M3 Reading Guide 3: DSE/LSS Flashcards
What are the subgroups of this classification?
- Extension
- Flexion
- Lateral shift
Which is the most common subgroup for DSE?
extension
Which pts tend to have a flexion preference?
pts with
- LSS
- over 65
- radiographic evidence of stenosis
Subgroups of DSE identified by
direction of movement that results in centralization
What are the key factors that determine patient placement into each of the subgroups?
Extension
- *Slumped sitting posture
- *PAIVM hypomobile or painful
- onset often related to flexion movements and activities
- extension relieves
- reduced lordosis
- pain
- extension AROM deficit greater than flexion
What are the key factors that determine patient placement into each of the subgroups?
Flexion
- *SLR may or may not be positive
- Pts prefer flexion activities
- Limited flexion AROM with extension AROM full range
- PAIVM may be provocative
- Repeated extensions produces, worsens or peripheralizes
- Flexion eases or centralizes, may increase flexion ROM
What are the key factors that determine patient placement into each of the subgroups?
Lateral shift
- *Sudden or recent postural change
- *Standing and walking aggravate
- Unilateral or asymmetrical symptoms
- Flexion and extension activities aggravate
- Sidelying may be an easing position
What are the 3 overall components of treatment for patients in the extension subgroup?
- Maintenance of lumbar lordosis via temporary avoidance of flexion activities
- Posture correction
- Extension exercise repeated 10x every 2-3 hours
What are the steps in the extension progression?
i. Prone on 1-2 pillows
ii. Prone lying w/out pillows
iii. Prone lying on elbows
iv. Prone pressup or REIL
v. Prone press up with exhalation at end of extension
vi. REIL with belt fixation
vii. REIL with therapist OP
viii. Extension mobilization
ix. REIS
How does one determine where to start and how to progress with the extension progression?
- not all pts start at the lowest level.
- all pts do not progress through each level
- starting point determined by clinician
- progression determined by pt response
What are the steps in progression for the lateral shift subgroup?
- Pt attempts self correction in standing or against wall
2. If unsuccessful, manual shift correction in standing
If manual shift correction is successful, what should be done next?
- pt instructed on self-correction in prone with REIL
- hips off center as needed as well as procedures in standing
How should a therapist respond to reports of increased LBP when doing direction specific exercise?
The exercises should be continued and discontinued only if peripheralization occurs
When does recovery of function (resuming movements that have been avoided) begin?
When a pt is asymptomatic for a period of several days
How does recovery of function (resuming movements that have been avoided) begin?
- Pt begins exercise in the direction that has been avoided or peripheralizes
- always follow by repeated extension
reintroduction of avoided movements for someone in extension subgroup
- Start RFIL 5-6 reps, 5-6x/day for 1-2 days
- from here, may progress slowly to sitting and standing
What is the typical presentation and progression of a patient with symptomatic lumbar spinal stenosis?
- LBP with related LE symptoms and diminished walking tolerance.
- Relatively stable
- Severe disability and neuro deficits may develop over time, but not in a rapid manner
What are some appropriate interventions for each of the impairments typically seen in patients with symptomatic spinal stenosis?
- conservative care
- surgical interventions
- injections
Appropriate interventions for LSS: conservative care
- US
- moist heat
- TENS
- ESI
- stretching and strengthening program for trunk and LE
- manual therapy
- walking program
- lumbar stabilization exercise
What are the 3 types of traction?
- manual
- mechanical
- positional
What are the 5 key factors indicating when to treat using traction?
- leg sx (below buttock), pain, and/or paresthesia
- s/s of nerve root compression
- peripheralization with extension (all motions peripheralize)
- inability to centralize sx
- peripheralization with crossed SLR
compression =
decreased transmission
What is the goal of traction?
- centralization with progression to another classification
- matched or impairment based intervention
