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Spine Eval & Treat Flashcards

1
Q

LBP Subjective Hx

A

Pain: location/movement, MOI/onset, time, description, behavior, intensity, better/worse, 24h bahavior

Pt Demopgraphics: age, race, hobbies, work, participation, impact of s/s, psychosocial considerations

General Health: Prior Hx, Co-morbidites, surgeries, Pregnancies, Medications

Red Flag Qs: Neural involvement, fracture, infection, cancer (Constant pain, intense pain, weight loss), AAA

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2
Q

Anterior Column

A

-vertebral bodies and discs
-Weight bearing and shock absorption

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3
Q

Posterior Column

A

-articular processes
-Zygapopphhyseal (facet) joints
-Gliding mechanism for movements

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4
Q

Lumbar Spinal Segments

A

-3 joints: 2 vertebral bodies and 1 disc, facet joint of sup and inf
-horizontal surfaces favor rotation
-vertical surfaces favor block rotation

-facets in earmuff to limit rotation

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5
Q

Amount of Motion Determinants

A

-Disc height ratio
-fibrocartilage compliance
-shape of end plates
-age
-disease
-gender

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6
Q

Type of Motion Determinants

A

-shape and orientation of articulations
-ligaments and muscles
-size and location of segment (lumbar biggest)

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7
Q

Intervertebral Discs

A

-largest avascular structure in body
-Nucleus Pulposus, Annulus Fibrosis, End plate (bone)
-Thoracic & Lumbar: thicker anteriorly
-nutrition diffuses from endplate

Resists:
-compression
-shearing
-bending
-twisting
-combined motions

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8
Q

Spinal Juntions

A

CV: atlas, axis, head
CT: mobile c spine to stiffer upper t spine
TL: t-spine rotations meet limited L-spine
LS: mobile l spine to stiff SI joints

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9
Q

Mechanical Stability

A

state of equilibrium when body is still

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10
Q

Dynamic or Controlled Stability

A

Passive: resist forces at end ranges

Active: muscles coodinated to control body

CNS: feedforward and feedback control to augment stiffness

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11
Q

Lumbar Spine Open Packed Position

A

midway between flexed and extended

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12
Q

Lumbar Spine Closed Packed Position

A

full extention

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13
Q

Lumbar Spine Capular Pattern

A

SB= rotation, then extension

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14
Q

L5

A

-transitional vertebra
-smaller disc
-larger TP, smaller SP
-tends to slide anterior and inferior

Lumbarization: S1 becomes mobile
Sacralization: L5 fuses to sacrum

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15
Q

Zygapophyseal Joint

A

-synovial joints: articular cartilage, fibroadipose meniscoid
-supported by multifidi and ligamentum flavum
-innervated by medial branch of doral root
-move 5-8mm

Normal disc: 20-25% axial load on facet
Degenerated disc: 70% axial load on facet

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16
Q

Annulus Fibrosis

A

60-70% of water
-layered
-attaches to endplate
-transmit compression forces

Outer zone: sharpey’s fibers (fibrocarttilage)
Intermediate: fibrocartilage
Inner zone: most fibrocartilage

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17
Q

Nucleus Pulposus

A

70-90% water
-no nerve oor blood supply
-absorb compression

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18
Q

Interspinous Ligament

A

-bwtn spinouos processes
-resistt hyperflexion

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19
Q

Supraspinous Ligament

A

-from spinous processes from sacrum to C7
-end of nuchal lig
-resists hyperflexion

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20
Q

Intertransverse Ligament

A

-bwtn TPs
-well developed in lumbar
-limits LSB

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21
Q

Iliolumbar Ligament

A

-lumbar to pelvis
-stabilize L5 from ant displacement and ressits LSB at L4

Anterior band: anterior TP of L5 to ant iliac crest
-resist ipsi side bending and ant translation

Postterior Band: sup TP to ilium
-prevents flx

Superior Band: post TP of L5 to post iliac crest
-prevents flx

Inferior Band: inf TP of L5 to ant iliac crest
-taut in extention

Vertical Band: ant-inf tp of L5 to ilio-pectineal line

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22
Q

Thoracolumbar Fascia

A

-T12 SP to PSIS and iliac crest

-muscle attachment
-resisted flx
-assists in extension during lifting

-activation of TA increases tension

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23
Q

Errector Spinae action

A
  1. Unilaterally laterally flex vertebral column ipsilaterally.
  2. Bilaterally extend vertebral column.
  3. Anterior pelvic tilt
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24
Q

Multifidus action

A

Stabilize facets by compression.

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25
Quadratus lumborum action
1. Unilaterally laterally, hike, pelvis and LSB 2. Bilaterally extends vertebral column. 3. Bilaterally fix last rib during forced inspiration.
26
Iliopsoas major action
1. Iliacus: Flex the hip 2. Psoas: lumbar side bending, vertical stabilizer 3. Externally rotate the hip. 4. Flex the trunk toward the thigh 5. Tilted pelvis anteriorly 6. Stabilize the hip joint.
27
Piriformis
1. Hip ER 2. Hip ABD 3. When >90 flx: Hip IR
28
External oblique action
1. Unilaterally laterally flex vertebral column to the same side. 2. Unilaterally rotate the vertebral column to the CONTRA side. 3. Bilaterally flex the vertebral column. 4. Bilaterally compress, abdominal contents. 5. Posterior pelvic tilt
29
Internal oblique action
1. Unilaterally laterally flex vertebral column to the same side. 2. Unilaterally rotate the vertebral column to the IPSI side. 3. Bilaterally flex the vertebral column. 4. Bilaterally compress, abdominal contents.
30
Transverse abdominous action
Bilat: Compress and support abdominal viscera -primary stabilizer -synergist to Miltifidi -Antagonist to diaphragm with expiration
31
Axial Compression
Slow Loading: -bodies aproximate -Schmorl's Node: end plate bows towards vertebra Disc: -squeeze out 5-11% of water -height loss plateaus at 90min Facet Joint: -<30% of load unlikely to fail -37-80% of load will fail after 1000 cycles
32
Intradiscal Pressure
-Laying down to standing to bending Bending forward 150% >> Lifting weight with back beinding and knees straight 169% of load
33
Lumbar AROM Values
Flexion: 70-90 Extension: 39-50 Rotation: 20-40 LSB: 25-35
34
Flexion of Lumbar Spine
-70-90deg -1st in lumbar spine (not L5-S1) -anterior rock and translation -glides backwards 5-7mm Resistance: -39% of joint capsule -19% supra and interspinous ligs
35
Extension of Lumbar Spine
-30-50 degrees -posterior rock and translation Reistance: -SPs -ligs
36
Rotation of Lumbar Spine
-20-40 degrees -torsion of disc -gapping of ipsi and compression of contra facet
37
Lateral Side Bending of Lumbar Spine
-25-35 degrees -compression ipsi, contra gapping -ipsi face glides inf, contra sup -coupled motion: ipsi LSB, contra rotation
38
Global Issue of LBP
Acute, Recurrent (MC), Chronic ($$ and harder to diagnose) -no strong RK to predict outcomes
39
LBP and Age
Spondylolisthesis: 10-20y -moving more Disc Herniation: 15-40y -loosing water over time OA/ Spondylosis: >45y Cancer/compression fx, stenosis: >65
40
Evaluation Steps of LBP
1. Subjective Hx 2. Scan/Not (neuro, no MOI, not MSK) 3. Observation 4. ROM 5. Strength 6. Special Tests 7. Repeated Measures (if needed)
41
Piriformis Syndrome
-Dx of exclusion S/s: -hx of trauma so SIJ or glute -pain around SIJ or piriformis -worse with lifting, sitting -palpable tension -+ SLR -(+) provocation pain -(+) LE paresthesias -Glute atrophy
42
Spondylolysis
-fx to pars -often asymptomatic -usually L5 -Pt perfer flx
43
Spondylolisthesis
-Fx and slippage Grading: I (1-25%) - V (>100%)
44
Disc Herniation Process
1. Endplate compression and degrades 2. Exposes NP to blood and irritates it 3. NP looses water and height 4. Decrease Resistance of loads 5. Osteophyte formation 6. More load on facet 7. Fissure of Annulus Fibrosis 8. Disc disruption
45
Disc Pathology Stages
Protrusion: disc bulge w/o rupture Prolapse: outlayers of AP contain NP Extrusion: AP perforated into epidural Sequestration: disc fragments disconnect
46
End Plate Fx S/s
-trauma or MOI -Acute pain -(-) SLR -(+) compression test
47
Internal Disc Disruption S/s
-separation of inner layers -LBP or referred hip pain -(-) SLR
48
Disc Protrusion/Prolapse S/s
-contained -some AF and PLL intact -LBP or referred hip -pain with cough or sneeze -(-) SLR
49
Disc Extrusion of Sequestration S/s
-uncontained -LBP -Pain with cough/sneeze -True Sciatica (radicular pain) -(+) SLR
50
Nerve Compression Stages
Herdiation of Disc of L4-L5 -compresses root -1 nerve Large Herniation of L5-S1: -compresses nerve root and nerve coming out of same foramen -multiple nerves Massive Central Sequestration L4-L5: -all nerve roots in cauda equina
51
Nerve Root Entrapment Causes/Tx
-structural Causes: -subluxed facet -facet osteophytes (MC) -laminar compression -disc -stenosis -edema -tumor -surgical scar Tx: -LBP with radic not as great of outcomes
52
Spinal Stenosis S/s
-narrowing spinal canal (vascular or neurogenic) -congenital development or acquired S/s: butt pain, limping, lack of sensation, dec walking ability Central: -spinal canal dec -claudication, butt pain Lateral: -narrowing of facets -can impinge nerve roott
53
Facet Dysfunction S/s
-hypomobility at a facet joint S/s: -localized pain -specific AROM deficits -hyper mobility at another level Tx: -manual therapy > mobility > strengthening
54
Lumbar Instability S/s/Tx
-loss of passive restraints to movement -lack of NM control S/s: -catching in back -inconsistent symptoms -(+) Prone instability Tx: -strengthening/stabilization -recurrence is common
55
Ankylosing Spondylitis S/s
-chronic inflammatory disease that can restrict motion -usually SI joint first -Male, <30 -bamboo spine Tx: -meds and conservative management to slow progression
56
Fibromyalgia S/s
-chronic condition -causes pain, stiffness and tenderness of muscles, tendons and joints -physcosocial component Dx: 11/18 tender points w/o other reason S/s: -Pain (100%) -Fatigue (90%) Emotional Disturbances (50%) -Restless sleep -Disturbances in bowel function
57
IFC Category: (non-chronic) LBP w/ Mobility Deficits
-hypomobility -pain in back, butt, thigh -impaired movement -(-) neuro -<3m s/s onset
58
IFC Category: (Maybe chronic) LBP w/ Movement Coordination Impairments
-instability -Pain in back, butt, groin or thigh (worse at end range) -Dec NM control, activity tolerance -(+) Prone instability test
59
IFC Category: Acute LBP Referred LE Pain
-referred (not nerve) -pain in back, butt, thigh, leg -(+) Repearerd mmts test -Onset <3 days
60
IFC Category: (maybe Chronic) LBP w/ Radiating pain
-radiating, nerve -radiating pain in dermatomal pattern -nerve weakness -(+) Neuro exam -(+) Neurodynamic Tests -(+) repeated movement tests
61
IFC Category: LBP w/ Related Cognitive or Affective Tendencies
-sensitivity to noxious stimuli -range of emotions -tendencies to elaborate s/s (catastrophizing) -Inconsistent results -Onsett <3 Months -(+) Waddell's Test
62
IFC Category: Chronic LBP w/ Generalized Pain
-whold body chronic pain -inconsistent MSK dysfunction -appropriate emotion -changes in brain -catastrophizing -Onset >3 months
63
Manual Therapy Classification
CPR: -No sx distal to knee - <16 days (acute/subacute) -FABQ score <19 (fear avoidance beliefs) -1 hypomobile segment -1 hip >35deg internal rotation (loss of ER) Tx: -HVLAT -ROM
64
Stabilization Classification
CPR: - <40 yrs old - Post parum/SLR >91 deg (flexible) - Instability catch or aberrant movements during flx/ext -(+) Prone instsbility test -Postpartum: (+) posterior pelvic pain provocation, ASLR, mod Trendelenburg OR Pain w/ palpation of long dorsal SI ligament or pubic symphysis Tx: -isolated contraction of deep stabilizers (TA, Multifidi) -Strengthen large spinal stabilizers (ES, Obliques) -Hooklying to Side Plank
65
Extension Direction-Specific Classification
CPR: -Sx distant to Butt -Sx centralize with extension -sx peripheralize with flexion -directional preference for extension (standing/walking) Tx: -End range exetnsion -mobilize to promote extension -Avoid flexion
66
Flexion Direction-Specific Classification
CPR - >50yrs -Directtional preference for flexion -Lumbar Spinal stenosis Tx: -mobilize or manip spine -strength and flexibility exercises -body weight supported treadmill
67
Lateral Shift Direction-Specific Classification
CPR -visible frontal plane shift -directional preference for lateral translation movements Tx: -exercises to correct shift (manual glide from PT or leaning on walls) -traction
68
Traction Classification
CPR -Sx decrease w/manual or auto traction *don't respond to anything else* *(+) Crossed SLR * *Peripheralization of multipple directions*
69
>1 Classification
-25% Prioritize by: -Level of risk -Psychosocial factors (lessen outcomes) -Co-morbidities (lessen outcomes) Tx: -Symptoms -Movement control -Functional movements
70
Acute LBP Phase
3-4w -decrease pain, inflammation -increase pain-free ROM -increase NM control -low level exercise (walking, modalities, manual therapy) -Pt education
71
Subacute LBP Phase
<12w -sig decrease in pain -Restore full ROM -restore NM control -PREVENT CHRONICITY -Progression of activity -functional training -Pt education
72
Chronic LBP Phase
>12w (pain without tissue damage) -maximize function and encourage education -decrease pain in chronic stage -Multimodal approach -address accominations -de-threaten biggest fears
73
Pain Science: Stages
Primary Hyperalgesia: -protective mechanism from damage Secondary Hyperalgesia: -decreased pain threshold Central Sensitization: -hallmark of chronic pain -changes in CNS for pain response
74
Direction-Specific (McKenzie) Terms
Postural: -pain not reproduced with repeated testing -pain when stationary Dysfunction: -pain only produced at the end range -conditioning unchanged after testing Derangement: -sx produced with mid range movements -painful arc -variable pain patterns -changes after testing
75
Conservative Tx for LBP
Active more useful: -Mobilization/Manip -Exercise -Traction Passive: -less evidence supported Progression: -Manual therapy -Mobility -NM Re-ed -Strength training -Activity tolerance
76
Pt Education for LBP
-Remain active -Decreased focus on anatomy -decrease stress
77
Joint Manipulation Contraindications
-Serious pathology -fracture* -lack of skill -Ligament rupture* -No working hypothesis -Worsening neuro function* -Unremmitting night pain* -Severe multi directional spasms -UMN Lesions*

MSK (48 decks)

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