M2 Knowledge Check Qs Flashcards
Primary purpose for performing medical screen on pt with LBP (3)
- identify clinical behavior that warrants immediate medical workup
- identify clinical behavior that warrants non-urgent yet necessary medical consultation
- identify co-morbid medical conditions that will impact current episode of care for LBP
Prevalence/incident rates of significant Red Flag behaviors
3-8% incident rate of serious pathology associated with LBP
What is the leading red flag condition that will present in the clinic for evaluation of LBP?
pathological/insufficiency spinal fracture
Clinical patter of pathological/insufficiency spinal fracture
older, limited ability to stand or walk, history of corticosteroid medication
Critical responsibilities of the PSP/first contact practitioner managing pts with LBP at initial encounter
- medical status/hx
- identify confounding medical/psych variables
- establish neurological baseline
- track neurological status
Neuropathic classification LBP signs/symptoms
- LBP with:
- leg pain
- sensory and reflex changes
- muscle weakness
- altered neurodynamics
Nociplastic LBP classification signs/symptoms
Nociplastic dominant will present with altered behavioral characteristics, attributed to altered cognitive processing (poor self-efficacy, depressive sx, kenesiophobia)
Nociceptive LBP classification signs/symptoms
can be either mechanical or inflammatory, but won’t have corresponding clinical signs of peripheral neurological involvement
psycho-emotional LBP classification signs/symptoms
underlying psychological condition that will require specific evaluation and management
According to Dr. Chris Standeart, ESI has best chance of success and should be considered when:
the individual with acute, subacute leg pain that is not responding favorably to mechanical interventions
Primary reason for performing spinal surgery
- reduce/eliminate the threat posed to neurological structures.
- MYOTOMAL WEAKNESS is the most significant clinical sign of nerve root injury/dysfunction
- pts with progressive or persistent neurological involvement despite receiving appropriate non-surgical care likely will require surgical decompression/removal for recovery to occur
p-value implying statistical SIGNIFICANCE
p-value LESS than 0.05 is statistically significant
p-value implying statistical IN-significance
p-value GREATER than 0.05 is statistically insignificant
Summary of the TBC Movement Control Approach
human movement is a complex dynamic that depends on interplay of LOCAL MOBILITY needs, GLOBAL STABILITY needs, which are impacted by BOTH cognitive behavioral and socio-occupational factors
Type of clinical tests that can help clinicians rule OUT conditions
tests with HIGH sensitivity
SNOUT
Type of clinical tests that can help clinicians rule IN conditions
tests with HIGH specificity
SPIN
Clinical tests to help identify lumbar spondylolisthesis, according to Ahn and Jhun
- Low Midline Sill Sign
- Interspinous Gap Test
Primary finding of the Pilz et.al article
Using trunk performance ratios, they were able to demonstrate appreciable difference in age-matched individuals with and without LBP.
Lumbar disc/discogenic LBP typical characteristics:
- acute antalgia
- difficulty assuming lordosis w sit to stand
- painful obstruction to lumbar extension (reduces with repeated/sustained ext)
- centralization of distal symptoms that are present
Lumbar spinal stenosis typical characteristics:
- 48+yrs
- predominantly LE sx that are WORSE WITH WALKING
CDR - Clinical Diagnostic Rule for patients with sacroiliac joint pain
- lack of centralization and reproduction of low back pain
WITH 3/5 positive tests/ Laslett Cluster:
- distraction test
- compression test
- thigh thrust
- Gaenslen’s test
- sacral thrust
CDR - Clinical Diagnostic Rule for disc herniation with nerve root involvement by Petersen, Laslett, Juhl:
- Positive SLR plus 3/4:
- dermatomal P in correspondence with a nerve root
- corresponding sensory deficit
- motor weakness/decreased DTR
CDR - Clinical Diagnostic Rule for spinal stenosis:
- 3/5 of the following:
- age 48+
- b/l LE symptoms
- leg P worse than back P
- P during standing/walking that is relieved with sitting
Capsular pattern of loss of hip ROM:
- significant loss of passive Flexion, abduction and internal rotation, slight loss of passive Extension, little or no loss of passive external rotation
MC psychological factors that can impact risk for spine pain chronicity:
- anxiety
- situational depression
- disability
- passive coping
- low self-efficacy
What is graded exposure for LBP patients?
therapeutic approach most appropriate with nocioplastic or nociceptive sensitization, where a functional activity identified as painful is REPEATED, creating repeated exposure to the stimulus to decrease the perception of subsequent stimulation AKA habituation
- rather than activating perfipheral nociceptors, it DECREASES PERIPHERAL SENSITIZATION
- NOT appropriate for acute inflammatory pain or mechanical nociceptive pain
Pain neuroscience education facilitates achievement of therapeutic goals by:
decreasing the belief that pain poses a threat to their health and wellbeing
Best way to improve patient engagement for patients that do not regularly exercise
utilize motivational interviewing to elicit motivation for behavior change
