spinal conditions Flashcards
what happens to spinal diameter during flexion and extension
Ext - IVF narrows (inferior glide)
Flex - IVF opens (superior glide)
nerve compression from
ext
osteophyte
disc herniation
swelling
Signs and symptoms of nerve compression
pain, tingles, numb
loss of nerve condition
loss of neural mobility
how do we test nerve conduction
reflexes
myotomes
dermatomes
T/F need intact annulus for normal biomechanics
tre
nucleus pulpous migrates __ to the direction of the movement
opposite
during flexion where does nucleus pulpous migrate
posteriorly
whats worst thing that can happen after traetemtn
leg pain
clinical presentation of disc lesion
age
central low back pain referred to butt/leg
loss off normal lordosis
aggravated by flexion, coughing, sneezing
eased by ext
lateral shift named based on
what the shoulder are doing in relation to pelvis
where do you stand when naming the shift
behind the patient
positions that inc intradiscal pressure
sitting, leaning fowd
standing, leaning fwd
activities that increase intradiscal presure
cough / sneeze
valsalva
breath holding
bearing down
positions that decrease intradiscal pressure
lying down, knees supported side lying lying prone standing with one leg on step sitting lumbar supported
what to do for disc lesions
centralise pain correct shift support lordosis educate patient on posture avoid flexion
ergonomics, exercise, prevention
when to refer to physician disc lesion
neurological sign is present
worsening (loss of reflex, mytome, sensation)
should you peripheralize symptoms
no centralize
do you want to increase or decrease intradiscal pressure
dec
t/F x ray helpful in investigating for disc lesion
no but you can see the disc space narrowing
t/f MRI / CT scan helpful disc lesion
yes you can see nerve compression
stenosis means
narrowing
spinal stenosis
bone spurs creating narrowing
who gets spinal stenosis
older hx of low back pain
where is pain in spinal stenosis s
can be central
can radiate bilaterally
what aggrevates spinal stenosis
positons that dec IVF (standing , walking)
pain relieved by what in spinal stenosis
positions that inc IVF, sitting, standing, lean fwd
treatment of spinal stenosis
avoid positions of ext
education on positions
pace back to activities
address mm imbalance (ab strength, hamstring flexibility)
what can x ray show in spinal stenosis
spurs / narrows
what can MRI/ CT scan show for spinal stenosis
where there is neurological compromise if SIGNS worsening
whats an objective measure that shows worsening in patient with spinal stensos
clonus, babinksi
spondyloliothesis
the gymnast
fwd slippage of one vert
decreases IVF
hows spondylolthesis graded
grade 1-4
clinical presentation fo spondylolisthese
gymnast, dancer hyperextension activiteis central low back pain, referred weak abs tight hamstrings aggravated by ex eased by flexion
treatment of spondlolisthesisi
address low quadrant mm imbalance focus on ab strengthening (TA) education miomechs avoid hyperexntion
X-rays in sponolishtsis
useful in standing to visualize slippage
can confirm clinical suspicions
get if its a career decidier
MRi for spondolisthesis
not needed unless worsening neurological signs
do spondolisthesis need specalist
not unless worsening neurological signs of significant slippage
optimum lumber spine posture _____
supports the normal lumbar lords
why do we need to know optimal posture
clinical relevance?
understand pathology of abnormal posture
understand effect on spinal diameter
understand condition specific limitations
postrural back pain clinical presentaiton
any age group pain increases with prolonged postures poor posture/ ergonomics not caused by flex/ext better in AM, worse in PM
associated with decreased fitness
no neuro signs
treating postural back pain
address posture / ergonomics address mm imbalance address fitness add spinal suport educate on rest postures
guidelines for treatment of impairments with flexion bias
avoid ext if it increases neurological /pain
rest /support in positions of flexes when it reduces neurological /pain
reducate on posture
return to activity
why flexion bias
widens IVF, decreases pressure on roots
reduces effects of derangement in joint
why extension bias
reduces disc derangement
facilities centralization of pain
if flexion is contraindicated
how does extension facial centralization
by encouraging anterior migration of nuclear material
decreases stress on posterior annulus
guidelines for management of impairments with an extension bias
rest / support in extension if it helps
re educate on posture
return to activities
some components of patient education
lifting standing avoid prolonged sitting flexiblity / strength pillows, chairs
likely treatment for postural back pain
they can do flex and ext
likely treatment for disc pathology
do ext first progress to flex after they can sit n reach fwd
spondyloslisthesis likely treatment
give them flexion, avoid ext because an instabilty in anterior direction
spinal stenosis likely treatment
flexion , avoid ext
