MSK- Lumbar Flashcards
What is the purpose of the Slump test?
Detects adverse nerve root tension
What is the purpose of the SLR (Lasegue) test?
It aims to assess for lumbosacral nerve root irritation.
What are the ranges for a positive SLR test?
Less than 30• : not a positive test. Slack of sciatic.
Between 30-70• : considered a positive test with reproduction of symptoms
Above 70• : not considered a positive test ( due to other structures involved)
What is the “crossover sign” for SLR?
Indicates a large disc bulge ( protrusion)
Occurs when performing a SLR, on the unaffected side, the pt experiences pain in the affected leg.
What is the relief position for someone with spinal stenosis?
Flexion- bc it opens intervertebral foramen
What is a worse position for someone with spinal stenosis?
Extension - bc it closes the intervertebral foramen
What are the signs /symptoms for spinal stenosis?
Low back pain
Possible b/l numbness and tingling
Pain in b/l legs
Pain decreases as the morning progresses
Repetitive motion cause pain
Chronic pain w acute episodes
What is the Bicycle test for?
For neurogenic claudication. Indicative of spinal stenosis
What are some differences between neurogenic and intermittent claudication?
Neurogenic: nerves are getting compressed
Gets better w spine flexion
Onset: typically immediated
Pain characteristics: burning or tingling
Intermittent: caused due to ischemia ( decreased blood flow to the area)
Gets better w rest ( not position dependent)
Onset: gradually increases w activity
Pain characteristics: cramping
What are some interventions for spinal stenosis?
Flexion based exercises and positioning
( cycling)
Traction
Aerobic exercs
Surgical: laminectomy
What is laminectomy? What is a contraindication for position on the “protection phase ( 1week)?
Laminectomy: spinal decompression
Contraindication: pt is not supposed to rotate during transfers , on the protection phase.
Pt is encouraged to log roll.
What is the mechanism of injury for Postero lateral disc herniation?
Flexion
What are some interventions for Postero lateral disc herniation?
Typically prefer extension based exercise and mov such as repeated extensions in prone
Traction
Lumbar stabilization exercs : with core activation/ brace
What are some interventions for anterior bulge disc herniation?
Flexion based exercs
What is the main characteristic of pelvic crossed syndrome?
Imbalance patterns wich promotes increased lumbar lordosis
What is Spondylosis?
Normal age related changes
“arthitis in the spine”
What is Spondylolysis?
Stress type of fracture. It’s a repetitive stress injury
What is spondylolisthesis?
Stress fracture and slinding of the vertebra (forward)
What is retrolistheses?
Backward displacement of one vertebra on another
How are the grades for spondylilisthesis?
Grade 1: less then 25% slippage
Grade 2: 25% -50% slippage
Grade 3: 50% -75% slippage
Grade 4: more then 75% slippage
Grade 5: 100% slippage
What are the treatments for spondylolisthesis based on their grades?
Grades 1-2-3: core strengthening exercs
Grades 4-5: will need fixation
What is a common sign on the x ray for spondylolisthesis?
Scotty dog with collar sign
Scotty dog with decapitation sign
What is some
Interventions for spondylolisthesis?
Inner core stability exercises
Education regarding avoiding aggravating movements (extension)
What is contraindicated on spondylilisthesis?
Manipulation
What are some contraindications for laminectomy or fusion on the Maximum protection phase?
No heavy lifting more than 5-10 lbs for up to 3 months
Extension exercs ( pt that had a laminectomy)
Log roll for a week
Do not sit for more than 20-30min continuously for 2ws
Dont push,pull or lift
What is Cauda equina syndrome?
What are some signs/symptoms of Cauda equina syndrome?
Damage to cauda equina( nerve roots below L1)
Loss of bowel and bladder control
B/l leg pain
Saddle paresthesia. (Numbness or different sensations in the backs of your legs, butt, hip and inner thighs (your saddle area, as in the parts of your body that would touch the saddle if you were on a saddled horse)
What are some signs and symptoms for Malignancy?
Previous history of CA
Unexplained weight loss
Constant unrelenting pain
Pain unrelieved by rest
Pain worsens at night
Night sweats
Failure to improve w conservative therapy within one month
To test patellar reflex…
L3-4
To test achilles reflex…
S1-2
Shopping cart sign
Relief from symptoms when leaning forward over the shopping cart, while shopping. often seen in a pt w lumbar spinal stenosis
Which dermatome covers the great toe?
L4
Laminectomy
Removal of lamina to make room to relieve compression on nerve roots and spinal cord
Cause of neurogenic claudication
Nerve root compression due to lateral stenosis
Slump test procedure
Therapist instructs the pt to place hands behind back, go into a slump posture( w rounded shoulders) and bring chin to their chest
Therapist passively extends the uninvolved knee then repeats the test on the involved le.
If symptoms have not been reproduced ankle df is added
If symptoms of low back pain/radiating pain in post leg are recreated,ask pt to ext their neck while maintaining a rounded back
Positive slump test findings
Relief of symptoms when pt extends neck indicates neural tension/restriction of lumbosacral roots
Which dermatome goes over the patella?
L4
You suspect the patient may be presenting with sign of the buttock. Which of the following correctly describes underlying pathologies associated with sign of the buttock?
a. Rheumatic bursitis, osteomyelitis of the femur, neoplasm of the upper femur, ischiorectal abscess.
b. Fractured sacrum, osteomyelitis of the tibia, neoplasm of the tibia, ischiorectal abscess.
c. Septic sacroilitis, gluteal bursitis, rectal cancer.
d. Ischiorectal abscess, rheumatic bursitis, rheumatoid arthritis or osteoarthritis, neoplasm of the upper femur.
A
A physiotherapist is training a patient with spasticity of lumbar extensors, notices that the patient tends to extend the trunk quite often.
The physiotherapist decides to rectify this by promoting excess anterior tilt at the pelvis.
Which of the following can be done in order to do so?
A) Pelvic positioner angled at 45° to the seat
B) Decrease the seat width by 1 inch on both sides
C) Pelvic positioner angled perpendicular to the seat
D) Provide knee blocks anteriorly to free pelvis
C
A middle aged man is referred to your clinic for persistent hip and buttock pain. The patient is acute and irritable.
You perform a mobilization to increase hip flexion. Select the most appropriate treatment:
a. Rest and ice as the patient is acuterand irritable.
b. Oscillation or grade 1 posterior glide with hip in 30 degrees of flexion, 30 degrees of abduction and slight external rotation.
c. Oscillation or grade 1 anterior glide with hip 30 degrees of flexion, 30 degrees of abduction and slight external rotation.
d. Oscillation or grade 1 posterior glide with hip in 10 degrees of flexion, 10 degrees of abduction and neutral rotation.
B
• When the joint is acute or irritable, oscillations or grade 1 mobilizations are appropriate.
According to the convex/concave rule, to increase hip flexion, you would want to perform a posterior glide. You would perform the mobilization in the open pack position of the hip - 30 degrees of flexion, 30 degrees of abduction and slight external rotation.
A fracture is a contraindication to all of the following except:
a. Resistance exercises in the area.
b. Grade 1 joint mobilizations.
c.Flexion exercises in spondylolisthesis.
d. Rib springing
C
• Spondylolisthesis is a fracture of the pars leading to anterior slippage of one vertebrae on another. Without treatment, this can lead to cord compression. Extension is contraindicated NOT flexion when a spondylolisthesis is present.
