spine Flashcards
common causes of LBP
Muscular spasm, strain
Ligament sprain
Spondylosis
Herniated nucleus pulposus
Facet joint dysfunction
Spondylo-lysis or -listhesis
Seronegative spondyloarthropathies
slipping or shifting of vertebrae out of their space is?
spondylolisthesis
the diagnosis for LBP is divided into?
Specific spinal pathology
Non specific spinal pathology
Radicular pathology
acute, subacute, and chronic
how can we differentiate them according to time?
acute up to 6 weeks
6-12 subacute
>12 chronic
Corticosteroids for severe pain
true or false?
true
increased level of c-reactive protein is indication of?
inflammation
ex, acute low back pain
in acute LBP the pain is?
severe sudden onset
Acute low back pain usually does have a specific cause
true or falsE?
false, does not have specific cause
what are the red flags for rehabilitation?
Cauda equina, spinal fracture-infection, cancer, abdominal aortic aneurysm
Degenerative joint disease affecting the vertebrae and intervertebral disc, arthiritis
is?
Spondylosis
Fracture in pars interarticularis
is?
Spondylolysis
Displacement of one vertebra on another
is?
Spondylolisthesis
what are the stages of developing Ankylosing spondylitis?
1- formation of osteophytes of margins of vertebrae
2-then both osteophytes ossified into a joint as syndesmophytes
3- non-marginal syndesmophytes
non radicular pain is caused by ?
referred pain facet joint or disc
radicular pain is related to?
nerve compression
radicular pain will effect the motor and sensory nerves of the same segment\true or false?
true
which part of the disc is soft and movable and the other one is stable?
nucleus pulposus
annulus fibrosis
what is the physiology of disc herniating?
1-Tears in the annulus fibrosis
2- Herniation of nucleus pulposus
what are the stages of herniated disc?
bulging
protrusion
extrusion
sequestration
there is only extension of the disc margin beyond the margins of the adjacent vertebral endplates without tearing of annuluses fibrosis
which one is this?
bulging
the nuclear materials emerge through the annular fibers, but the posterior longitudinal ligament remains intact
which one is this pathology?
extrusion
the nucleus pulposus impinges on the annulus fibrosis and the posterior longitudinal ligament remains intact
nucleus pulposus getting thicker
which one is this pathology?
protrusion
the nuclear material emerges through the annulus fibrosis and the posterior longitudinal ligament is disrupted and a portion of nucleus fibrosis has protruded into the epidural space
which pathology is this?
sequestration
radiculopathy happens in extrusion and sequestration in disc herniation
true or false?
true
descending root can be impinged by ?
protrude posterolateral
for flexion based which compartment will affect?
Muscular
Ligamentous
Compression Fracture
Discogenic
Stenosis
Facet
Spondylosis
Central Disc
will be affected by?
extension base
Transitional
force will affect?
Spondylolisthesis
Sacroiliac
Facet
anterior compression of the disc will be cause by?
flexion force
extension force will lead to?
posterior compression
hyperflexion force will lead to posterior compression having posterior longitudinal ligament torn
true or false?
true
anterior compression will affect posterior annulus
and with the posterior compression will centralized annulus
true or false?
true
what does it mean centralization?
the pain was peripheral but with the movement it centralizes
what are the pain characteristic of LBP?
sharp and burning relating to nerve and dull ach
pain with prone we will have?
Facet, Lat Herniated Nucleus Pulposus (HNP), systemic
pain with sitting we will have?
Paramedian HNP, annular tear
Lateral HNP, central stenosis, facet syndrome
is related with ?
standing pain
central stenosis is for pain with walking
true or false?
true
how radiation occurs?
Up back
To sacrum
To buttocks
Down leg
what are the symptoms ?
radiation
Cough/valsalva exacerbation
Distal neuro symptoms - weakness/paresthesia
Perianal paresthesia
Bowel/bladder symptoms
length of stride
arm swing
trunk motion
?pelvic tilt
related to?
walking
we have to assest what in LBP?
walking
standing
supine
sitting
flexion of back is 90
exention of back is 15-20
side bending = 30
and trunk rotation
are ROM for trunk
true or false?
true
what should we assist for lower back pain in palpation?
Spinous processes
Dorsal lumbar fascia/soft tissues
what is Stork Test for sacroiliac j ?
Single leg extension
Toe raises
for?
Gastrocnemius strength
how can we asset LBP while the patient is standing?
by palpation
ROM
posture
stroke test
toe raises
single leg raise
Distracted SLR
DTR - patellar & Achilles
Strength - EHL, TA, Peroneals, quads, hip flexors
Sensation
for?
sitting examination
how to Stretch the Spinal Cord or Sciatic Nerve in supine position?
Straight Leg Raise
Cross Leg SLR
Kering Test
what tests are applied in supine position?
straight Leg Raise
Cross Leg SLR
Kering Test
Hamstring flexibility
Leg lengths
how to measure leg length?
measured ASIS to Med Mal
l4 radicular pathy will cause?
Quads/Tibialis Anterior
Patellar reflex decreased
Sensory Great toe and medial leg loss
l5 radicular pathy will cause?
Strength of Ankle and great toe dorsiflexion
Extensor Hallucis Longus
Sensory to dorsum of foot loss
Ankle reflexes and sensation of posterior calf and lateral foot
Peroneals/Gastroc
Achilles reflex
Sensory to lateral and plantar foot
are lost by which innervation?
s1
muscle relaxions are mostly used in acute management
true or false?
true
what are the acute management?
NSAIDS
muscle relaxers
heating agent
back exercises ‘Stretching - HS, hip extensors, erector spinae
Strengthening - abs, erector spinae’
prolonged sitting/standing
recurrent bending
twisting
are avoid especially in?
subacute stage
what are the goals for chronic LBP?
Control pain
Maintain function
Prevent disability
what exercises we can do for chronic LBP?
standing hamstring stretch 15-30 sec
quadruped arm/leg swing rep 10 times
gluteal stretch
15-30 sec
cat and camel
3 stets of 10
pelvic tilit
3 sets of 10
partial curl
3 sets of 10
extension exercise
4 sets 2 min rest
side plank
muscle strain in 7 to 10 days, ligament sprain in 3 to 4 weeks
disk herniation in 8 to 10 weeks
true or false?
true
which exercises centralizes pain with trunk extension?
MCKenzie
centralizing the pain allows the source of the pain to be treated rather than the symptoms is done in which approach?
McKenzie approach
1.Double knee to chest in supine lying
2. Step standing trunk flexion with involved side on ground and uninvolved leg on bench, in this case right leg on ground
3.Quadruped stretch
4.Lumbar extension
are for?
Mc Kenzie Stretching
In a derangement presentation, the direction of preference for treatment is lumbar flexion
true or false?
false, extension
lumbar extension in lying would have decreased and centralized the pain
trunk flexion, which would have increased and peripheralized the pain
true or false?
true
what are lumbar extension exercises for derangement?
Prone press-ups without or with overpressure
Standing lumbar extension
Standing lumbar extension using wall to sag into
In any kind of derangement it is important to perform the exercise short enough for the fluid to alter its position anteriorly
true or false?
false, long 5-10 min
In derangement, extension in standing is designed to reduce accumulation of nuclear material in the posterior compartment of the intervertebral joint
true or false?
true
extension in standing mostly effective for?
after prolonged sitting
list the Meckenzie exercises
lying prone
extension in lying
extension in standing
rotational mobilization exercises
SIJ pain causes?
TRAUMATIC (Fall, heavy weights)
ATRAUMATIC (bulging[L4-5/L5-S1], scoliosis, postpartum, inflammatory arthropathy [AS])
Low back pain (BELOW L5)
Pelvis/buttock pain
Hip/groin pain
Poor sleep habits
Unilateral leg instability
Sitting problems
Lower extremity pain
are for?
SIJ pain characteristics
Sit to stand
Prolonged walking
Unilateral weight bearing (stairs, putting on pants-socks)
Prolonged standing
are ?
aggravating factors for SIJ pain
what are the relieving factors for SIJ pain?
Weight bearing unaffected side
Lying on unaffected Side
Compression manually or with a belt to relieve hypermobility
Fortine’s finger test is?
patient pointing to inferior-medially to posterior superior iliac spine
in SJ pain, patients point to ASIS
true or false?
false, PSIS
what are Provocative Tests for SIJ?
distraction
thigh thrust
FABER
GAEnslean
compression
3 of 5 must be positive
1 of 3 positive results must be thigh thrust or compression
first aim for SIJ pain is to decrease its mobility
true or false?
true
list three exercises for SIJ pain relief
push pull
isometric push and pull
modified dead bug
what are the EARLY INTERVENTION IN ACUTE CASES ?
ROM exercises in a pain-free range
isometric activity of the injured muscles or the muscles around an injured joint,
directional preference exercises
what are the AROM for cervical pain ?
rotation, chin retraction, and head nodding
6-10 repetitions
patients who have more than about 30 degrees of available pain free motion, isotonic exercises can be introduced within the pain free range
true or false?
true
Isometric contractions holding for 6-10 sec and should be performed through ranges of motion at about 30 degree
true or false?
false, 20 degrees
what is the strategy for cervical region pain?
- Evaluate and train deep segmental stabilizers
- Address postural factors and respiration
- Address muscle imbalance of large torque producers
Stretch short tight cervical muscles
Evaluate/re-train scapula stabilizers
Strengthen large torque producers of the neck - Re-train the sensory-motor response loop
weak flexor neck muscles compensated by increased activity in the superficial SCM and anterior scalene
true or false?
true
Quadruped/prone series (Jull) for?
Treatment options for deep extensors
Combined treatment option for?
Quadruped track (Murphy
chin tucks
Craniocervical flexion
Isometric holds with chin tuck
ball squeeze
forehead ball roll with good AROM
for?
Treatment options for inhibited deep stabilizers
Upper cervical spine 🡪 maximally extending
Lower cervical spine 🡪 maximally flexing
for chin tuck true or false?
false, opposite
acute phase, patient practice holding a supine chin retraction while holding the head off the edge of a mattress
true or false?
false, post-acute
the acute phase the head should be supported
how much isometric holds with chin tuck is done?
6 second holds, 6 repetitions
