP = herniated nucleus pulposis (herniated disc)

Question 4

if a pt has a flexion directional preference what kind of injury have they had?
* 3

Answer 4

Flexion feels good extension feels bad = stenosis pressing on spinal n

could also indicate ankylosing spondylosis (OA of the spine) or a facet pathology

Question 5

Radicular pain =

Radiculopathy =

Answer 5

Radicular pain = pain that is traveling down in a fine set pattern (think deramtome pattern)

Radiculopathy = we now have neural involvement - DTR issues, myotome weakness, dermatome sensation loss

Is it enough to cause neural issues is the difference between radicular pain and radiculopathy

Question 6

When is radiating pain hardest to centralize?

Answer 6

In the very acute phase when it is flared up

Question 7

KNOW: Low back pain w/ radiating leg pain tends to travel passed the knee

Question 8

KNOW: W/ back pain that has raidaitng pain - LE parethesias (abnormal sensation), numbness, and weakness may be reported

Question 9

KNOW: Back pain w/ radiating pain may have directional preference noted w/ history of clinical examination to alleviate LE pain

Question 10

Peripheraliztion of leg pain is most often bright on through ____

Answer 10

backwards bending (note this would be more geard at a stenosis)
* note: in the acute phase this backward extension wont even affect disc pain (its for flared up we wont see it getting better w/ extension)

Question 11

Someone w/ back pain w/ radiating pain will likely have a positive straight leg raise for leg pain at ___ degrees of hip flexion

Answer 11

< 45 degrees of hip flexion brings on leg pain

Question 12

Someone w/ back pain w/ raidating pain will likely have a positive crossed SRL at ____ degrees of hip flexion

Answer 12

< 45 degrees of hip flexion will bring on leg pain

Question 13

Will someone w/ back pain w/ raiding pain have neurosigns and symptoms (weakness, numbness, DTRs)?

Answer 13

Yes

Question 14

What will putting weight on the affected side do to someone w/ radiating pain?

Answer 14

Make it a lot worse
* Think disc = buldging = putting weight on that side will cause it to press more on n
* Think stenosis = facets coming togher more w/ weight bearing = more pressure on spinal n

NOTE: This can also be brought on in sitting or standing (we’ll see them side bend away from that affected extremeity)

NOTE: this will cause them to laterally shift away from that side to avoid putting weight through spinal n

Question 15

What kind of modality would we do for someone w/ back pain w/ radiating pain?

Answer 15

Traction
* pulling facets apart = decreased spinal n pushing w/ stenosis
* Letting the disc stop its herniation = decrease spinal n pressing w/ disc hernaition

Question 16

What kind of intervation would we do for someone w/ radiating pain (most common and easy exercise to do to get rid fo symptoms)

Answer 16

repeated motion testing (doing whatever motion centralizes symptoms)

Question 17

What should we do before going into repeated motion testing (which allivates someones symptoms w/ radiating back pain)

Answer 17

Fix their lateral shift!

Question 18

How many times should repeated motion testing be done?

Answer 18

5-10 times to see if it takes away their symptoms

Question 19

Know: when appropriate clinican can add OP to end the ends of repeated motion testing to see if it allivates symptoms

Question 20

KNOW: If standing bothers the pt we can do repeated motion testing in sitting

Question 21

How many times is repeated motion testing done?

Answer 21

5-10 times

Question 22

How would you do repeated motion testing for extension if it hurts for the pt to stand?

Answer 22

Question 23

Do lateral shifts normally go with flexion or extension biases?

Answer 23

Extension biases

So if they like extension (pain w/ flexion) they’re likely to have a lateral shift

Question 24

KNOW: Lateral shift correction
* pt is standing; examiner passively shifts patients pelvis in frontal plane while stabilizng shoulder
* pt is returned to starting position and the movement is repeated
* May sustain up to 30 seconds (think irritability)
* Slowly get them into neutral, assessing as you go

Question 25

If someone has radiating pain what modality would I use?

Answer 25

Traction

Question 26

Whats the other intervention you could do for someone w/ radiating pain?

Answer 26

Thrust/non thurst manipulation (make sure they meet the CPR for it)
* make sure they dont have symptoms passed the knee because this automatically rules it out

NOTE: your rusty crusty guys w/ stenosis love manipulations. Normally their symptoms are just into the back of their thigh (not their knee) so they won’t have any contraindications to manipulation

Question 27

What kind of exercises are best for someone w/ radiating pain/

Answer 27

Directional preference exercise EX (best for symptom modulation)

Question 28

Analgesic =

Answer 28

reliving pain

Question 29

NOTE: any exercises that have an analgesic response (reduce pain)are indicated for pts w/ radiating pain

Question 30

Predictors for pts who will respond to specific exercise:

Answer 30

1) Symptoms centralize w/ repeated movement in one direction (flexion, extension, side glide)

2) If directional preference with centralization found, then interventions based on movement in that direction
* Centalizeation w/ flexion –> flexion based exercise
* Centralization w/ extension –> extension based EX
* Centalization w/ side glide –> side flide + extension (usually)

Question 31

If a pt centralizes w/ side glide what directional preference will they likly have?

Answer 31

Extension

Do side glide w/ extension

Question 32

NOTE: sometimes pts cant tollerate their directional preference while wt bearing - so start in prone or supine first and work into standing

Question 33

KNOW: w/ directional preference I dont move into working on the motion that peripheralizes symptoms until they are consistently centralized
* if they are staying centralized week 1 –> week 2. (made up #’s jsut shows consistency)
* then start moving into those peripheralization exercises (dont actually peripehralize symptoms just go the the point symptoms start peripehralizing then back off)
* Just work into more and more getting to that edge then backing off

Question 34

KNOW: we self done repeated motion tests are done 1-2 times per hour for every hour that they are awake (this will add up to 10-20 per day)

Question 35

Which side is this opening?

Answer 35

The top

opposite side of the bolster

Question 36

If the pt has right sided leg pain where do you put the bolster?

Answer 36

Under the left side to open the right side (close down on the left side)

Question 37

Note when distracting w/ bolster always rotate the the up side (flip flopped of what you would think and is true of thoracic and cervical)

NOTE: this seperates that foramen taking tension off of that spinal n
= great for radiating pain

Question 38

If pt has chronic LBP would we use traction

Answer 38

Never, doesnt do any good
* only use traction when they have that radicular pain

Question 39

Why would we use CPA’s / UPAs as manual therapy interventions for radiating LBP?

Answer 39

Because a CPA/UPA puts your into extension and that can tap into that directional preference and make the pt feel better (if they are extension biased it will help them feel better because you are putting them into extension)

HOWEVER - if this is ever peripheralizing symptoms stop using it immedialy (i.e., they are hurt when going into extension but not flexion we wouldnt use this)

Question 40

When would thrust manipulation be an appropriate intervention for LBP patients w/ radiating pain? (2)

Answer 40

when there symptoms are less than 16 days old

When they dont have symptoms are the knee

Question 41

Would lumbar traction be a good intervention for LBP w/ radiating pain pts?

Answer 41

Yes

We would start w/ manual traction first to see if its effective

We can also use a physioball and pull their ankles to get some of that lumbar traction

Question 42

This is a form of manual traction w/ a directional bias. Which side is being opened?

Answer 42

Right side

Question 43

Dont fully understand this slide

go back to 29 mins in this lecture

Question 44

adverse neural dynamics:

Answer 44

Side to side difference greater than 10 degrees

brings on comparible pain

Synsetize / desensitize structures

Question 45

He said know these really well

tensioning peripheral nerves

Question 46

Know dermatomes and myotomes in LE