MDT

Question 1

What are the three general syndromes in MDT?

Answer 1

Derangement
Dysfxn
Postural

Question 2

What are the four subcategories of the dysfxn syndrome in MDT?

Answer 2

Flexion
Extension
Side gliding
Adherent nerve root

Question 3

What MDT syndrome results from displacement of the IVD?

Answer 3

Derangement syndrome

Question 4

What does derangement syndrome result from?

Answer 4

Sustained flexion and/or rotational forces
Chronic postural stresses into flexion and/or rotation

Question 5

T/f: derangement syndromes can result in possible localized pain, paresthesias, and ROM loss

Answer 5

True

Question 6

The paresthesias in derangement syndromes can be from what two causes?

Answer 6

Referred pain
Radicular pain

Question 7

If there is pressure on the nerve root in a derangement syndrome, what may result?

Answer 7

Peripheral symptoms

Question 8

What peripheral symptoms can manifest in derangement syndromes when there is pressure on the nerve root?

Answer 8

Pain
Motor weakness
Sensory changes (loss/paresthesia)

Question 9

What determines the direction of a lateral shift?

Answer 9

The shoulders

Question 11

Is centralization or peripheralization of symptoms a good sign?

Answer 11

Centralization

Question 12

If a patient has a ______ disc, they may have a slower progression

Answer 12

Incompetent

Question 13

What MDT syndrome involves contracted tissues?

Answer 13

Dysfunction syndrome

Question 14

What MDT syndrome may have tight peri-articular tissues around a spinal segment with pain at end range motions?

Answer 14

Dysfunction syndrome

Question 15

T/f: dysfunction syndrome may result from secondary restriction due to surgery, sciatica, trauma, disc derangement

Answer 15

True

Question 16

What is a great intervention to use for dysfunction syndromes?

Answer 16

Manual therapy to loosen tight tissues

Question 17

What is the presentation of someone with a dysfunction syndrome?

Answer 17

Increased pain with stress of tissue typically at the restricted zone
Pain that decreases with relief of tissue stress
Uni/multi planar symptoms

Question 18

How are dysfunction syndromes named?

Answer 18

For the direction of restriction and symptom reproduction

Question 19

What is an adherent nerve dysfunction?

Answer 19

Adhered spinal nerve root or dura
Extremity pain with lumbar flexion in standing (RFIS, loaded flexion)
No/reduced pain with lumbar flexion in supine (RFIL, unloaded flexion)

Question 20

With adherent nerve root (ANR), why is flexion in supine more comfortable than flexion in standing?

Answer 20

Bc in supine, there is less nerve tension behind the leg

Question 21

How does ANR (adherent nerve root) differ from derangement syndrome?

Answer 21

With ANR, symptoms will be better in supine, but in derangement syndrome, both flexion in supine and standing will be painful bc the pressure on the disc will be the same

Question 22

What MDT syndrome has normal soft tissue under abnormal stress?

Answer 22

Postural syndrome

Question 23

The symptoms of a postural syndrome improve with what?

Answer 23

Improved posture

Question 24

What is the least common MDT syndrome we will see?

Answer 24

Postural syndrome

Question 25

Are patients with postural syndrome likely to seek care?

Answer 25

No bc they have subclinical pain

Question 26

T/f: if a postural syndrome is not addressed, it can lead to more significant problems

Answer 26

True

Question 27

PTs have a potential role in ______ and ______ prevention with postural syndrome

Answer 27

Primary, secondary

Question 28

What does the evidence say about the interrater reliability of MDT with credentialed therapists?

Answer 28

It is acceptable

Question 29

T/f: depending on the experience of the patient, MDT is highly effective in diagnosis and management of LBP

Answer 29

True

Question 30

With ____ LBP, there is mod to high quality evidence that MDT is NOT superior to other rehab interventions

Answer 30

Acute

Question 31

With ____ LBP, there is mod to high quality evidence that MDT IS superior to other rehab interventions

Answer 31

Chronic

Question 32

Why may MDT not be as great for acute LBP?

Answer 32

Bc the inflammation can confound symptoms The problems don’t reveal themselves so obviously bc too much inflammation early on can lead to everything hurting

Question 33

Why may MDT be better for chronic LBP?

Answer 33

Bc pts have lived with the pain for longer, they are more likely to be able to distinguish what directions are problematic

Question 34

Why do we want to know if a pt is currently still working?

Answer 34

Bc if they are still doing a job that makes their issue worse, treatment will be an uphill battle

Question 35

T/f: we have to gather quantifiable pain of the LEs if it is present

Answer 35

True

Question 36

If a pt is not pain free for more than 10% of the day is their pain likely constant?

Answer 36

Yes

Question 37

How can we ask pts about the constant nature of their pain?

Answer 37

“Does the pain ever get to a 0/10 for more than 30 minutes a day?”

Question 38

For insurance purposes, what should we do if a pt has pain that has been ongoing for years?

Answer 38

Ask them why they decided to get help now

Question 39

Before we start a LBP exam, what should we do to ensure we can tell if the symptoms centralize?

Answer 39

Get a baseline of what their pain is before starting the exam

Question 40

What is an awaking symptom?

Answer 40

Symptoms upon opening your eyes in the morning before even rolling over to turn off your alarm

Question 41

T/f: pts may shift towards or away from pain with a lateral shift

Answer 41

True

Question 42

T/f: we should we a baseline of symptoms in standing, supine, and prone

Answer 42

True

Question 43

What is level 1 Quebec task force classification?

Answer 43

LBP and/buttock pain

Question 44

What is level 2 Quebec task force classification?

Answer 44

Level 1 (LBP/buttock) and symptoms to knee

Question 45

What is level 3 Quebec task force classification?

Answer 45

Level 2 (LBP/buttock and sx to knee) and symptoms below the knee

Question 46

What is level 4 Quebec task force classification?

Answer 46

Level 3 (LBP/buttock, sx below knee) and neuro signs

Question 47

What is involved in interventions for postural syndrome?

Answer 47

Remove abnormal stresses (and strengthen and work on endurance)

Question 48

What are interventions for dysfunction syndromes?

Answer 48

Remodeling of shortened tissues to reduce movt restrictions Movt into the painful direction Stretching OMPT

Question 49

What interventions are involved in treating derangement syndromes?

Answer 49

Reduce internal displacement Maintain reduction Restore full motion Movt away from the painful direction

Question 50

What is involved in the treatment and home program in the ABC?

Answer 50

PREP (pain relieving exercise program) Posture alignment ADL modification Pt self monitoring effects of PREP, sitting, and awakening on sx

Question 51

What are the goals of treatment and home programs in ABC?

Answer 51

Protect against reiniury Progress from extension to reintegration to normal activity Prevent exacerbation and reiniruy

Question 52

What should we tell patients to expect with progression and improvement of symptoms?

Answer 52

To expect a “sawtooth progression”

Question 53

What is something important we should teach our patients with an extension bias?

Answer 53

How to sit and stand from a chair without flexion

Question 54

What is a good thing pts can do at home to get a better understanding of their symptoms behavior?

Answer 54

Have them keep a pain diary

Question 55

T/f: for pts with an extension bias, we have to reintegrate them into flexion very slowly with stabilization along the way

Answer 55

True

Question 56

What is the criteria for moving into flexion when a pt has an extension bias?

Answer 56

Symptom free (or very minimal and occasional) for 7-10 days

Question 57

During week 1 of the 3 week program, what are we telling our pts to do?

Answer 57

PREP Prone press ups x10 Double knee to chest x 10 Prone press up 2x10 (Flexion sandwiched by extension)

Question 58

During week 2 of the 3 week program, what are we telling our pts to do?

Answer 58

PREP PPU x10 Seated trunk flexion x10 PPU 2x10

Question 59

During week 3 of the 3 week program, what are we telling our pts to do?

Answer 59

PREP PPU x10 Standing trunk flexion x 10 PPU 2x10

Question 60

What positions can we do lateral shift corrections in?

Answer 60

Prone, supine, or hanging

Question 61

T/: treatment of LBP should involve a fxnal exercise progression overlaid with a pain relieving program as allowed by symptoms

Answer 61

True

Question 62

Should the 3 week progression be done in the clinic, or as part of the HEP?

Answer 62

As part of the HEP