MSK 731 Exam 1 Flashcards
What plane is the thoracic spine facet joints in
frontal plane
Why is greater SB in the thoracic spine limited
due to the ribs
list the Thoracic region greatest to least motion
Rotation, SB, FLX, EXT
At what level does the thoracic spine have the most movement
T5 and T10
Why does T11 and T12 have the least amount of motion out of the thoracic spine
transition to shape of lumbar facets
What motions does the lumbar spine have
most: FLX, EXT
least: rotation
What are the 4 variables for stabilization
- joint integrity
- passive stiffness
- neural input
- muscle function
Name some characteristics of local muscles
-closer to axis of motion
-often deeper
-greater stabilization
-postural
-aerobic
-more often type 1 fibers
Name the main local muscles of thoracolumbosacral
-psoas
-quadratus lumborum
-pelvic floor
-transversus abdominus
-multifidi/rotatores
Does muscle function normalize automatically once symptoms are improved?
no
How much (%) does it take to activate muscles
30%
What are the 4 main reasons for stabilization issues
- pain
- swelling
- joint laxity
- disuse
What plane is the lumbar spine anterior facet joints in
coronal/frontal plane
What plane is the lumbar spine posterior facet joints in
sagittal plane
What are the main frontal stabilizer (local muscles) of the thoracolumbosacral
-Posas
-quadratus lumborum
How does the pelvic floor and transversus abdominus help stabilize the thoracolumbosacral
increases contraction of multifidus
If the multifidi/rotatores are smaller, what is more likely to happen
-higher injury rates
-LBP
How long do you hold for myotome testing
10 seconds
How long do you hold & range for mmt & or resisted testing to assess for a grade 1 strain
shorten & 10 seconds
What is the best MET parameters for achieving a combo of strength & coordination
3 set of 20 reps w/ moderate load
When a person rotates their trunk describe what the upper thoracic is doing
ipsiaterally coupling w/ SB (i.e. R rotation & R SB)
When a person rotates their trunk describe what the lower thoracic is doing
opposite rotation & SB (i.e. R rotation & L SB)
What type of scoliosis does a person have if they FLX forward and the abnormality in the spine does NOT go away
structural scoliosis
describe scoliosis/rotoscoliosis
- greater /equal to 10 degrees SB curvature
- SB & Contralateral rotation
What is the normal curvature of the spine
-cervical = lordosis
-thoracic = kyphosis
-lumbar = lordosis
-sacral = kyphosis
What is indicated if a pt has limited SB & FLX
indicates contralateral Z joint
What is indicated if a pt has limited SB & EXT
indicates ipsilateral Z joint
If a pt spine is a ‘C’ curve in trunk rotation, what vertebrae should a PT first assess
T10
What position does SB occur in
neutral
When does thoracolumbar fascia & posterior passive restraints have more tension
in neutral
When does thoracolumbar fascia & posterior passive restraints slacken
EXT/hyper EXT
Why does EXT/hyper EXT lead to LESS stability of the lower trunk
thoracolumbar & posterior restraints are slacken in that position
Anterior shearing forces are more greater in EXT/hyper EXT. True or false
true
What can a PT observe when a pt EXT/Hyper in the trunk for instability/anterior shearing
crease, especially a unilateral crease
Lumbar compression test are primarily testing what structures
vertebral body & disc
When should a PT do combined motions
-limited motion
-P! in a motion
-unilateral motions do NOT provide any information even though the pt is having problems
When should a PT do stability test
-hypermobility is indicated
A radiograph of the thoracolumbar spine best shows what levels
L4-L5 interspinous space
What is a good landmark for the L3-L4 interspinous space
top of iliac crest
PSIS is a good landmark for what SP (spinous process)
S2 SP
What rib is the best landmark to finding T12
12th rib (follow)
What can cause a pt to have ‘Sway Back’
-increased lumbar lordosis
-anterior pelvic tilt
-associated w/ flexible body typeswe32p0o
Describe ‘Flat Back’
-flattening of normal curves
-greater portion of LBP pt due to LESS dissipation of forces
What can cause a pt to have ‘Flat Back’ (straight spine)
-posterior pelvic tilt
-associated w/ rigid body type
What can cause ‘Rounded/Crouched back’
-increased thoracic kyphosis
-flattening lumbar curve
-posterior pelvic tilt
-associated w/ FHP
What region of the spine for LBP is the leading cause of worldwide disability & activity limitation/work absence
lumbar spine
What percentage of people will experience LBP in their lifetime
80%
Risk factors that could contribute to LBP
-previous LBP
-co-morbidities
-awkward postures
-genetics w/ age related disc changes ONLY
What populations are more prevalent to have LBP
-biological women
-older than 65 yrs
-lower du. status
-higher physical work demands
Who should get imaging with LBP
-greater than 50 yrs
-saddle paresthesia
-bowel/bladder dysfunction
-NO improvement after 6 weeks of conservative Rx
describe PT Rx education & advice
-1st line Rx w/ moderate to strong evidence
-stay active w/ early resumption of ADLS
describe PT Rx overcoming barriers
-increase consultation time & follow up
-reward quality
What are the 4 main subgroups of LBP Rx classifications
- mechanical traction
- directional pref
- mobilization/manip
- stabilization
describe mechanical traction
-NO benefit w/ static Tx
-intermittent tx for LBP w/ LE P!
-NOT use w/ persistent LBP w/ LE P!
-radiculopathy
describe directional preference
helps choose position to avoid/alleviate P! motions
describe mobs/manips
-strong preference
-short term effectiveness
-acute/sub acute
-greater/equal to a score of 4
describe stabilization for acute LBP
-safe/effective to do early
describe stabilization for sub acute & persistent LBP
-strong support
-first line Rx
-most effective Rx for functions in this order
Prognosis of LBP
-rapid improvements within 1 month
-most improve substantially 6 weeks
Cognitive therapy is best use for what type of LBP
-first line Rx w/ persistent LBP
When is medication recommended
-ONLY when inadequate response to exercise & cognitive behavioral therapy
Epidural injection are used for what type of pain phenotype
-radicular p!
-no benefit by 4 weeks
