Part A - Lumbar Flashcards
cardinal features of MDT
classification of sub groups centralization and directional preference self-treatment progression of forces patient education
stages of recovery
injury and inflammation - hours to days
repair and healing - days to weeks
remodeling - weeks to months
management of injury and inflammation phase
protect from further damage
mid-range movements
isometric contractions
management of repair and healing phase
gentle tension and loading w/o lasting pain (produce, no worse)
end-range movements
management of remodeling phase
full range movements
increase strength and flexibility
contraindications for MDT
serious spinal pathology cauda equina cancer cord signs infections fractures widespread neurological deficit
derangement syndrome
mechanical OBSTRUCTION of an affected joint
directional preference is an essential feature
most common syndrome
variable
always includes diminished range
loading strategies centralize or make symptoms better
centralization
phenomenon by which distal pain originating from the spine is progressively abolished in a distal to proximal direction
only occurs in derangement syndrome
centralizing
during the application of loading strategies (process)
centralized
as a result of the application
peripheralization
phenomenon by when proximal symptoms originating from the spine are progressively produced in a proximal to distal direction
peripheralizing
during the application of loading strategies (process)
peripheralized
as a result of the application
directional preference
the clinical phenomenon where a specific direction of repeated movement and/or sustained position results in a clinically relevant improvement in either symptoms and/or mechanics
not all are centralizers
posterior derangement directional preference?
extension procedures/positions
anterior derangement directional preference?
flexion procedures/positions
right lateral shift direction?
the upper trunk and shoulders are shifted to the right
left lateral shift direction?
the upper trunk and shoulders are shifted to the left
contralateral shift
symptoms are in one leg and the shift is in the opposite direction
ipsilateral shift
symptoms are in one leg and the shift is to the same side
lateral shift
onset of shift occurred with back pain visibly and unmistakably shifted unable to correct shift voluntarily correction affected intensity of symptoms correct in weightbearing
dysfunction syndrome
present for at least 8-12 weeks
pain is always intermittent and produced only when loading structurally impaired tissue
pain only produced at limited end-range
symptoms cease when loading is ended and the pain never lasts (produce, no worse)
pain is always local except in the case of an adherent nerve root (ANR)
postural syndrome
no pathological changes prevalence is high in students most common provocative posture is slumped sitting posture correction abolishes no loss of movement repeated movements have no effect pain only on static loading
during loading
increase decrease produce abolish centralizing peripheralizing no effect
after loading
worse not worse better not better centralized peripheralized no effect
biomechanics fo intervertebral disc
postero-lateral annulus is weakest
anterior compression caused by flexion “squeezes” the nucleus backwards and conversely extension forces it forward
biomechanical features of lumbar flexion
intervertebral disc is compressed anteriorly and the posterior annulus is stretched
causes a posterior displacement of the nucleus pulposus
biomechanical features of lumbar extension
intervertebral disc is compressed posteriorly and the anterior annulus is stretched
causes an anterior displacement of the nucleus pulposus
force progression
patient generated patient over-pressure therapist over-pressure (dynamic) mobilization (passive) manipulation
extension principle - static (p.63-66)
DEMO
prone lying
lying prone in extension
sustained extension
posture correction
extension principle - dynamic (p.67-72)
DEMO
extension in lying (w/patient OP) extension in lying w/clinician OP extension in lying w/belt fixation extension mobilization extension manipulation extension in standing slouch-overcorrect
extension principle - lateral component (p.73-78)
DEMO
extension in lying w/hips off center extension in lying w/hips off center w/clinician OP (sagittal or lateral) extension mobilization w/hips off center rotation mobilization in extension rotation manipulation in extension
lateral principle (p.79-83)
DEMO
self-correction of lateral shift or side gliding
manual correction of lateral shift
flexion principle (p.84-87)
DEMO
flexion in lying
flexion in sitting
flexion in standing
flexion in lying w/clinician OP
flexion principle w/lateral component (p.88-91)
DEMO
flexion in step standing
rotation in flexion
rotation mobilization in flexion
rotation manipulation in flexion
4 stages of derangement management
reduction of derangement
maintenance of reduction
recovery of function
prevention of recurrence
reduction of derangement
identification of treatment principle
regular performance of self-management exercise until all symptoms are abolished and both range and function are full restored
maintenance of reduction
regular performance of the reductive procedure postural correction (lumbar roll if relevant)
recovery function
reintroduce normal movements in all directions following successful reduction
all movements must be made full range and pain-free
rarely required in anterior derangement
prevention of recurrence
patient education
procedure for reduction if kyphotic deformity is present
sustained extension is required as time is a factor
initiate reduction by accommodating the deformity w/use of pillows
never add lateral force
adherent nerve root (ANR)
consistent activities produce symptoms
leg pain does not persist when movement has ceased
flexion in standing is restricted and consistently produces leg pain or tightness at end-range
no rapid reduction or abolition of symptoms
aim is to remodel scar tissue surrounding nerve root
after remodeling, teach derangement prevention
key factors in the identification of pain of a chemical nature
constant pain
swelling, redness, heat, tenderness
no movement found which abolishes, centralizes, or makes the pain better
lasting aggravation of pain by all movements
key factors in the identification of pain of mechanical origin
more commonly intermittent but may be constant
movements in one direction will improve symptoms, whereas movements in the opposite direction may worsen them
key factors in the identification of chronic pain
may be influenced by non-mechanical factors
the link to the original tissue damage may become minimal
there may be neurophysiological, psychological or social factors
length of time symptoms have been present does not mean a mechanical assessment should be withheld
steps when monitoring mechanical response during examination
establish symptoms present prior to testing
ask about pain response during the movement (PDM or ERP)
establish symptoms after testing
continued displacement of collagen fibers with sustained load is called?
creep
restoration of “normal” shape with unloading is called?
hysteresis
which occurs more slowly, creep or hysteresis?
hysteresis
during repeated movements in dysfunction syndrome, the only time distal symptoms will be produced is with?
adherent nerve root
what syndrome will repeated movements have no effect?
postural
what should be considered when symptoms remain unchanged following a procedure?
force progressions
what should be considered if a procedure results in the worsening or peripheralization of symptoms?
force alternatives
