Spinal Conditions

Question 1

Because of ___ we don’t see a lot of anterior disc herniations

Answer 1

ALL

Question 2

The IVF is mechanically maintained by the ____ of the disc

Answer 2

height

Question 3

Any thickening of the ____ joint = comprised IVF space

Answer 3

facet

Question 4

________ corner of vertebrae = most common area of disc lesions

Answer 4

posterolateral

Question 5

Extension = IVF is made _____, ____ glide of the facet joint

Answer 5

smaller; inferior

Question 6

Flexion = IVF made _____, _____ glide of the facet joint

Answer 6

larger, superior

Question 7

S/S of nerve compression depend upon degree of ______

Answer 7

compression

Question 8

3 S/S of nerve compression?

Answer 8

1. pain
2. tingling
3. numbness

Question 9

Clinical presentation of LOSS of nerve conduction?

Answer 9

Changes in …

1. reflexes
2. myotomes
3. dermatomes

Question 10

Clinical presentation of LOSS of neural mobility?

Answer 10

1. • femoral nerve stretch test

2. + SLR

Question 11

The nucleus pulposis moves in the (same/opposite) direction that the disc moves.

Answer 11

OPPOSITE

Question 12

We need an intact _____ for normal biomechanics

Answer 12

annulus

Question 13

With a disc herniation, pt’s may present with a ______ shift away from the painful side

Answer 13

lateral

Question 14

How to treat disc injury?

Answer 14

fix lateral shift WITHOUT causing any leg pain!!!

Question 15

With a disc lesion, there will be ____ LBP +/- referred pain to _____ or down ____

Answer 15

central; buttock; leg

Question 16

Pt’s with a disc lesion may present with loss of normal _____

Answer 16

lordosis

Question 17

Why do pts with disc lesions present with loss of normal lordosis?

Answer 17

because they are trying to increase the IVF space by flexing

Question 18

Disc lesions are often aggravated by _____ postures such as sitting and bending forward

Answer 18

flexion

Question 19

Disc lesions are often aggravated by ____ or _____.

Answer 19

coughing; sneezing

Question 20

The lateral shift seen in pts with disc lesions is always named for what the _____ are doing relative to the _____.

Answer 20

shoulders; pelvis

Question 21

What are 4 positions that increase intradiscal pressure?

Answer 21

1. sitting, leaning forward
2. sitting
3. standing, leaning forward
4. standing

Question 22

Once you restore a pt’s extension, they cannot go into a _____ posture for a set period of time!

Answer 22

flexed

Question 23

3 exercises to restore extension?

Answer 23

1. standing back extensions with hands on low back
2. cobra
3. cat cow (progression)

Question 24

4 activities that increase intradiscal pressure?

Answer 24

1. cough/sneeze
2. valsalva
3. breath holding
4. bearing down

Question 25

5 positions that decrease intradiscal pressure?

Answer 25

1. lying down. knees supported 2. sidelying 3. lying prone 4. standing, one leg on step 5. sitting, lumbar support maintaining lordosis

Question 26

5 steps for treating disc lesions?

Answer 26

1. centralise pain 2. correct shift 3. support lordosis 4. educate pt re specific postures 5. avoid flexed postures

Question 27

Always monitor ______ signs in pts with disc lesions, and refer if they worsen

Answer 27

neurological

Question 28

Refer pt's with disc lesions immediately if any ____ or ___ involvement

Answer 28

bowel; bladder

Question 29

In pt's with disc lesions, avoid any positions that ______ the symptoms

Answer 29

peripheralize

Question 30

In pt's with disc lesions, avoid any exercise or activity that increase ______ ______

Answer 30

intradiscal pressure

Question 31

2 investigations that may be used for disc lesions?

Answer 31

1. X-Rays | 2. MRI/CT scan

Question 32

How long should you avoid flexed postures for a pt with a disc lesion?

Answer 32

dependent on the pt!!!!

Question 33

For a pt with a disc lesion, when should you introduce flexion type positions and exercises?

Answer 33

for a soft tissue injury, give at least 6 weeks, but again dependent on pt presentation

Question 34

Stenosis = _____

Answer 34

narrowing

Question 35

Spinal stenosis = usually ______ pt, with previous Hx of ____

Answer 35

older; LBP

Question 36

With spinal stenosis, pain can be both _____ and radiate ______ into both legs and feet

Answer 36

central; bilaterally

Question 37

Will X-rays show any signs of spinal stenosis?

Answer 37

YES bc of bony changes (think bone spurs, facet degeneration, DDD, etc.)

Question 38

What positions aggravate pain in pt's with spinal stenosis? Relieve?

Answer 38

``` Aggravate = positions that decease the IVF (standing, walking) Relieving = positions that increase the IVF (sitting, standing, leaning forward) ```

Question 39

3 Rx's for spinal stenosis?

Answer 39

1. avoid positions of extension (decrease IVF) 2. Educate re positions that increase the IVF and pacing of activities 3. address muscle imbalances esp abdominal strength and hamstring flexibility

Question 40

4 further investigations for someone with spinal stenosis?

Answer 40

1. X-ray 2. MRI/CT scan 3. specialist referral 4. list an objective measure of worsening that could warrant specialist referral

Question 41

________= forward slippage of one vertebra on the other

Answer 41

spondyloslisthesis

Question 42

Spondylolisthesis ______ IVF

Answer 42

DECREASES

Question 43

Grade I spondy?

Answer 43

0-25%

Question 44

Grade II spondy?

Answer 44

25-50%

Question 45

Grade III spondy?

Answer 45

50-75%

Question 46

Grade IV spondy?

Answer 46

75-100%

Question 47

Spondy = ______ pars

Answer 47

elongated

Question 48

Spondylolisthesis can be diagnoses at any age (T/F).

Answer 48

TRUE

Question 49

_______ activities are a common cause of spondy

Answer 49

hyperextension

Question 50

Where is the pain in pt's with a spondy?

Answer 50

central LBP + - referred pain

Question 51

_________ is associated with weak abdominal muscles +/- tight hamstrings

Answer 51

spondy

Question 52

Spondy = aggravated by ______ postures, relieved by ______

Answer 52

extension; flexion

Question 53

There (is/is not) radiological evidence of spondy

Answer 53

IS

Question 54

5 steps in Rx of spondy?

Answer 54

1. address lower quadrant imbalance 2. focus on abdominal strengthening 3. education 4. biomechanical counselling 5. avoid hyperextension activities

Question 55

With spondy, specialist usually not warranted unless worsening neurological signs or significant increase in slippage (T/F).

Answer 55

TRUE

Question 56

Optimum L spine posture supports the normal lumbar ______

Answer 56

lordosis

Question 57

Postural back pain = not specifically caused by flexed or extended postures (T/.F).

Answer 57

TRUE

Question 58

Postural back pain = worse in am, better at night (T/F).

Answer 58

FALSE; the way around

Question 59

Postural back pain = often associated with decreased _______

Answer 59

fitness

Question 60

There may be neurological S/S with postural back pain (T/F).

Answer 60

FALSE; NO NO NO

Question 61

Postural back pain = due to increased strain on ______ and reduced endurance of postural muscles because they're not in an ______ position

Answer 61

tisses; advantageous

Question 62

There is no need to do further investigations for postural back pain (T/F).

Answer 62

TRUE

Question 63

5 Rx steps for postural back pain?

Answer 63

1. address posture / ergonomics for work / studying 2. address muscle imbalance. specific muscle weakness and tightness 3. address fitness issue 4. add spinal supports as indicated 5. educate includes rest postures / breaks

Question 64

Flexion or extension Treatment: postural back pain?

Answer 64

can do either

Question 65

Flexion or extension Treatment: disc pathology

Answer 65

extension when acute; progress to to flexion

Question 66

Flexion or extension Treatment: spondy

Answer 66

flexion + core stability

Question 67

Flexion or extension Treatment: spinal stenosis

Answer 67

flexion; will never progress to extension activities

Question 68

X-Ray required only where the need to know status of ____ ____ exceeds the radiation risk

Answer 68

bone health

Question 69

MRI/CT scan indicated where worsening ________ signs and where ______ is likely an option, failure to respond to treatment

Answer 69

signs; Sx