Spinal Conditions Flashcards
Because of ___ we don’t see a lot of anterior disc herniations
ALL
The IVF is mechanically maintained by the ____ of the disc
height
Any thickening of the ____ joint = comprised IVF space
facet
________ corner of vertebrae = most common area of disc lesions
posterolateral
Extension = IVF is made _____, ____ glide of the facet joint
smaller; inferior
Flexion = IVF made _____, _____ glide of the facet joint
larger, superior
S/S of nerve compression depend upon degree of ______
compression
3 S/S of nerve compression?
- pain
- tingling
- numbness
Clinical presentation of LOSS of nerve conduction?
Changes in …
- reflexes
- myotomes
- dermatomes
Clinical presentation of LOSS of neural mobility?
- femoral nerve stretch test
2. + SLR
The nucleus pulposis moves in the (same/opposite) direction that the disc moves.
OPPOSITE
We need an intact _____ for normal biomechanics
annulus
With a disc herniation, pt’s may present with a ______ shift away from the painful side
lateral
How to treat disc injury?
fix lateral shift WITHOUT causing any leg pain!!!
With a disc lesion, there will be ____ LBP +/- referred pain to _____ or down ____
central; buttock; leg
Pt’s with a disc lesion may present with loss of normal _____
lordosis
Why do pts with disc lesions present with loss of normal lordosis?
because they are trying to increase the IVF space by flexing
Disc lesions are often aggravated by _____ postures such as sitting and bending forward
flexion
Disc lesions are often aggravated by ____ or _____.
coughing; sneezing
The lateral shift seen in pts with disc lesions is always named for what the _____ are doing relative to the _____.
shoulders; pelvis
What are 4 positions that increase intradiscal pressure?
- sitting, leaning forward
- sitting
- standing, leaning forward
- standing
Once you restore a pt’s extension, they cannot go into a _____ posture for a set period of time!
flexed
3 exercises to restore extension?
- standing back extensions with hands on low back
- cobra
- cat cow (progression)
4 activities that increase intradiscal pressure?
- cough/sneeze
- valsalva
- breath holding
- bearing down
5 positions that decrease intradiscal pressure?
- lying down. knees supported
- sidelying
- lying prone
- standing, one leg on step
- sitting, lumbar support maintaining lordosis
5 steps for treating disc lesions?
- centralise pain
- correct shift
- support lordosis
- educate pt re specific postures
- avoid flexed postures
Always monitor ______ signs in pts with disc lesions, and refer if they worsen
neurological
Refer pt’s with disc lesions immediately if any ____ or ___ involvement
bowel; bladder
In pt’s with disc lesions, avoid any positions that ______ the symptoms
peripheralize
In pt’s with disc lesions, avoid any exercise or activity that increase ______ ______
intradiscal pressure
2 investigations that may be used for disc lesions?
- X-Rays
2. MRI/CT scan
How long should you avoid flexed postures for a pt with a disc lesion?
dependent on the pt!!!!
For a pt with a disc lesion, when should you introduce flexion type positions and exercises?
for a soft tissue injury, give at least 6 weeks, but again dependent on pt presentation
Stenosis = _____
narrowing
Spinal stenosis = usually ______ pt, with previous Hx of ____
older; LBP
With spinal stenosis, pain can be both _____ and radiate ______ into both legs and feet
central; bilaterally
Will X-rays show any signs of spinal stenosis?
YES bc of bony changes (think bone spurs, facet degeneration, DDD, etc.)
What positions aggravate pain in pt’s with spinal stenosis? Relieve?
Aggravate = positions that decease the IVF (standing, walking) Relieving = positions that increase the IVF (sitting, standing, leaning forward)
3 Rx’s for spinal stenosis?
- avoid positions of extension (decrease IVF)
- Educate re positions that increase the IVF and pacing of activities
- address muscle imbalances esp abdominal strength and hamstring flexibility
4 further investigations for someone with spinal stenosis?
- X-ray
- MRI/CT scan
- specialist referral
- list an objective measure of worsening that could warrant specialist referral
________= forward slippage of one vertebra on the other
spondyloslisthesis
Spondylolisthesis ______ IVF
DECREASES
Grade I spondy?
0-25%
Grade II spondy?
25-50%
Grade III spondy?
50-75%
Grade IV spondy?
75-100%
Spondy = ______ pars
elongated
Spondylolisthesis can be diagnoses at any age (T/F).
TRUE
_______ activities are a common cause of spondy
hyperextension
Where is the pain in pt’s with a spondy?
central LBP + - referred pain
_________ is associated with weak abdominal muscles +/- tight hamstrings
spondy
Spondy = aggravated by ______ postures, relieved by ______
extension; flexion
There (is/is not) radiological evidence of spondy
IS
5 steps in Rx of spondy?
- address lower quadrant imbalance
- focus on abdominal strengthening
- education
- biomechanical counselling
- avoid hyperextension activities
With spondy, specialist usually not warranted unless worsening neurological signs or significant increase in slippage (T/F).
TRUE
Optimum L spine posture supports the normal lumbar ______
lordosis
Postural back pain = not specifically caused by flexed or extended postures (T/.F).
TRUE
Postural back pain = worse in am, better at night (T/F).
FALSE; the way around
Postural back pain = often associated with decreased _______
fitness
There may be neurological S/S with postural back pain (T/F).
FALSE; NO NO NO
Postural back pain = due to increased strain on ______ and reduced endurance of postural muscles because they’re not in an ______ position
tisses; advantageous
There is no need to do further investigations for postural back pain (T/F).
TRUE
5 Rx steps for postural back pain?
- address posture / ergonomics for work / studying
- address muscle imbalance. specific muscle weakness and tightness
- address fitness issue
- add spinal supports as indicated
- educate includes rest postures / breaks
Flexion or extension Treatment: postural back pain?
can do either
Flexion or extension Treatment: disc pathology
extension when acute; progress to to flexion
Flexion or extension Treatment: spondy
flexion + core stability
Flexion or extension Treatment: spinal stenosis
flexion; will never progress to extension activities
X-Ray required only where the need to know status of ____ ____ exceeds the radiation risk
bone health
MRI/CT scan indicated where worsening ________ signs and where ______ is likely an option, failure to respond to treatment
signs; Sx
