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Physio > MSK - Lower Body > Flashcards

MSK - Lower Body Flashcards

Bones, muscles & stuff...

1
Q

Stages of Healing

A
  1. Inflammation: immediately following injury to 3-5 days, signs of inflammation, POLICE
  2. Repair: day 5 to 4-6 weeks, essential to begin moving the injured joint through ROM, formation of scar tissue
  3. Remodelling: 6 weeks - 6 months, functonal actitivites, maturation of myofibers. organization of scar tissue
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2
Q

Contusion

A
  • Muscle injury caused by sudden external force
  • Results in bleeding in deep muscle regions
  • Recovery is dependent on grade: grade 1 = 2-3 wks, grade 2 = 4-6 wks, grade 3 = 8 wks
  • Treatment: POLICE, no heat, no massage, no alcohol, no running, put muscle on stretch to prevent healing in shortened range, gentle pain free ROM
  • Complications: compartment syndrome (check capillary refill), myositis ossificans (formation of bone within muscles, suspect if haven’t improved in 2-3 weeks)
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3
Q

Strains and Tears

A
  • Acute or chronic (excessive lengthening vs overuse)
  • Majority occur at biarticular muscles at the muscle tendon junction
  • Mainly occur during eccentric loading or high intensity
  • Grade One: microscopic tearing, pain and tightness, no weakness, relative rest to protect
  • Grade Two: partial, macroscopic tearing, pain and sturctural change (laxity and decreased strength)
  • Grade Three: complete tear, painless and weak, may see lump
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4
Q

Strains and Tears: Treatment in Recovery Stages

A
  • Acute: POLICE, crutches if LE
  • Repair: modalities (US, IFC) DTF, strength and stretching
  • Remodeling: strength (increase in velocity) + stretching (static and dynamic)
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5
Q

Laceration

A
  • Cutting of muscle fibres, require surgical repair with sutures
  • Acute phase: optimize gait so scar tissue can arrange properly
  • Repair: gradual ROM and strength
  • Promote remodelling by gradually increasing load and velocity
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6
Q

Mechanical Low Back Pain: MOI, S/S, testing, treatment approach, education, precautions

A

MOI: Uniatera pain with no referral below the knee, often centralized to back, may be caused by muscles (strains) or ligament sprains, facet joint or SIJ. May be caused by traumatic injury, postural pain, lumbar sprain/strain.
Risk factors: Increase when pregnant, obsessive, increased driving or sitting time, anxiety and/or depression, prior LBP
S/S: Refers into buttock and thighs, AM stiffness or pain is common, pain with initiation of movements, pain worse at the end of day
Testing: AP
Treatment approach: Exercise, postual control, manual therapy, soft tissue release, NO traction or TENS
Education: Lifting mechanics, stay physically active
Precautions: AP

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7
Q

Degenerative Disc Disease (Spinal Stenosis): MOI, S/S, testing, treatment approach, education, precautions

A

MOI: Narrowing of spinal canal. Caused by degeneration of vertebral disc or lumbar facet. Associated with aging. Age of onset in 60’s - often insidious.
S/S: Bilateral numbness and tingling, pain in bilateral legs, flexed position decreases pain (sitting and bending), extension increases pain (walking and standing), pain decreases as morning progresses, repetitive movements cause pain, chronic pain with acute episodes
Testing: Bicycle test, shopping cart sign
Treatment approach: lumbar flexion exercises, ergonomic advice, stabilization of core, traction, improve ROM, aerobic exercise, core stability, aquatic exercise
Education: easing positions, options for exercise that allow flexion (cycling)
Precautions: AP

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8
Q

Lumbar Spine Disc Herniation/Radiculopathy: MOI, S/S, testing, treatment approach, education, precautions

A

MOI: Nucleus pulposus is displaced and protrudes beyond the annulus fibrosis, most common direction is posterior-lateral
S/S: Pain worsens in weight bearing activities, pain with cough/sneeze, no pain in reclined position, can impinge of surrounding nerve roots (radic). Most common L4-L5 and L5-S1, pain can be localized to low back + with herniation can radiate into lower leg.
Testing: Lumbar spine scan (myotomes, dermatomes, reflexes), SLR (+ if pain from 35-75 degrees), slump test
Treatment approach: extension exercises, traction, core stabilization
Education: avoid flexion, posture
Precautions: avoid prolonged flexion

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9
Q

Greater Trochanter Hip Bursitis: MOI, S/S, testing, treatment approach, education, precautions

A

MOI: Inflammation of bursa on greater trochanter. Can come from falls, contact blows to lateral hip or repetitive contractions glute med and IT band (running, walking, over training). Infections (TB).
Risk factors: W > M, affects all images, obesity
S/S: pain with palpation of GT bursa, pain with abduction and/or ER, prolonged standing pain, may see Trendelenburg sign.
Testing: FABER, Obers, pain with resisted abduction.
Treatment approach: myofasical release of ITB/TFL, flute/ITB stretching, clamshells, leg lifts.
Education: Activity modification
Precautions: 3 different times (inflammation, hemorrhagic from blow, septic from infection)

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10
Q

Piriformis Syndrome: MOI, S/S, testing, treatment approach, education, precautions

A

MOI: Peripheral neuritis of the branches of sciatic nerve caused by abnormal piriformis. More common in women with larger Q angle.
Two types: primary (anatomical cause, piriformis lays over sciatic nerve and some have nerve come thru muscle), secondary (macro trauma of buttock, muscle spasm, swelling, nerve compression)
S/S: painful buttock or hip pain, referral sacrum, gluteal and down posterior thigh, irritated with long sitting, walking, squating and hip adduction. No + neuro signs.
Testing: TOP over piriformis, resisted lateral rotation
Treatment approach: gluteal stretching, core strengthening, education.
Education: avoid extended periods of sitting, take micro breaks, remove items in back pocket.
Precautions: Ensure referral pain is not due to spinal pathology.

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11
Q

Plantar Fascitis: MOI, S/S, testing, treatment approach, education, precautions

A

MOI: Overuse caused by medial calcaneal tuberosity, can come from over training/sudden increase in load
Risk factors: excessive or repetitive weight bearing work, increase in training, obesity, flat feet OR high arches, decreased DF, hyperpronation, leg length discrepancy, Windlass mechanism
S/S: Pain over plantar fascitis and calcaneal tuberosity, pain first thing in the morning (first few steps), antalgic gait, 30% patients present bilaterally, decreased DF
Testing: active and passive - full ROM, resisted isometrics, sensation & reflexes - WNL
Treatment approach: Activity modification, Strasberg sock, low dye taping, stretching & strengthening (increase calf length and stretch, intrinisic foot muscle), mobilization (increase DF), biomechanics (pronator and supinator)
Education: Activity modification, POLICE
Precautions: PF may be accompanied by heel spurs
AP for differental diagnosis

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12
Q

Medial Tibial Stress Syndrome: MOI, S/S, testing, treatment approach, education, precautions

A

MOI: Associated with running or any vigourous. Happens when muscular and periosteum become over worked.
Risk factors: Increase in unaccustomed activity or trianing load, flat feet or high arches, obese, improver foot wear.
S/S: Pain on medial aspect of tibia, 2nd third of posterior medial border of tibia, pain during or after exercise, worse at the beginning of exercise.
Testing: Tenderness on palpation of medial border + pain with resisted gastroc complex
Treatment approach: Low dye taping, ice massage, compression socks, stretching and strengthening (increase calf length and strength + intrinsic foot muscles)
Education: Prevention and gradually increasing training load
Precautions: Rule out stress fracture.

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13
Q

Ankle Sprain: MOI, S/S, testing, treatment approach, education, precautions

A

MOI: Lateral, Syndesmosis, Medial
S/S: Grade 1-3. Common grade 2/3 presentation –> local pain, edema, increased temperature, ecchymosis, hyper mobility or instability, loss of motion and/or function.
Testing: Anterior drawer, posterior drawer, Kleigers, etc.
Treatment approach: AP
Education: Preventitive rehab - common re-occuring injury
Precautions: Suspected # - Ottawa Ankle Rules

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14
Q

Lateral Ankle Sprain: MOI

A

Inversion and PF
Anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) normally injured

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15
Q

MOI, S/S, testing, treatment approach, education, precautions

A

MOI:
S/S:
Testing:
Treatment approach:
Education:
Precautions:

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16
Q

Achilles Tendinopathy: MOI, S/S, testing, treatment approach, education, precautions

A

MOI: Overuse of Achilles tendon/plantar flexors + increase activity. Insertional is more common than non-insertional.
Risk factors: pronation, reduced DF, reduced ipsilateral plantar flexion strength, tight calf, age, diabetes, high cholesterol, glute med weakness
S/S: Localized pain and perceived stiffness in Achilles tendon following periods of inactivity, decreased dorsiflexion and subtalar joint ROM, decreased PF strength due to pain and weakness, pain worse in the morning or during warm up.
Testing: Strength and ROM testing, (hop test, London Hosiptal test)
Treatment approach: Eccentric loading (heel drops), footwear/orthodics, stretching/strength, mobilization, taping, heel lifts, deep transverse friction
Education: Monitor exercise, activity modifcation
Precautions: Rule out Achilles tendon rupture

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17
Q

Meniscal Tear: MOI, S/S, testing, treatment approach, education, precautions

A

MOI: Contact or non-contact injury. Repetitive or forceful rotation of the knee that is combined with flexion and varus/valgus stress.
Risk factors: age, increased knee laxity of ACL surgery
S/S: Joint line pain, loss of flexion more that 10 degrees, loss of extension more than 5 degrees, swelling, crepitus, positive special test, reported “locking”, swelling at time of injury
Testing: ROM, strength, McMurray’s, Apley’s
Treatment approach: Injury to 4 weeks –> restore normal knee extension, decrease swelling, safe use of protection equipment. 4 weels to 3 months –> single leg stand control, normalize gait, good control and no pain with functional movements. 3+ months –> good control and no pain with sport and work specific movements.
Education: Same as above.
Precautions: Post surgical percautions
Common differential diagnosis: Plica syndrome - fluid that failed to reabsorb during development

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18
Q

Cruciate Ligament Sprian: ACL: MOI, S/S, testing, treatment approach, education, precautions

A

MOI: Tibia translates anteriorly on the fixed femur. Plant and twist when changing direction, suddenly stopping or direct impact on the knee. More common in females over males.
S/S: Pain, feeling of instability, giving way of the knee, loss of ROM, swelling, hemathrosis in the knee - refer back to doctor
Testing: Lachman’s (most common), Anterior Drawer
Treatment approach: Closed chain functional strengthening of quads, hamstrings, important to restore extension, joint mobs start as soon as pain free
Education: time line, unhappy triad (ACL, MCL, medial meniscus)
Precautions:

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19
Q

Syndesomosis Ankle Sprain: MOI

A

ER of the ankle is most common OR excessive DF and ER of the leg on a foot when its planted (slamming on brake)
Anterior, posterior and transverse tibiofibular ligaments and interosseous membrane support

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20
Q

Medial Ankle Sprain: MOI

A

Gradual degeneration of medial ligaments OR valgus force to leg creating eversion OR awkward fall resulting in excessive pronation or eversion of foot
Fan shaped deltiod ligament: anterior and posterior timbotalar, tibionavicular and tibiocalcaneal ligaments.

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21
Q

Collateral Ligament Sprain: MCL: MOI, S/S, testing, treatment approach, education, precautions

A

MOI: Valgus force (towards center of body) with or without external rotation. Can be contact or non-contact.
S/S: Joint line tenderness, localized knee pain, stiffness, brusing and redness. Protective spasm, ligament laxity.
Testing: Valgus stress test at 0 and 30 degrees.
Treatment approach: AP
Education: Possible outcome measures: LEFS, balance tests, vertical jump, SL squat
Precautions: Differential - Pes Ansetine Bursitis.

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22
Q

IT Band Friction Syndrome: MOI, S/S, testing, treatment approach, education, precautions

A

MOI: Inflammation of the IT band from excessive knee flexion and extension (most affected at 30 degrees of knee flexion). TFL is contractile portion of IT band. Inserts on lateral epicondyle on tibia and Gerdy’s tubercle. Provides lateral stability of hip and anterior-laterally supports knee is stance phase.
Risk factors: weak hip abductors and tight TFL, internal knee rotation during stance phase, abnormal neuromuscular control, rapid training increases, downhill running
S/S: Deep achy pain along lateral aspect of knee, fluid accumulation around lateral epicondyle
Testing: Nobles compression, Ober’s
Treatment approach:
Education: POLICE in acute, hip abduction exercises, stretching lateral structures, muscle and postural re-education.
Precautions: 2x more common in women than men. Cyclists and runners.

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23
Q

MOI, S/S, testing, treatment approach, education, precautions

A

MOI:
S/S:
Testing:
Treatment approach:
Education:
Precautions:

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24
Q

Patella femoral pain syndrome: MOI, S/S, testing, treatment approach, education, precautions

A

MOI: “Runners knee”. Caused by overuse, overloading, improper alignment. Women more than men.
External Risk Factors: vigorous physical activity (repeated stress). Sudden change in PA. Improper technique. Changes in footwear.
Internal Risk Factors: Poor patellar tracking (Q angle, excessive knee valgus or vacuum, weak or imbalanced quads)
S/S: Tight quads, weak hip abductors, medial tibial torsion. Anterior knee pain, pain with climbing or descending stairs, stepping up or down, prolonged sitting, squating
Testing: Thomas test, hip abductors, hamstrings, knee extensors, DF/PF, MMT VMO & glute med. SL squat, step down. Clarke’s sign (patellar grind).
Treatment approach: Strengthening weak muscle groups.
Education: Activity avoidance. Taping.
Precautions: Avoid high impact activities (running, jumping and open chain leg extension exercises)

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25
Q

Osgood Schlatters Disease: MOI, S/S, testing, treatment approach, education, precautions

A

MOI: Stress on developing tibial tuberosity at patellar tendon insertion. Commonly bilateral. Boy 12-15, girls 8-12. Repetitive use of quads. Runners and gymnasts.
S/S: Inflammation at tibial tuberosity - warmth, red, swelling, pain. Pain with squatting, stairs and jumping.
Testing: TOP tibial tuberosity. History of adolescent who is active.
Treatment approach: Activity modification, encourage non-weight bearing exercises. Stretch quads, educate on pain management. Knee padding, taping or bracing.
Education: As above.
Precautions: Avoid high intensity exercises to strengthen quads as it would increase stress on tibial tuberosity.

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26
Q

MOI, S/S, testing, treatment approach, education, precautions

A

MOI:
S/S:
Testing:
Treatment approach:
Education:
Precautions:

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27
Q

MOI, S/S, testing, treatment approach, education, precautions

A

MOI:
S/S:
Testing:
Treatment approach:
Education:
Precautions:

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28
Q

MOI, S/S, testing, treatment approach, education, precautions

A

MOI:
S/S:
Testing:
Treatment approach:
Education:
Precautions:

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29
Q

Serious Spinal Red Flags

A
  • Presentaion younger than 20 or onset older than 50
  • Violent trauma, such as fall from height or car
  • Constant, progressive, non-mechanical
  • Thoracic pain
  • Hx of carcinoma, systemic steroids, drug abuse, HIV
  • Systemically unwell weight loss
  • Persisting severe restriction of flexion in lumnar spine
  • Structural deformity
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30
Q

Cauda Equina

A
  • Difficulty with urination
  • Loss of anal sphincter tone or fecal incontinence
  • Saddle anesthesia
  • Widespread (more than one nerve root) or progressive motor weakness
  • Gait disturbances
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31
Q

Flexion Exercises for Low Back Pain for DDD/spinal stenosis

A
  • PPT
  • Single knee to chest
  • Double knee to chest
  • Forward bend in sitting and standing
  • Partial or full sit ups
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32
Q

Extension Exercise for Low Back Pain for disc protrusion.

A
  • Prone lying
  • Prone on elbows
  • Prone press up onto hands
  • Standing extension
  • Bridge
  • Prone leg extension
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33
Q

Lumbar Stabilization Exercises: TA

A
  • Heel slides
  • Hip flexion
  • Knee fall outs
  • Cat cow
  • Belly button to spine
  • Bridging
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34
Q

Myositis Ossificans (Or Heterotopic or Ectopic Bone Formation)

A
  • Part of hematoma is replaced with bone
  • Can be recognized on plain film radiographs
  • Contra-indication in acute stage: heat and massage
  • Work on PROM, AROM and isometrics
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35
Q

Grade One Strain/Tear: Fibers torn, pain on isometric, disability, weakness, pain on stretch, palpable defect, range of motion

A

Fibers torn: Few
Pain on isometric: Minor
Disability: Minor
Weakness: Minor
Pain on stretch: Yes
Palpable defect: No
Range of motion: Decreased

36
Q

Grade Two Strain/Tear: Fibers torn, pain on isometric, disability, weakness, pain on stretch, palpable defect, range of motion

A

Fibers torn: ~ Half
Pain on isometric: Moderate
Disability: Moderate
Weakness: Moderate to major
Pain on stretch: Yes
Palpable defect: No
Range of motion: Decreased

37
Q

Grade Three Strain/Tear: Fibers torn, pain on isometric, disability, weakness, pain on stretch, palpable defect, range of motion

A

Fibers torn: All (rupture)
Pain on isometric: None to minor
Disability: Major
Weakness: Moderate to major
Pain on stretch: No
Palpable defect: Yes
Range of motion: Varies, depends on swelling

38
Q

Tarsal Tunnel: Cause, Pain, Agg Factors, AROM, PROM, Resisted isometrics, Sensory Deficits, Reflexes

A

Cause: Trauma, space occupying lesion, inflammation, inversion, pronation, valgus deformity
Pain: Medial heel and medial longitudinal arch
Agg Factors: Worse with standing, worse at night
AROM: Full
PROM: Full
Resisted isometrics: Normal
Sensory Deficits: Possible
Reflexes: Normal

39
Q

Other differential diagnosis for plantar fasciitis or tarsal tunnel: Neurological, Soft Tissue, Skeletal

A

Neuro: abductor digiti minimi nerve entrapment, medial calcanel branch of posterior tibial nerve, tarsal tunnel syndrome, diabetic neuropathies

Soft tissue: achilles tendinopathy, trauma to fat pad in heel, plantar fasciitis rupture, posterior tibial tendonitis, retrocalcaneal bursitis

Skeletal: calcaneal #, subtalar arthritis, Severs disease (inflammation of growth plates)

40
Q

Acute Compartment Syndrome

A
  • Fascia does not stretch or expand easily
  • Normally in anterior front compartment of the lower leg
  • Causes: #, badly bruised muscle, crush injuries, constricting bandages
  • 5 P’s: pain (disproportionate), pallor (pale), pulselessess (muscle may feel tight), paresthesia (tingling or burning), paralysis (loss of use)
41
Q

Chronic Compartment Syndrome

A
  • Pain comes on acutely with activity and ceases with rest
  • Conservative treatment: biomechanical correction, soft tissue therapy (stretching massage)
  • Surgical treatment: fasciectomy
42
Q

General Ankle Treatment Plan: Phase 1-4

A

Phase 1: Protect and decrease inflammation
Phase 2: Increase mobility, increase strength and functional gait
Phase 3: Increase function
Phase 4: Return to sport

43
Q

Ottawa Ankle Rules

A
  1. Tenderness over the lateral malleolus and 6cm proximal
  2. Tenderness over the medial malleolus and 6cm proximal
  3. Tenderness over the navicular
  4. Tenderness over the base 5th metatarsal
  5. Cannot weight bear for more than 4 steps
  • Do not use for patients under 18
44
Q

High Ankle Sprain

A

MOI: external rotation, when foot is turned outward.
Tests: Squeeze Test and External Rotation Test

45
Q

Tendinitis VS Tendinopathy VS Tendinosis

A
  • Tendinitis: acute inflammation due to microtrauma
  • Tendinopathy: clinical syndrome of tendon pain and thickening
  • Tendinosis - chronic tendon dysfunction – degenerative changes plus ongoing attempt to adapt and heal
46
Q

Achilles Tendon Rupture

A
  • “Shot in the lower calf”
  • Gastroc/soleus will migrate proximally
  • Thompson test will be positive
  • Males more than females
  • 30-40
  • Surgery unlikely
  • Use boot walker, active PF and DF, proprioception, return to sport
47
Q

Tibialis Posterior Tendinopathy

A
  • Compressed under medial malleolus. If HYPERPRONATE can irritate: TDANH
    T: Tibialis posterior
    D: Flexor digitorum longus
    A: Posterior tibial artery
    N: Tibial nerve
    H: Flexor hallicus longus
48
Q

Meniscus Repair Treatment

A

Stage One:
ROM - knee extension, prone hangs, supine wall slides, heel slides, knee flexion off edge of bed
Strengthening - quad setting, SLR, abs
Cardio - upper body
Progress if… pain free gait, no swelling

Stage Two:
ROM - as above
Strengthening - balance and proprioception, bike, hip and core, quad strengthening
Cardio - bike, Nordic track, swimming

49
Q

Anatomy of ACL

A
  • Tibia to femur in superior, posterior and lateral direction
  • Prevents anterior translation of tibia on femur, checks lateral rotation of the tibia in flexion and will help with checking extension and hyperextension at the knee.
  • Controls rolling and gliding of the knee
  • Tears most common in the mid portion of the ligament
50
Q

Anatomy of PCL

A
  • Tibia to femur in superior, anterior and medial direction
  • Strong, fan shaped
  • Prevents posterior translation of tibia on femur and checks extension and hyperextension
51
Q

Screw Home Mechanism

A
  • Occurs at the end of knee extension
  • Medial tibial plateau articular surface is longer than lateral tibial plateau
  • Tibia is then in external rotation and in position of maximal stability
52
Q

Pes Anserine

A
  • Fluid filled bursa
  • Common insertion for:
    S: Sartorius
    G: Gracilis
    B: Bursa
    T: SemiTendinosis
53
Q

Tibial Plateau #

A
  • Proximal end of the tibia terminates in a broad, flat region called the plateau. Intercondylar eminence runs down the midline.
  • Fracture caused by strong force on lower leg while it is in valgus or varus position OR vertical stress at the same time as flexion of the knee
  • S/S: unable to WB, swelling, stiffness, hx of trauma
54
Q

Patellar #

A
  • Geniculate Arteries supply the patella
  • Could be: direct, or minor fragment fracture
    S/S: sharp intense pain in anterior knee. Often pt limp to avoid pressure through the knee and difficulty with functional activities.
55
Q

Fxn of Patella

A
  • Acts as a lever
  • Improved efficiency of extension during the last 30 degrees of extension bacause it holds the quad tendon away from the axis
  • Decrease friction of the quads
56
Q

Chondromalacia Patella

A
  • Degenerative process beginning with irritation and fragmentation if the hyaline cartilage of the patella
  • Quad exercises, SLR
  • Similar presentation to PFPS (swelling, crepitus, tight quads, etc).
57
Q

Patellar Dislocation Treatment: Education, Exercises and Prevent Re-Injury

A
  • Education: forces on knee joint, laxity of medial structure, tightness of lateral structure, weak hip abductors
  • Exercises: squats, lunge, proper tracking, clamshells, quad over roll
  • Prevent Re-Injury: muscle strengthening, stretching, avoid pivots, use brace
58
Q

Arch of the Foot: Medial Longitudinal Arch

A
  • Higher of the two arches.
  • Formed by calcaneous, talus, navicular, three cuneiforms and first three metatarsals
  • Muscle support: TA, TP, fibularis longus, flexor digitiorum longus, flexor halluses, intrinsitc foot muscles
  • Ligament support: plantar ligaments, calcaneonavicular (spring) ligamnet
59
Q

Arch of the Foot: Lateral Longitudinal Arch

A
  • Flatter of the two arches. Lies on the ground in standing position.
  • Formed by calcaneus, cuboid and 4th and 5th metatarsal
  • Muscular support: fibularis longus, flexor digititorum longus, flexor halluses and intrinisic foot muscles
  • Ligament support: plantar ligaments
60
Q

Arch of Foot: Transverse Arch

A
  • Located on the coronal plane
  • Formed at the base of the metatarsal bases, cuboid and three cuneiform bones
  • Muscular support: fibularis longus, TP
  • Ligament support: plantar ligaments, deep transverse metatarsal ligaments
61
Q

Pes Cavus: High Arch

A
  • High medial longitudinal arch
  • Decrease in shock absorption during walking which increases stress places on the ball and heel of the foot
62
Q

Pes Planus: Flat footed

A
  • Longitudinal arch has been lost
  • Arches do not develop until 2-3 years of age, meaning flat feet during infancy is normal.
63
Q

Spondylosis

A
  • Arthritis of the spine
  • Treat as degenerative joint disease
64
Q

Spondylolysis

A
  • Fracture of the pars articularis
  • Occurs most frequently at lower lumbar (L5-S1)
  • PT Treatment: avoid extension, stabilize hypermobile low back with core stability
  • Postural re-training
  • Bracing, taping
65
Q

Spondylolisthesis

A
  • Fracture of the pars, leading to anterior slippage of 1 vertebrae on another, typically at L5-S1
  • Can lead to cord compression
  • PT Treatment: avoid extension, stabilize hypermobile low back with core stability
  • Postural re-training
  • Bracing, taping
66
Q

Mechanical Low Back Pain

A
  • AM stiffness for < 40 minutes
  • Max pain/stiffness late in the day/after activities
  • Activity worsens symptoms
  • Duration can be acute or chronic
  • Age of onset 20-65 yrs
67
Q

Inflammatory Back Pain

A
  • AM stiffness for > 60 minutes
  • Max pain/stiffness early AM
  • Exercise/activity improves symptoms
  • Duration is chronic
  • Age of onset 12-40 yrs
68
Q

Pregnancy: Overview

A
  • 20-30lb weight gain
  • Postural changes: COG is anterior and upwards, increase lordosis, anterior pelvic tilt, increase foot pronation, ligament laxity
69
Q

Pregnancy: Absolute and Relative CI’s to Exercise

A

Absolute:
- Restrictive lung disease
- Multiple gestation with risk of preterm labour
- Persistent 2nd or 3rd trimester bleeding
- Placenta previa after 26 weeks of gestation
- Pregnancy-induced hypertension
- Reptured membranes

Relative:
- Diabetes
- Thyroid disease
- History of preciptious labour

70
Q

Pregnancy: Exercise Guidelines

A
  • Safe level of exertion during exercise = 60-70% HRmax
  • Do not exceed 140bpm
  • HR measured at peak activity
  • Maternal core temp should not exceed 38 degrees
  • Avoid deep flexion and extension of joints
  • Use RPE
71
Q

Pregnancy: Positioning

A
  • LEFT SIDE LYING to improve circulation to the fetus (decrease pressure on vena cava)
  • In side lying, can use pillow between legs to support SI joint
  • In supine, do high Fowlers
72
Q

Pregnancy: Cesarean Exercise

A
  • No lifting 10-15lbs for 6 weeks
  • No core exercises (except TA and PF for 6 weeks)
  • TENS for incision pain
  • Deep breathing
  • Pelvic floor exercises
  • Ambulation
  • Prevent incisional pain
73
Q

Diastatis Recti Abdominis

A
  • Seperation of rectus abdomens muscle at the line alba >2.5cm or 2 fingers is significant
  • Can result in back pain
    ~50% incident rate
  • May see abdominal bulge/doming
  • Recovery 2-6 months or longer
74
Q

How to Test for Diatatis Recti

A
  • One hand on pt belly with fingers at, below and above navel in horizontal orientation
  • Ask pt to bring head up OR raise leg off plinth
  • Palpate for seperation
75
Q

Diatatis Recti: PT Treatment

A
  • Education
  • Body mechanics
  • Movement patterns
  • Core exercises: TA, PF, multifidus, diaphragm
  • DO NOT perform sit ups, straight leg raise
  • External supports: kinesiotape/abdominal binder
76
Q

Placenta Previa

A
  • Placenta is in a position below the fetus
  • Continue with pelvic floor and breathing exercises
77
Q

Pre/Post Pregnancy Conditions: Pelvic floor disorders

A

Common Features:
- Due to stretching, can lead to organ prolaps of bladder into vagina, rectum into vagina or uterus into vagina

Management:
- Pelvic floor exercises
- Postural re-education
- Women’s health PT

78
Q

Pre/Post Pregnancy Conditions: Postural Low Back Pain/Pelvic Gridle Pain

A

Common Features
- ‘Hang’ off ligaments - poor posture
- Muscle imbalances
- Gait: waddling, shuffling, dragging limb

Management:
- Education on balance activity with rest
- Address movement patterns (squatting and lifting)
- Exercises for stabilization
- Muscle techniques and massage

79
Q

Pre/Post Pregnancy Conditions: SI Joint Dysfunction

A

Common Features:
- Buttock pain that may radiate down leg
- Pain with walk, sit and stand
- Tests: Posterior pelvic pain provocation test, cluster

Management:
- TA and multifidus strengthening
- External stabilization (SI belt)
- No single leg stance WB
- Joint protection strategies

80
Q

Pre/Post Pregnancy Conditions: DeQuervain’s/Carpel Tunnel

A

Common Features:
- Temporary because of fluid retention/hormone changes and poor lifting technique
- Strains AbPL and EPB

Management:
- Education
- Ice
- Stretches
- Correct body mechanics
- Splints
- Self limiting

81
Q

Pre/Post Pregnancy Conditions: Urinary Incontinence

A
  • Increased risk with vaginal delivery and prolapse risk if baby >4500g
  • Up to 8-% have perineum damage

Management:
- Pelvic floor exercises and functional recruitment of pelvic floor
- Posture and body mechanics

82
Q

Pre/Post Pregnancy Conditions: Varicose Veins

A

Common Features
- Heaviness, dull pain, ache in legs with standing/walking

Management
- Compression stockings
- Circulation exercises (ankle pumps)
- Posture and positioning

83
Q

Pre/Post Pregnancy Conditions: Gestational Diabetes

A

Common Features
- Abnormal glucose reading in pregnancy
- Can be severe for mom and baby

Management
- Diet, insulin and exercise to achieve euglycemia
- 20 minute walks post meals

84
Q

Pre/Post Pregnancy Conditions: Direct Hernia

A

Location:
- Superior to the inguinal ligament but behind inguinal ring
- Accounts for 2/3 of hernias

S/S:
- Usually painless
- Reduces when person lies supine
- Round swelling near pubis in area of deep inguinal ring

85
Q

Pre/Post Pregnancy Conditions: Indirect Hernia

A

Location:
- Contained sac protrudes through the deep inginal ring
- Tissue can stay contained or pass into scrotum or labia

S/S: pain with straining, may decrease as someone lies supine, swelling that increases as intraabdominal pressure rises

86
Q

Pre/Post Pregnancy Conditions: Sports Hernia

A
  • Deep, sharp pain in the groin or lower abdominal region that can radiate to the proximal thigh, low back, lower abdominal muscles, peroneum or scrotum
  • Unilateral groin pain, relieved by rest and returns with activity

Physio (11 decks)

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