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McKenzie Institute > Part C - Advanced Lumbar Spine & Extremities (Lower Limb) > Flashcards

Part C - Advanced Lumbar Spine & Extremities (Lower Limb) Flashcards

1
Q

at the completion of the history you should have a hypothesis on?

A

location
classification
direction
force

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2
Q

list 3 baselines you can identify in the physical exam

A

mechanics
symptoms
functional

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3
Q

how can you determine that you are at end range?

A

feels like a strain

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4
Q

terms used for recording during the repeated movements?

A 
produce
centralizing
peripheralizing
increase
decrease
abolish
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5
Q

terms used for recording after the repeated movements?

A 
no worse
no better
worse
better
peripheralized
centralized
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6
Q

words which indicate a “red” light?

A

worse

peripheralized

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7
Q

words which indicate a “green” light?

A

better

centralized

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8
Q

words which indicate an “amber”/”yellow” light?

A

no worse
no better
no effect

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9
Q

list 3 things centralization determines

A

classification
direction
prognosis

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10
Q

what criteria allow us to make the mechanically inconclusive classification?

A

no position or lasting improvement

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11
Q

what does a mechanically inconclusive classification indicate regarding prognosis?

A

highly variable

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12
Q

describe the worse section for a typical posterior derangement

A

flexion

prolonged sitting

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13
Q

describe the better section for a typical posterior derangement

A

stand
walk
move

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14
Q

describe the worse section for a typical anterior derangement

A

extension

prolonged standing

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15
Q

describe the better section for a typical anterior derangement

A

flex

sit

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16
Q

what is the typical pattern of movement loss in an anterior derangement?

A

flexion

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17
Q

what is the “provocation test” for anterior derangement?

A

sustained extension

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18
Q

what percentage of spinal patients are able to be classified as dysfunction?

A

~5%

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19
Q

what factors contribute to the percentage of dysfunction patients?

A 
surgery
previous derangements
trauma
men > women
>55 y/o
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20
Q

what analogies might be effective when education patients?

A

disc model
jelly donut
knuckle papercut

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21
Q

how can we achieve commitment by the patient?

A

non-invasive
demo change w/posture
involve patient in cause/effect

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22
Q

an end-range response of decreased or abolish, but no better indicates what?

A

increase force

increase frequency

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23
Q

an end-range response of increased, no worse indicates what?

A

apply over-pressure
increase reps
add sustained

24
Q

an end-range response of increase or produce, remains worse indicates what?

A

wrong direction

wrong classification

25
Q

what clues suggest more time is required for reduction to occur?

A

lack of motion

26
Q

what clues in the history and the physical exam suggest the presence of a relevant lateral component?

A

visual shift
asymmetrical symptoms
lateral movements affect pain
deviation in sagittal plane

27
Q

if relevant lateral component is present how does it alter management?

A

avoid turning/twisting

sleep position

28
Q

how is maintenance of the reduction accomplished?

A

compliance
good posture
reincorporate provocative movement

29
Q

why is recovery of function important?

A

prevent dysfunction
prevent future derangements
ensure full reduction

30
Q

why is prophylaxis important?

A

minimize recurrences

self manage future recurrences

31
Q

when do we apply clinician procedures?

A

exhausted patient over-pressure
sitting at “yellow” lights
no better

32
Q

clinician procedures can be used to confirm?

A

direction

reduce derangement or expose dysfunction

33
Q

when would you consider a force alternative?

A

exhausted one plane of motion
worse symptoms
symptoms plateau

34
Q

aims of taking the history are?

A 
provisional classification
stage of the disorder
functional limitations
serious pathologies
guide the physical exam
baseline measurements
35
Q

what portion of the history section justifies need for PT to insurance companies?

A

functional disability from present episode

36
Q

what are the “yellow” flags to recovery barriers?

A

attitudes/beliefs
reduced level of activity
looking for a diagnosis
emotions

37
Q

what are the “black” flags to recovery barriers?

A

family influences

38
Q

what are the “blue” flags to recovery barriers?

A

work influences

39
Q

what are the “orange” flags to recovery barriers?

A

psychosis - disconnect from reality

40
Q

serious spinal pathology

A

cancer

cauda equina syndrome

41
Q

tests may be used to detect a sacroiliac source of low back pain once a…?

A

McKenzie evaluation has ruled out the lumbar spine

42
Q

list 5 SIJ provocation tests

A 
distraction or "gapping"
posterior shear or "thigh thrust"
compression
sacral thrust
pelvic torsion
43
Q

distraction or “gapping”

A

patient lying supine
the therapist applies pressure to both ASIS’s
the force is directed posteriorly and laterally

44
Q

posterior shear or “thigh thrust”

A

patient lying supine
the therapist applies a posterior shearing stress to the sacroiliac joint through the femur whilst the sacrum is stabilized
excessive adduction of the hip is to be avoided as flex/add of the hip normally is uncomfortable or painful

45
Q

compression

A

patient lying on side
the therapist applies pressure to the uppermost iliac crest
the force is directed towards the opposite iliac crest

46
Q

sacral thrust

A

patient lying prone
the therapist applies pressure directly to the sacrum whilst the ilia are fixed on the treatment table
this causes an anterior force of sacrum on the ilia

47
Q

pelvic torsion or “Gaenslen’s test”

A

posterior rotation of the left ilium on the sacrum is obtained by flexion of left hip and knee whilst simultaneously the right hip is extended
overpressure is applied to force the sacroiliac joint to end range
anterior rotation of the right ilium on sacrum is performed by forcing the right thigh towards the floor

48
Q

SI joint pain history

A 
asymmetrical symptoms that do not cross midline
female > men
below L5
young (18-45 y/o)
athletic
MOI
49
Q

use what 2 movements to assess directional preference and for self-treatment of SI joint pain?

A

posterior rotation SIJ

anterior rotation SIJ

50
Q

articular dysfunction

A

intermittent pain consistently produced at a restricted end-range with no rapid change of symptoms or range

51
Q

contractile dysfunction

A

intermittent pain, consistently produced by loading the musculotendinous unit
only during movement or loading
remodeling process must affect both the tissue’s ability to contract and stretch
less predictable

52
Q

hip derangement percentage?

A

53% extension responders

53
Q

knee derangement percentage?

A

90% extension responders

54
Q

ankle derangement percentage?

A

75% dorsiflexion responders

55
Q

“target zone”

A

the point in the arc of movement that provokes pain or where pain is at its max (contractile dysfunction)

56
Q

what has been shown to be useful in the rehab of chronic tendon problems?

A

eccentric loading

McKenzie Institute (3 decks)

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