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Therapeutic Exercise > Spine Impairments > Flashcards

Spine Impairments Flashcards

1
Q

What are some examples of PT diagnoses for impairments related to the spine?

A
  • limited thoracic mobility
  • muscle weakness
  • decreased endurance
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2
Q

T/F: TrA is active with both isometric trunk flexion and extension.

A

true

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3
Q

The TrA has a coordinated link with what other groups of muscles?

A
  • pelvic floor/ perineum
  • multifidi
    • also coordinates with respiration
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4
Q

Why would we train the TrA, what are the benefits to that?

A

improving postural stability and control

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5
Q

What muscle fiber type are we likely to find in multifidi and TrA?

A

type I: endurance muscle fibers

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6
Q

For a pt with general pain (acute inflammation and radiculopathy), what would you expect your intervention to be?

A

strength, ROM, endurance exercise

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7
Q

For patients with non-weightbearing bias, what intervention would you expect to help them?

A

traction

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8
Q

If a pt says their head feels heavy when standing/sitting, what might you do to help this?

A

manual traction (they have non-weightbearing bias)

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9
Q

Why do we use extension exercises on IVD herniations?

A

this gently pushes the disk anterior and away from the nerve

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10
Q

T/F: Hypomobile patients would benefit from core or neck stabilization exercise.

A

false, these patients are too stable so they actually would need mobilization to help

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11
Q

On what kind of patients would you use stabilization or immobilization techniques?

A

hypermobile patients, ones that display lack of stability in their trunk

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12
Q

How does feedforward control impact spinal stability?

A

the CNS activates trunk muscles to anticipate the load imposed by limb movement to stabilize the spine
- these are feedforward mechanisms that activate spinal muscles to kick in for stability

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13
Q

Which rib muscles help with posture?

A

internal intercostals

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14
Q

When the body is pushing something and using the pec major and serratus anterior, what muscles are stabilizing the spine in this motion?

A

intercostals and abdominals

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15
Q

What muscles help fight the iliopsoas during active hip flexion and stabilize the spine?

A

abdominal muscles help avoid this increased lumbar lordosis

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16
Q

During valsalva maneuver, what muscles contract to raise intra-abdominal pressure?

A

TrA, IO, EO

- this actually helps stabilize spine

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17
Q

How can we tell if pain is caused mechanically or pathologically?

A

pathologically displays with inflammation, mechanical does not

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18
Q

What happens if we don’t relieve mechanical stress?

A

tissue breakdown occurs and inadequate healing can ensue, leading to musculoskeletal disorders or overuse syndromes

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19
Q

List the deep and superficial lumbar muscles of the spine.

A

deep: multifidus, rotatores, deep quadratus lumborum, TrA
superficial: rectus ab, IO, EO, lateral quadratus lumborum, erector spinae, illiopsoas

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20
Q

List the deep and superficial muscles of the cervical region of the spine.

A

deep: longus colli/capitus, rectus capitis ant/lateralis
superficial: SCM, scalene, levator scap, upper trap, erector spinae

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21
Q

What causes forward head posture?

A

tight SCM and scalenes (superficial cervical flexors)

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22
Q

What symptoms may arise with a forward head posture?

A

tingling/numbness down arms, upper mid-back pain and fatigue, impaired GH motion

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23
Q

Cervical pain doesn’t just come from the cervical region… what else might be a cause for this pain?

A

thoracic hypomobility, scapular dysfunction, TMJ disfunction, or from cranium

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24
Q

How can you help develop neuromuscular control in patients with forward head posture?

A

do stabilization exercises
- start with static and then move to extremity movements with stabilization, then dynamic trunk movements with stabilization

25
Q

What motions are you going to work on with your patients to help with faulty posture?

A
  • axial extension
  • scapular retraction
  • pelvic tilt and neutral spine (go into excessive extremes, then find neutral to that)
  • encourage slight thoracic extension with breathing exercises`
26
Q

How do we teach our pts to maintain good posture 24/7?

A
  • this can’t be done: just focus on cues throughout the day to improve your posture
  • discuss pt’s daily life and find what cues throughout the day (mirrors, everytime they talk to someone, at a red light) will work for them
27
Q

With forward head, what relationships can we show our patients to enforce that they shouldn’t engage in this posture?

A
  • relationship with pain: have them move in and out of that posture and have them notice pain relief with greater axial extension
  • relationship with GH movement: make them aware of how much easier it is to move their arms with proper posture
28
Q

Your patient presents with upper crossed syndrome, leading to forward head posture. Describe your therapeutic approach.

A
  • stretch superficial cervical flexors (SCM and scalenes) and upper trap
  • strengthen deep cervical flexors and extensors (longus colli/capitus, multifidus)
  • work on endurance for axial extension
  • work on scapular retraction
  • work on cuing to remember to bring head into correct posture
29
Q

What superficial muscles do a chin up motion?

A

semispinalis capitus and cervicis

30
Q

What muscles can get inhibited first in the cervical region with trauma or whiplash?

A

the stabilizers like multifidus and rotatores shut down, and the superficial muscles take over
- you need to retrain the stabilizers to kick in first

31
Q

T/F: Low back pain pts take less time to reposition themselves.

A

false, they take a longer time to reposition because they aren’t as aware of where they are in space
- they are also less accurate in the repositioning

32
Q

Why are low pack pain pts bad at repositioning?

A

because their pain overrides their proprioception, so they’re not able to tell where their body is in space

33
Q

What should you remember is also often impaired with LBP pts?

A
  • SLS standing balance!!! work on balance stuff, as well as stability training and challenging their sensory system
  • breathing! focus on diaphragmatic breathing
34
Q

Which abdominal muscles are also stabilizers? Why?

A

TrA and IO because they attach to the thoracolumbar fascia

35
Q

If a muscle attaches to the thorax and/or pelvis, is it likely a mover or stabilizer?

A

mover

- stabilizers attach directly onto the L-verts

36
Q

T/F: Quadratus lumborum is a mover of the spine, not a stabilizer.

A

false, it is both because its deep fibers act as stabilizers

37
Q

How can you treat diastasis recti?

A
  • bind trunk with sheet to allow for compression and growing back together
  • while bound, work on core stabilization exercise
38
Q

How do we palpate the TrA?

A

find ASIS, and go medially and inferiorly

39
Q

T/F: The stabilizers of the spine have multi-segmental innervation, as well as co-contraction.

A

false, this applies to movers of the spine

- stabilizers have a high amount of proprioceptors

40
Q

What does is mean that TrA is tonic throughout the ROM?

A

it’s constantly active, vs phasic bursts of activity like other muscles

41
Q

T/F: ES contraction precedes TrA contraction when the load is expected. When the load is unexpected, TrA contracts first.

A

false, TrA activates first for either an unexpected load or an expected load

42
Q

In what ways does intra-abdominal pressure increase?

A
  • via flexion/extension

- via lifting, bending, or spine perturbation

43
Q

What muscle works as a feed-forward mechanism to stabilize the spine, regardless of direction of perturbation?

A

TrA: anticipate movement by activating TrA

44
Q

T/F: The diaphragm is a core stabilizer.

A

true, because it attaches to the lumbar spine

45
Q

Why should we emphasize diaphragmatic breathing with our patients?

A

this will help with core stability, since diaphragm is in fact a core stabilizer
- people with CLBP breathe differently during lifting tasks!!

46
Q

At what level of contraction do we get the strongest relationship between the pelvic floor and the TrA?

A

at submaximal contractions, you get the most connection with the TrA and the pelvic floor

47
Q

How can we describe to our patients to activate their TrA and/or multifidus?

A

“draw up” maneuver: make it like you have to hold in your pee

48
Q

T/F: If you’re engaging your core, you should have your pelvic floor activate before your arm movement.

A

true: pelvic floor activity precedes arm movement

49
Q

T/F: Erector spinae is more type I than type II.

A

true, ES = 62-65% type I because it’s a postural muscle

50
Q

What 3 ways can we get inactivation of the spinal stabilizers?

A
  • trauma, whiplash, etc
  • instability of segments can turn off stabilizer muscles
  • inflammation and pain
51
Q

There are lots of stimuli that go into the core and give it information. Describe the three categories where the lumbar spine houses mechanoreceptors to give afferent info to the body.

A
  1. articular, facet joint, interspinal ligaments, outer disk
  2. musculotendinous (GTO, muscle spindle)
  3. visual, vestibular, cunateous
52
Q

T/F: Instability can cause Type II fibers conversion to Type I.

A

false, instability would cause type I to convert to type II (like in multifidus)

53
Q

What are the tree interacting subsystems involved in the neutral zone theory?

A
  1. neutral (control subsystem)
  2. spinal column (passive subsystem)
  3. spinal muscles (active subsystem)

all three need to work together!

54
Q

What areas do lumbopelvic stability processing in the brain?

A
  • cerebral cortex
  • brainstem
  • spinal reflexes
55
Q

How does the neural control subsystem operate?

A
  • it receives info from the passive (spinal column) and active (muscles) subsystems to determine requirements for stability
  • then generates a specific motor output to maintain stability
56
Q

What are the two basic types of exercise programs for patients with LBP?

A
  • general exercise: activate abdominals or paraspinals as a whole, emphasizing flexion and extension, or either or
  • core stabilization: work on endurance, strength, and/or stability for the core muscles
57
Q

What 4 indications are there that may point to a core stabilization exercise program?

A
  1. positive prone instability test
  2. 91 degrees (tells you there’s not radicular pain)
  3. presence of aberrant spinal movements
58
Q

A patient comes into your clinic with low back pain. What should you be thinking about in regards to how you’re going to treat?

A
  • think if you need to do core stabilization or general exercise program
    • core stabilization more for younger people with no radicular pain (b/c not disk affiliated)
  • look at their balance and ability to reposition (probably impaired)
  • look at their breathing
  • look at lifting techniques and posture

Therapeutic Exercise (6 decks)

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