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McKenzie Institute > Part A - Lumbar > Flashcards

Part A - Lumbar Flashcards

1
Q

cardinal features of MDT

A 
classification of sub groups
centralization and directional preference
self-treatment
progression of forces
patient education
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2
Q

stages of recovery

A

injury and inflammation - hours to days
repair and healing - days to weeks
remodeling - weeks to months

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3
Q

management of injury and inflammation phase

A

protect from further damage
mid-range movements
isometric contractions

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4
Q

management of repair and healing phase

A

gentle tension and loading w/o lasting pain (produce, no worse)
end-range movements

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5
Q

management of remodeling phase

A

full range movements

increase strength and flexibility

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6
Q

contraindications for MDT

A 
serious spinal pathology
cauda equina
cancer
cord signs
infections
fractures
widespread neurological deficit
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7
Q

derangement syndrome

A

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

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8
Q

centralization

A

phenomenon by which distal pain originating from the spine is progressively abolished in a distal to proximal direction
only occurs in derangement syndrome

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9
Q

centralizing

A

during the application of loading strategies (process)

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10
Q

centralized

A

as a result of the application

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11
Q

peripheralization

A

phenomenon by when proximal symptoms originating from the spine are progressively produced in a proximal to distal direction

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12
Q

peripheralizing

A

during the application of loading strategies (process)

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13
Q

peripheralized

A

as a result of the application

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14
Q

directional preference

A

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

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15
Q

posterior derangement directional preference?

A

extension procedures/positions

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16
Q

anterior derangement directional preference?

A

flexion procedures/positions

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17
Q

right lateral shift direction?

A

the upper trunk and shoulders are shifted to the right

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18
Q

left lateral shift direction?

A

the upper trunk and shoulders are shifted to the left

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19
Q

contralateral shift

A

symptoms are in one leg and the shift is in the opposite direction

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20
Q

ipsilateral shift

A

symptoms are in one leg and the shift is to the same side

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21
Q

lateral shift

A 
onset of shift occurred with back pain
visibly and unmistakably shifted
unable to correct shift voluntarily
correction affected intensity of symptoms
correct in weightbearing
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22
Q

dysfunction syndrome

A

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)

23
Q

postural syndrome

A 
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
24
Q

during loading

A 
increase
decrease
produce
abolish
centralizing
peripheralizing
no effect
25
Q

after loading

A 
worse
not worse
better
not better
centralized
peripheralized
no effect
26
Q

biomechanics fo intervertebral disc

A

postero-lateral annulus is weakest

anterior compression caused by flexion “squeezes” the nucleus backwards and conversely extension forces it forward

27
Q

biomechanical features of lumbar flexion

A

intervertebral disc is compressed anteriorly and the posterior annulus is stretched
causes a posterior displacement of the nucleus pulposus

28
Q

biomechanical features of lumbar extension

A

intervertebral disc is compressed posteriorly and the anterior annulus is stretched
causes an anterior displacement of the nucleus pulposus

29
Q

force progression

A 
patient generated
patient over-pressure
therapist over-pressure (dynamic)
mobilization (passive)
manipulation
30
Q

extension principle - static (p.63-66)

DEMO

A

prone lying
lying prone in extension
sustained extension
posture correction

31
Q

extension principle - dynamic (p.67-72)

DEMO

A 
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
32
Q

extension principle - lateral component (p.73-78)

DEMO

A 
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
33
Q

lateral principle (p.79-83)

DEMO

A

self-correction of lateral shift or side gliding

manual correction of lateral shift

34
Q

flexion principle (p.84-87)

DEMO

A

flexion in lying
flexion in sitting
flexion in standing
flexion in lying w/clinician OP

35
Q

flexion principle w/lateral component (p.88-91)

DEMO

A

flexion in step standing
rotation in flexion
rotation mobilization in flexion
rotation manipulation in flexion

36
Q

4 stages of derangement management

A

reduction of derangement
maintenance of reduction
recovery of function
prevention of recurrence

37
Q

reduction of derangement

A

identification of treatment principle
regular performance of self-management exercise until all symptoms are abolished and both range and function are full restored

38
Q

maintenance of reduction

A 
regular performance of the reductive procedure
postural correction (lumbar roll if relevant)
39
Q

recovery function

A

reintroduce normal movements in all directions following successful reduction
all movements must be made full range and pain-free
rarely required in anterior derangement

40
Q

prevention of recurrence

A

patient education

41
Q

procedure for reduction if kyphotic deformity is present

A

sustained extension is required as time is a factor
initiate reduction by accommodating the deformity w/use of pillows
never add lateral force

42
Q

adherent nerve root (ANR)

A

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

43
Q

key factors in the identification of pain of a chemical nature

A

constant pain
swelling, redness, heat, tenderness
no movement found which abolishes, centralizes, or makes the pain better
lasting aggravation of pain by all movements

44
Q

key factors in the identification of pain of mechanical origin

A

more commonly intermittent but may be constant

movements in one direction will improve symptoms, whereas movements in the opposite direction may worsen them

45
Q

key factors in the identification of chronic pain

A

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

46
Q

steps when monitoring mechanical response during examination

A

establish symptoms present prior to testing
ask about pain response during the movement (PDM or ERP)
establish symptoms after testing

47
Q

continued displacement of collagen fibers with sustained load is called?

A

creep

48
Q

restoration of “normal” shape with unloading is called?

A

hysteresis

49
Q

which occurs more slowly, creep or hysteresis?

A

hysteresis

50
Q

during repeated movements in dysfunction syndrome, the only time distal symptoms will be produced is with?

A

adherent nerve root

51
Q

what syndrome will repeated movements have no effect?

A

postural

52
Q

what should be considered when symptoms remain unchanged following a procedure?

A

force progressions

53
Q

what should be considered if a procedure results in the worsening or peripheralization of symptoms?

A

force alternatives

McKenzie Institute (3 decks)

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