Part A - Lumbar

Question 1

cardinal features of MDT

Answer 1

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

Question 2

stages of recovery

Answer 2

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

Question 3

management of injury and inflammation phase

Answer 3

protect from further damage
mid-range movements
isometric contractions

Question 4

management of repair and healing phase

Answer 4

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

Question 5

management of remodeling phase

Answer 5

full range movements

increase strength and flexibility

Question 6

contraindications for MDT

Answer 6

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

Question 7

derangement syndrome

Answer 7

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

Question 8

centralization

Answer 8

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

Question 9

centralizing

Answer 9

during the application of loading strategies (process)

Question 10

centralized

Answer 10

as a result of the application

Question 11

peripheralization

Answer 11

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

Question 12

peripheralizing

Answer 12

during the application of loading strategies (process)

Question 13

peripheralized

Answer 13

as a result of the application

Question 14

directional preference

Answer 14

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

Question 15

posterior derangement directional preference?

Answer 15

extension procedures/positions

Question 16

anterior derangement directional preference?

Answer 16

flexion procedures/positions

Question 17

right lateral shift direction?

Answer 17

the upper trunk and shoulders are shifted to the right

Question 18

left lateral shift direction?

Answer 18

the upper trunk and shoulders are shifted to the left

Question 19

contralateral shift

Answer 19

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

Question 20

ipsilateral shift

Answer 20

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

Question 21

lateral shift

Answer 21

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

Question 22

dysfunction syndrome

Answer 22

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)

Question 23

postural syndrome

Answer 23

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

Question 24

during loading

Answer 24

increase
decrease
produce
abolish
centralizing
peripheralizing
no effect

Question 25

after loading

Answer 25

``` worse not worse better not better centralized peripheralized no effect ```

Question 26

biomechanics fo intervertebral disc

Answer 26

postero-lateral annulus is weakest | anterior compression caused by flexion "squeezes" the nucleus backwards and conversely extension forces it forward

Question 27

biomechanical features of lumbar flexion

Answer 27

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

Question 28

biomechanical features of lumbar extension

Answer 28

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

Question 29

force progression

Answer 29

``` patient generated patient over-pressure therapist over-pressure (dynamic) mobilization (passive) manipulation ```

Question 30

extension principle - static (p.63-66) DEMO

Answer 30

prone lying lying prone in extension sustained extension posture correction

Question 31

extension principle - dynamic (p.67-72) DEMO

Answer 31

``` 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 ```

Question 32

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

Answer 32

``` 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 ```

Question 33

lateral principle (p.79-83) DEMO

Answer 33

self-correction of lateral shift or side gliding | *manual correction of lateral shift*

Question 34

flexion principle (p.84-87) DEMO

Answer 34

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

Question 35

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

Answer 35

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

Question 36

4 stages of derangement management

Answer 36

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

Question 37

reduction of derangement

Answer 37

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

Question 38

maintenance of reduction

Answer 38

``` regular performance of the reductive procedure postural correction (lumbar roll if relevant) ```

Question 39

recovery function

Answer 39

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

Question 40

prevention of recurrence

Answer 40

patient education

Question 41

procedure for reduction if kyphotic deformity is present

Answer 41

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

Question 42

adherent nerve root (ANR)

Answer 42

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

Question 43

key factors in the identification of pain of a chemical nature

Answer 43

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

Question 44

key factors in the identification of pain of mechanical origin

Answer 44

more commonly intermittent but may be constant | movements in one direction will improve symptoms, whereas movements in the opposite direction may worsen them

Question 45

key factors in the identification of chronic pain

Answer 45

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

Question 46

steps when monitoring mechanical response during examination

Answer 46

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

Question 47

continued displacement of collagen fibers with sustained load is called?

Answer 47

creep

Question 48

restoration of "normal" shape with unloading is called?

Answer 48

hysteresis

Question 49

which occurs more slowly, creep or hysteresis?

Answer 49

hysteresis

Question 50

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

Answer 50

adherent nerve root

Question 51

what syndrome will repeated movements have no effect?

Answer 51

postural

Question 52

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

Answer 52

force progressions

Question 53

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

Answer 53

force alternatives