Mod 1 Lumbar/Women's Health

Question 1

Joint Mob Precautions

Answer 1

-Malignancy
– Bone disease
– Unhealed fracture
– Excessive pain
– Joint replacements
– Weakened tissue

Question 2

Joint Mob Contraindications

Answer 2

–Hypermobility
– Potential necrosis of ligaments or joint
capsule
– Inflammation
– Joint Effusion (from trauma or disease)

Question 3

General Symptom Modulation Phase Ideas

Answer 3

-Manual Therapy
* Modalities:
* Traction or Immobilization
* PROM/AAROM/AROM

Question 4

General Movement Control Phase Ideas

Answer 4

-AROM
* Stabilization activity
* Proprioception
* Coordination
* Balance
* Targeted strengthening (iso, con, ecc)

Question 5

Functional Optimization Ideas

Answer 5

-Multi-joint strengthening
– Power/endurance/stability
– Control and quality are focus
* Balance/proprioception progression
*Agility/coordination/plyometric progressions
* ADL simulated activity
* Introduce Sport or Work movements/activity
* Target muscles/movements and gross movements

Question 6

Return to Work/Sport Ideas

Answer 6

-Sport specific movements/activity
* Work specific movements/activity
* Explosive movements
* Change of directions/reaction movements
* Plyometric progressions
* Agility progressions
* Load for strength

Question 7

intervertebral foramen:
increases with ___ & ____
decreases with ___ & ____

Answer 7

flexion & contralat sidebend
extension & ipsilat sidebend

Question 8

Describe spinal motion in relation to the vertebral bodies & facet joints

Answer 8

defined by movement of anterior portion of the body of the superior vertebra

Question 9

lumbar facet orientation
-main movements here

Answer 9

vertical facets
-allow flexion/extension (limited rotation)

Question 10

Lumbar red flags (4)

Answer 10

bowel/bladder changes
peripheralization of s/s
numbness in peri/saddle area
parasthesias

Question 11

Lumbar special tests for:
L4-S2
L1-L3
C1-S2

Answer 11

SLR
Prone Knee Flexion Test
SLUMP test

Question 12

Signs and Symptoms (S/S):
– Dull, achy along one or both
sides of low back
– May radiate to buttocks
– Sharp with certain movements
– Limited ROM and function
-aggravated by stress, sleep & activity

Answer 12

Nonspecific LBP

Question 13

Lower Lordosis/Anterior Tilt (Lower Crossed)
tight: (2)
weak: (2)

Answer 13

hip flexor, lumbar extensors
abdominals, hip extensors (glutes)

Question 14

Common ligament sprain
Which combined motion?

Answer 14

Lumbar facet ligaments
flexion & rotation

Question 15

impaired gliding at facets w/ dec. movement
S/S:
– Shorter duration episodic unilateral pain
– Moderate pain/referral
– Flexion OR extension ROM loss
– No neurological signs or symptoms
– “locked up neck or back” “stuck feeling

Answer 15

Facet Involvement/Segmental Dysfunction

Question 16

Stress fracture in the pars interarticularis
* Pain with hyperextension and
excessive flex
-common w/ young athletes

Answer 16

Spondylolysis

Question 17

Forward shift of one vertebrae on another (commonly L4/L5, L5/S1)

Answer 17

Spondylolisthesis

Question 18

s/s: general low back pain, may radiate into buttocks, back stiffness,
muscle spasms, hamstring tightness, neural symptoms
(numbness/tingling/burning, weakness in legs)
This condition is aggravated by ___

Answer 18

Spondys
extension

Question 19

4 stages to disc herniation

Answer 19

degeneration, prolapse, extrusion, sequestration

Question 20

Narrowing of spinal canal (central) or nerve root
canal (lateral) which constricts and compresses
nerve roots
– Arthrosis or hypertrophy of facet joints
– Thickening of ligaments
– Loss of disk height

Answer 20

degenerative spinal stenosis

Question 21

take nerve to point of tension,
passively or actively move 1 joint so as to stretch and then
release tension

Answer 21

neural tension technique

Question 22

take nerve to point of tension,
passively or actively move 2 joints so that tension remains
but nerve glides proximally and distally

Answer 22

neural glide technique

Question 23

degenerative changes to joint cartilage
s/s: pain, tender, aches, crepitus, swelling
osteophyte formation
-ligament instability

Answer 23

Lumbar OA

Question 24

Narrowing of disc space and formation of
osteophytes
* OA of the spine = decreased articular cartilage

Answer 24

Spondylosis

Question 25

Lumbar Post-op protocols

Answer 25

no bend/lift/twist (> 10lbs)
abdominal brace

Question 26

SIJ motions:
nutation=
counternutation=
anterior & posterior ____
pelvic ____ & ____

Answer 26

sacral flexion
sacral extension
innominate rotation
upslip/downslip

Question 27

SIJ s/s:
ROM loss in ___
pain referral to ___

Answer 27

extension
pain down leg stopping at/above knee

Question 28

dynamic stabilizers to lumbar spine (2)

Answer 28

TA & multifidus

Question 29

PT Tx: IV Disc
centralize symptoms w/ ___ method
- ____-based exercise (not ____)

Answer 29

McKenzie
extension based, not flexion

Question 30

PT Tx: Degenerative Spinal Stenosis
___ method with ___-based exercises

Answer 30

Williams method w/ flexion-based

Question 31

which nerve innervates the PFMs & levator ani?

Answer 31

pudendal nerve

Question 32

PFM mm fiber types:
70%:
30%

Answer 32

type 1/slow twitch
type 2/fast twitch

Question 33

5 functions of Pelvic floor

Answer 33

-support pelvic organs
-stabilize spine/pelvis (cylinder)
-sphincteric (for continence & withstand intraabd pressure)
-sexual response/fxn
-sump-pump (mm move lymphatic fluid)

Question 34

Mm in the wall of the bladder

Answer 34

detrusor mm

Question 35

-loss of urine w/ rise in intra-abd pressure
ex: cough, sneeze, jump

Answer 35

stress urinary incontinence

Question 36

stress urinary incontinence tx:

Answer 36

strengthen PFMs & core/hip mm

Question 37

loss of urine d/t involuntary detrusor contractions
-sudden intense urge to urinate
d/t conditioned reflex or bladder irritants

Answer 37

urge urinary incontinence

Question 38

urge urinary incontinence tx:

Answer 38

dec. bladder irritants
urge suppression/relaxation techniques
pelvic tilts, core/hip strength

Question 39

combo of stress & urge incontinence s/s

Answer 39

mixed incontinence

Question 40

loss of urine d/t decrease in mobility status
-dec. mobility or impaired cognition

Answer 40

functional incontinence

Question 41

functional incontinence Tx:

Answer 41

bladder training (timed voids),
functional training (txfer/gait train)

Question 42

loss of strength, integrity or awareness of PFM & pelvic CT
-urinary/fecal incontincence
-pelvic organ prolapse
-post trauma mm dysfunction

Answer 42

supportive/disuse dysfunction

Question 43

lax supportive tissue of pelvic organs & levator plate weakness cause descent/malpositioning of pelvic organs

Answer 43

pelvic organ prolapse

Question 44

Supportive/Disuse Dysfunction Tx:

Answer 44

PFM strength test (biofeedback)
PFM strengthening (pelvic tilt, Kegels, hip & core strength)
pessary use
pelvic reconstructive surgery (mod to severe prolapse)

Question 45

inc. mm tension in PFMs causing pain or voiding dysfunction

Answer 45

hypertonus dysfunction

Question 46

Hypertonus Dysfxn Tx:

Answer 46

PFM downtraining (relax/eccentrics of PFM)
-vaginal dilator set
diaphragmatic breathing
manual therapy

Question 47

dec. mm control of pelvic floor w/ abnormal patterns of mm recruitment/timing
-3 examples

Answer 47

incoordination dysfunctions:
stress incontinence
neurogenic bladder
chronic constipation

Question 48

disease states &/or abnormal pelvic organ physiology
ex: urge incontinence, UTI, IBS, interstitial cystitis, hemorrhoid

Answer 48

visceral dysfunctions

Question 49

s/s: Strong, frequent urges to
urinate in small amounts
 Burning with urination
 Suprapubic or rectal pain
 Cloudy urine
 Strong smelling urine
 Blood in urine (pink or
brownish in color)

Answer 49

cystitis (UTI)