Part C - Advanced Lumbar Spine & Extremities (Lower Limb) Flashcards
at the completion of the history you should have a hypothesis on?
location
classification
direction
force
list 3 baselines you can identify in the physical exam
mechanics
symptoms
functional
how can you determine that you are at end range?
feels like a strain
terms used for recording during the repeated movements?
produce centralizing peripheralizing increase decrease abolish
terms used for recording after the repeated movements?
no worse no better worse better peripheralized centralized
words which indicate a “red” light?
worse
peripheralized
words which indicate a “green” light?
better
centralized
words which indicate an “amber”/”yellow” light?
no worse
no better
no effect
list 3 things centralization determines
classification
direction
prognosis
what criteria allow us to make the mechanically inconclusive classification?
no position or lasting improvement
what does a mechanically inconclusive classification indicate regarding prognosis?
highly variable
describe the worse section for a typical posterior derangement
flexion
prolonged sitting
describe the better section for a typical posterior derangement
stand
walk
move
describe the worse section for a typical anterior derangement
extension
prolonged standing
describe the better section for a typical anterior derangement
flex
sit
what is the typical pattern of movement loss in an anterior derangement?
flexion
what is the “provocation test” for anterior derangement?
sustained extension
what percentage of spinal patients are able to be classified as dysfunction?
~5%
what factors contribute to the percentage of dysfunction patients?
surgery previous derangements trauma men > women >55 y/o
what analogies might be effective when education patients?
disc model
jelly donut
knuckle papercut
how can we achieve commitment by the patient?
non-invasive
demo change w/posture
involve patient in cause/effect
an end-range response of decreased or abolish, but no better indicates what?
increase force
increase frequency
an end-range response of increased, no worse indicates what?
apply over-pressure
increase reps
add sustained
an end-range response of increase or produce, remains worse indicates what?
wrong direction
wrong classification
what clues suggest more time is required for reduction to occur?
lack of motion
what clues in the history and the physical exam suggest the presence of a relevant lateral component?
visual shift
asymmetrical symptoms
lateral movements affect pain
deviation in sagittal plane
if relevant lateral component is present how does it alter management?
avoid turning/twisting
sleep position
how is maintenance of the reduction accomplished?
compliance
good posture
reincorporate provocative movement
why is recovery of function important?
prevent dysfunction
prevent future derangements
ensure full reduction
why is prophylaxis important?
minimize recurrences
self manage future recurrences
when do we apply clinician procedures?
exhausted patient over-pressure
sitting at “yellow” lights
no better
clinician procedures can be used to confirm?
direction
reduce derangement or expose dysfunction
when would you consider a force alternative?
exhausted one plane of motion
worse symptoms
symptoms plateau
aims of taking the history are?
provisional classification stage of the disorder functional limitations serious pathologies guide the physical exam baseline measurements
what portion of the history section justifies need for PT to insurance companies?
functional disability from present episode
what are the “yellow” flags to recovery barriers?
attitudes/beliefs
reduced level of activity
looking for a diagnosis
emotions
what are the “black” flags to recovery barriers?
family influences
what are the “blue” flags to recovery barriers?
work influences
what are the “orange” flags to recovery barriers?
psychosis - disconnect from reality
serious spinal pathology
cancer
cauda equina syndrome
tests may be used to detect a sacroiliac source of low back pain once a…?
McKenzie evaluation has ruled out the lumbar spine
list 5 SIJ provocation tests
distraction or "gapping" posterior shear or "thigh thrust" compression sacral thrust pelvic torsion
distraction or “gapping”
patient lying supine
the therapist applies pressure to both ASIS’s
the force is directed posteriorly and laterally
posterior shear or “thigh thrust”
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
compression
patient lying on side
the therapist applies pressure to the uppermost iliac crest
the force is directed towards the opposite iliac crest
sacral thrust
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
pelvic torsion or “Gaenslen’s test”
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
SI joint pain history
asymmetrical symptoms that do not cross midline female > men below L5 young (18-45 y/o) athletic MOI
use what 2 movements to assess directional preference and for self-treatment of SI joint pain?
posterior rotation SIJ
anterior rotation SIJ
articular dysfunction
intermittent pain consistently produced at a restricted end-range with no rapid change of symptoms or range
contractile dysfunction
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
hip derangement percentage?
53% extension responders
knee derangement percentage?
90% extension responders
ankle derangement percentage?
75% dorsiflexion responders
“target zone”
the point in the arc of movement that provokes pain or where pain is at its max (contractile dysfunction)
what has been shown to be useful in the rehab of chronic tendon problems?
eccentric loading
