M4 RAT Flashcards
Neurodynamic tx is generally classified as either
a. Prophylactic or preventative
b. Tensioning or sliding
c. Pain-free or provocative
d. Central or peripheral
b. Tensioning or sliding
A chronic pain pt with a pathoanatomical pain generator but with other psychosocial and neurophysiological factors contributing to the pain probably belongs in the
a. Motor control impairment subgroup
b. Adaptive or protective altered motor response group
c. Movement impairment subgroup
d. Maladaptive motor control pattern
d. Maladaptive motor control pattern
Which of the following best applies to graded exercise
a. Exercise is used with the goal of pain resolution
b. Use operant conditioning to reinforce healthy behaviors
c. Fearful activities are gradually introduced to decrease anxiety → graded exposure
d. It is synonymous with graded exposure
b. Use operant conditioning to reinforce healthy behaviors
Following disc surgery or fusion, rehab should be guided by
a. A standard protocol for lumbar surgery
b. Pt preference and clinical expertise
c. Clinical reasoning and surgeon prescription
d. Strict avoidance of spine movement
c. Clinical reasoning and surgeon prescription
Friendliness, caring, showing empathy and respect have all been shown to
a. Increase professionalism
b. Improve pt outcomes
c. Improve communication
d. Increase pt satisfaction
d. Increase pt satisfaction
Which of the following is most true about a pt with PGP?
a. A pelvic girdle source should not be assumed until a lumbar source has been excluded
b. A lumbar source should be ruled out before starting lumbar and pelvic tx
c. A lumbar tx program should also include pelvic stabilization
d. PGP is usually secondary to lumbar pain so treating the spine will improve the PGP
a. A pelvic girdle source should not be assumed until a lumbar source has been excluded
Which of the abdominals is most likely to provide pelvic girdle stabilization?
a. Rectus abdominus
b. TrA
c. Internal oblique
d. External oblique
b. TrA
Which of the following best defines force closure?
a. Joint architecture that creates pelvic stability
b. It is provided by external orthotic compression
c. It depends primarily on muscle contraction
d. It equals muscle closure plus joint closure
c. It depends primarily on muscle contraction
Which of the following best describes specific pelvic girdle pain disorders?
a. Increasing joint stability is the key to tx
b. SI stress tests are the best dx tools
c. Imaging is of minimal use in dx of these
d. They typically require medical tx
d. They typically require medical tx
Examples of specific PGP =
- AS
- RA
- Reiter’s
Which of the following physical exam components best rules out PGP?
a. The 6 item test cluster
b. The 5 item test cluster
c. The 4 item test cluster
d. A detailed subjective exam
a. The 6 item test cluster
The 4 item test cluster is best for
ruling IN SIJ involvement
What will be done for neurodynamic issues?
treat and prevent problems (prophylactic)
What is especially important for pts with neural tension?
- Important that the patients don’t do more than prescribed
- sx’s will worsen
- must be very specific with how many sets/reps and what they should do if sx change
Which are more gentle: sliders or tensioners?
sliders
A pt with a neurodynamic problem is like to report:
hx of trauma or inflammation near a neural structure
A pt with L lumbar nerve root compression should be instructed in L sidelying positional traction over a pillow to reduce pain
a. True
b. False
b. False
A new pt with L LBP has ⅘ weakness of her left dorsiflexors that began a couple of weeks after her LBP began. Her R dorsiflexors are 5/5. She should be referred for imaging to rule out stenosis
a. True
b. False
b. False
A new pt with L LBP has ⅘ weakness of her left dorsiflexors that began a couple of weeks after her LBP began. Her R dorsiflexors are 5/5. She should be referred for imaging to rule out stenosis
Why is this false?
- nothing to suggest central
- monitor signs closely. If you see no change, consider referral
A pt who is initially most appropriate for the traction classification may later move into the mob/manip classification
a. True
b. False
a. True
Traction does NOT create residual increased IVF height but it CAN result in decreased residual nerve root compression, which diminishes pain and neurologic signs
a. True
b. False
a. True
temporarily increases IVF height
A pt with a neurodynamic problem is most likely to
a. Have true numbness in peripheral or nerve root distribution
b. Report a hx of trauma or inflammation near a neural structure
c. Report bilateral, symmetrical numbness and tingling with certain movement combinations
b. Report a hx of trauma or inflammation near a neural structure
What is an example of a trauma near a neural structure?
hamstring strain - brings collagen to area where sciatic nerve runs through
Which of the following is true?
a. A pt might have (+) neurodynamic tests but NOT radiculopathy
b. A pt with radiculopathy will NOT have (+) neurodynamic tests
c. A pt with true numbness is more likely to have a neurodynamic problem than radiculopathy
d. Pain proximal to the knee is more likely to result from a neurodynamic problem than a radiculopathy
a. A pt might have (+) neurodynamic tests but NOT radiculopathy
Which neurodynamic test is most diagnostic for upper-mid lumbar nerve root problems?
a. Slump (sidelying) knee bend
b. SLR
c. Slump test
d. Crossed SLR
a. Slump (sidelying) knee bend
A pt is seeing a PT for low back and posterior thigh pain. L SLR causes posterior thigh pain at 50 degrees.
a. This pt has a ND component
b. This pt doesn’t have a ND component
c. Not enough info to decide
c. Not enough info to decide
we need the sensitizing maneuver and bilateral comparison - is it “their” pain
Which of the following most accurately describes flossing
a. Good for prophylaxis but not treatment of neurodynamic problems
b. Sliding the nerve in a proximal direction followed by sliding in distal direction
c. Stretching a nerve but only one end at a time to prevent symptoms during treatment
b. Sliding the nerve in a proximal direction followed by sliding in distal direction
A new pt has worsening low back and R thigh pain & paresthesia of several weeks duration. SLR and slump are + for ND. DF’s are 4+/5 R, 5/5 L. Sensation is normal. Repeated flexion peripheralizes her thigh pain. The sagittal extension progression has no effect. The most appropriate treatment for her today is
a. Lumbar traction
b. Lumbar traction and flossing
c. Lumbar traction and tensioning
d. Flossing in SLR position
a. Lumbar traction
b. Lumbar traction and flossing
both are correct, may want to wait to add the flossing depending on how the traction relieves symptoms
