Lumbopelvic spine intervention: Mobility deficits - Lecture 5 Flashcards
What are latearl shifts named for?
The direction of the shoulders
If a pt has a directional preference into extension what kind of injury does this mean they have?
Extension feel good flexion feels bad = disc
HNP = herniated nucleus pulposis (herniated disc)
if a pt has a flexion directional preference what kind of injury have they had?
* 3
Flexion feels good extension feels bad = stenosis pressing on spinal n
could also indicate ankylosing spondylosis (OA of the spine) or a facet pathology
Radicular pain =
Radiculopathy =
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
When is radiating pain hardest to centralize?
In the very acute phase when it is flared up
KNOW: Low back pain w/ radiating leg pain tends to travel passed the knee
KNOW: W/ back pain that has raidaitng pain - LE parethesias (abnormal sensation), numbness, and weakness may be reported
KNOW: Back pain w/ radiating pain may have directional preference noted w/ history of clinical examination to alleviate LE pain
Peripheraliztion of leg pain is most often bright on through ____
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)
Someone w/ back pain w/ radiating pain will likely have a positive straight leg raise for leg pain at ___ degrees of hip flexion
< 45 degrees of hip flexion brings on leg pain
Someone w/ back pain w/ raidating pain will likely have a positive crossed SRL at ____ degrees of hip flexion
< 45 degrees of hip flexion will bring on leg pain
Will someone w/ back pain w/ raiding pain have neurosigns and symptoms (weakness, numbness, DTRs)?
Yes
What will putting weight on the affected side do to someone w/ radiating pain?
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
What kind of modality would we do for someone w/ back pain w/ radiating pain?
Traction
* pulling facets apart = decreased spinal n pushing w/ stenosis
* Letting the disc stop its herniation = decrease spinal n pressing w/ disc hernaition
What kind of intervation would we do for someone w/ radiating pain (most common and easy exercise to do to get rid fo symptoms)
repeated motion testing (doing whatever motion centralizes symptoms)
What should we do before going into repeated motion testing (which allivates someones symptoms w/ radiating back pain)
Fix their lateral shift!
How many times should repeated motion testing be done?
5-10 times to see if it takes away their symptoms
Know: when appropriate clinican can add OP to end the ends of repeated motion testing to see if it allivates symptoms
KNOW: If standing bothers the pt we can do repeated motion testing in sitting
How many times is repeated motion testing done?
5-10 times
How would you do repeated motion testing for extension if it hurts for the pt to stand?
Do lateral shifts normally go with flexion or extension biases?
Extension biases
So if they like extension (pain w/ flexion) they’re likely to have a lateral shift
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
If someone has radiating pain what modality would I use?
Traction
Whats the other intervention you could do for someone w/ radiating pain?
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
What kind of exercises are best for someone w/ radiating pain/
Directional preference exercise EX (best for symptom modulation)
Analgesic =
reliving pain
NOTE: any exercises that have an analgesic response (reduce pain)are indicated for pts w/ radiating pain
Predictors for pts who will respond to specific exercise:
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)
If a pt centralizes w/ side glide what directional preference will they likly have?
Extension
Do side glide w/ extension
NOTE: sometimes pts cant tollerate their directional preference while wt bearing - so start in prone or supine first and work into standing
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
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)
Which side is this opening?
The top
opposite side of the bolster
If the pt has right sided leg pain where do you put the bolster?
Under the left side to open the right side (close down on the left side)
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
If pt has chronic LBP would we use traction
Never, doesnt do any good
* only use traction when they have that radicular pain
Why would we use CPA’s / UPAs as manual therapy interventions for radiating LBP?
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)
When would thrust manipulation be an appropriate intervention for LBP patients w/ radiating pain? (2)
when there symptoms are less than 16 days old
When they dont have symptoms are the knee
Would lumbar traction be a good intervention for LBP w/ radiating pain pts?
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
This is a form of manual traction w/ a directional bias. Which side is being opened?
Right side
Dont fully understand this slide
go back to 29 mins in this lecture
adverse neural dynamics:
Side to side difference greater than 10 degrees
brings on comparible pain
Synsetize / desensitize structures
He said know these really well
tensioning peripheral nerves
Know dermatomes and myotomes in LE
