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Review of year 1 material Flashcards

1
Q

Manipulation is a _______ velocity technique.

A

High

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2
Q

Mobilization is a _______ velocity technique

A

Low

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3
Q

Distraction is a form of ?

A

traction

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4
Q

Mobilization principles

A
  • hands close to the joint line
  • patient comfortable?
  • therapist comfortable? (table height, joints in neutral)
  • position joint (open packed, end range)
  • keep arms in line with the direction of force
  • stabilize (proximal bone usually)
  • continually assess patient’s tolerance/response
  • if the patient isn’t relaxing, ask yourself what you can do to make them relax more
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5
Q

Lumbar tests

A
  • passive supine SLR
  • crossed supine SLR
  • slump (seated SLR)
  • femoral nerve tension test
  • spring test
  • prone instability test
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6
Q

SIJ tests (4)

A
  • SI distraction
  • SI compression
  • thigh thrust (posterior shear test)
  • sacral thrust (spring test)
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7
Q

Screening: tests of function (4)

A
  • chair stand
  • squat
  • single leg stance
  • back bending
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8
Q

Screening: active motion testing (5)

A
  • flexion/extension
  • lateral flexion
  • rotation
  • repeated movements
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9
Q

Things to watch for when testing active motion

A
  • symptoms
  • deviations
  • limitations of movement
  • curve reversal
  • rhythm
  • compensatory movement
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10
Q

Contraction of what muscle facilitates pelvic floor contraction?

A

TR

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11
Q

What two muscles might atrophy post lumbar surgery?

A

Multifidi

TRA

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12
Q

When would you perform dynamic lumbar stabilization with a patient?

A
  • hypermobile people who are symptomatic

- people with a fracture to promote stabilization

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13
Q

What is lumbar spinal stenosis?

A

Narrowing of the skeletal canal

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14
Q

Symptoms of lumbar spinal stenosis

A
  • loss of sensation
  • weakness
  • reflex changes
  • balance deficit from decreased nerve function
  • pain with extension like reaching overhead
    • relief with flexion, sitting, recumbence*
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15
Q

Clinical picture of spinal stenosis patient

A
  • 30’s 40’s: long history of low back pain
  • 50’s: generally asymptomatic
  • 60’s: slow onset, feels like leg pain but is actually compression. can’t walk or stand long due to upright posture. numbness, paresthesia, weakness. LE symptoms predominate back pain, if any.
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16
Q

Symptoms of neurogenic claudication

A
  • absent peripheral pulse (nerve compression affects blood circulation)
  • ischemic signs in calves (pain, paresthesia, cramping)
  • cauda equina symptoms (incontinence, saddle paresthesia, gait imbalance due to inability to coordinate muscle activity)
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17
Q

Spine diameter

A

C: 17-18mm
T: 12-14mm
L: 15-17mm

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18
Q

Interventions for stenosis

A
  • flexion: knees to chest, drape over a swiss ball
  • Neurontin: decreases nerve excitability
  • laminectomy: cutting away bone and cleaning out
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19
Q

Spondylosis is…

A

spinal arthritis

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20
Q

Spondilolysis…

A

defect or fracture of vertebrae (typically pars, located between facets)

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21
Q

Spondylolysthesis…

A

vertebrae shifted out of normal position

Grades: fraction of body slipped
I: up to 1/4
II: 1/4 to 1/2
III: 1/2 to 3/4
IV: 3/4 to full
V: complete
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22
Q

Symptoms of spondylolisthesis

A

pain with palpation

flexion (midrange) feels good

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23
Q

Symptoms of clinical lumbar instability

A
  • “catch in the back”
  • Gower’s sign
  • reversal of LP rhythm
  • pain moving into flexion
  • pain returning from flexion
  • clunking feeling or giving way
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24
Q

Treatment for clinical lumbar instability

A

core exercise in neutral spine

  • NSAIDS
  • lumbar fusion
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25
Q

Lateral shift is named for…

A

the direction the shoulders move

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26
Q

The upper body shifts _______ from pain in lateral shift.

A

away from the pain

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27
Q

Correction of lateral shift _______ intensity and causes _________.

A

increases intensity

centralization of symptoms

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28
Q

After correction of lateral shift, one should avoid…

A

flexion

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29
Q

Classifications of instability (5)

A 
stabilization
manipulation
specific exercise (flexion or extension biased)
traction
lateral shift
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30
Q

Factors for stabilization

A 
younger
\+ prone instability test
aberrant motions
greater SLR ROM
Spring test hypermobility
increasing episode frequency
3+ episodes
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31
Q

Factors against stabilization

A

discrepancy in SLR ROM of >10 degrees

low FABQ scores

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32
Q

Factors for manipulation

A

onset of pain

33
Q

Factors against manipulation

A

leg symptoms
no pain with spring test
increasing episode frequency
peripheralization with motion testing

34
Q

Factors for specific exercise

A

strong preference for sitting/walking
centralization with motion testing
peripheralization in direction opposite to centralization

35
Q

Factors against specific exercise

A

LBP only

no change with all movements

36
Q

Red flags for referral

A 
saddle anesthesia
urinary incontinence
history of cancer
abdominal pain that is non-musculoskeletal in nature
night pain
no response to treatment
37
Q

What motion is C2 built for?

A

rotation

38
Q

What are characteristics of the atlas?

A

no body
no spinous process
lateral masses

39
Q

What are implications of DDD for movement?

A

loss of rom

fear of moving

40
Q

What are functions of the disc?

A

shock absorption
structural stability
full mobility
protection of spinal cord and axial neural tissue

41
Q

What disc is most likely to degenerate?

A

C5-6

followed by C6-7

42
Q

Radicular

A

pertains to nerve root

43
Q

Radiculitis

A

inflammation of spinal nerve

pain, paresthesia but no signs of reflex, sensory or motor change

44
Q

Radiculopathy

A

disease of the nerve root

reflex, sensory and or motor changes!

45
Q

What are classifications of disc disorders?

A

Bulge
Contained (protrusion- annulus disrupted, nucleus confined)
Extrusion (prolapse- nucleus attached to disc but outside annulus)
Sequestered (nuclear material in intervertebral canal)

46
Q

Pain in the thoracic spine is…

A

poorly localized
A or P
may follow a rib

47
Q

What ribs are true? false? floating?

A

true 1-7
false 8-12
floating 11-12

48
Q

Describe the pump handle motion

A

upper ribs
up and forward motion of sternum
axis is the frontal plane

49
Q

Describe the bucket handle motion

A

upper ribs
up and lateral motion
axis is frontal plane

50
Q

How is scoliosis named?

A

apex of the convexity

51
Q

What are tests to determine scoliosis?

A

Adam’s sign (scoliosis persists with flexion and indicates structural curvature)
xray
Cobb angle

52
Q

What are components of a T spine exam?

A 
AROM
AROM with overpressure
neuroscreen
joint mobility assessment
PROM
special tests
palpation
53
Q

What is thoracic outlet syndrome?

A

compression of neurovascular bundle between c spine and axilla

54
Q

Typical symptoms of thoracic outlet syndrome?

A

swelling or arm/hand, fatigue in UE, pain, vein distention, weakness, problems with fine motor tasks, cramps, numbness, tingling

55
Q

Potential causes of TOS?

A

congenital anomaly, postural, exostosis (cartilaginous tissue on bone), trauma, pregnancy

56
Q

What could mimic thoracic outlet syndrome?

A

anterior scalene tightness
costoclavicular approximation
pec minor tightness
cervical rib

57
Q

What is T4 syndrome?

A

like TOS plus a headache caused by thoracic hypomobility

vague complaints of back and arm pain

58
Q

Why classify with McKenzie?

A

assess intensity and location of symptoms prior, during and after

59
Q

What are the possible McKenzie classifications?

A

posture
dysfunction
derangement

60
Q

McKenzie classifications: posture

A

intermittent pain
no pathology
not referred
soft tissue stress

61
Q

McKenzie classifications: dysfunction

A 
creeping onset
pain before end range
intermittent
only referred to adherent nerve root (ANR)
adaptive shortening
62
Q

McKenzie classifications: derangement

A 
affects joint surfaces ability to move
sudden onset
pain during movement
constant pain
may refer
63
Q

Describe a McKenzie spine assessment

A 
flexion
extension
lateral bending
loading and unloading
mobility
64
Q

Peripheralization means symptoms move

A

midline to distal

65
Q

Centralization means symptoms move

A

distal to prozimal

66
Q

How does the facet orientation of the thoracic spine change from T1-T12?

A

angle of inclination increases

middle limits flexion, facilitates rotation

67
Q

What is a potential negative consequence of the natural spinal curvatures?

A

shear forces at transitions between curves

68
Q

Amount of spinal motion depends on what?

A 
soft tissue extensibility
flexibility of ligaments
force of muscles
disc displacement
fear
pain
69
Q

What region produces the most axial rotation?

A

C1-C2

70
Q

What segments produce the most sagittal plane movement?

A

C4-5
C5-6
L5-S1

71
Q

What 2 major motions are the facet joints capable of?

A

gliding up and down

72
Q

What movements open the right facet?

A

Flexion
left side bend
left rotation

73
Q

What movements open the left facet?

A

Flexion, right side bend, right rotation

74
Q

What movements close the right facet?

A

extension, right side bend, right rotation

75
Q

What movements close the left facet?

A

extension, left sidebend, left rotation

76
Q

How do you know if it’s fixed or static posture?

A

Does the posture changes with movement during mobility testing?

  • if yes, it’s static
  • if no, it’s fixed
77
Q

What are possible impairments leading to poor posture?

A

proprioception
mobility
muscle impairment
body mechanics

78
Q

What are some common faulty postures?

A 
lordosis
flat back
kyphosis
forward head
scoliosis
79
Q

Where should the line of gravity fall?

A

posterior to the hip

anterior S2, knee and ankle

Spine (6 decks)

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