spondylolysis - posture - exam 1 Flashcards
what is spondylosis?
age related joint changes at multi segment levels
what is spondylolysis?
bony defect or fracture of pars interarticularis unilaterally or bilaterally
what are the causes of spondylolysis?
congenital
repetitive stress, esp ext and rot
direct trauma
how prevalent is spondylolysis?
6-12%
what level is most affected by spondylolysis?
L5, S1
S&S of spondylolysis
acute - fracture S&S plus (+) B torsion test
persistent - often asymptomatic, instability S&S if symptomatic
what is spondylolisthesis?
anterior vertebral segment slippage (w or w/o pars fracture)
how many types of spondylolisthesis is there? what are the two most common?
5
isthmic or adolescent w spondylolysis
– most common
– age group with most rapid slipping
– MOA: repetitive or traumatic ext
degenerative:
– due to age related disc changes and occurs after the 5th decade
– no fracture!
what are the degrees/grades of slippage?
grade I - 0-25%
grade II - 26-50%
grade III - 51-75%
grade IV - 76-100%
S&S of spondylolisthesis
worst case of instability S&S
possible lateral or central stenosis S&S with slippage
no correlation with slippage and degree of symptoms
could get stenosis S&S if slippage is enough
how does PT treat spondylolysis and spondylolisthesis?
worst version of instability
MET:
– better outcomes at 10 wks of local muscle training vs traditional ther ex alone out to 1.5 years
– 84% of children and young adults improved after 1 year with up to 25% slippage
does the lesion need to heal in order to improve symptoms in spondylolisthesis?
no
symptoms can get better without fracture healing by doing things such as local muscle activation
what are Sx indications for spondylolisthesis? outcomes?
confirmed imaging without conservative benefits
83% excellent to good outcome with modified Scott technique vs others (fusion)
pt. states “ I woke up and couldn’t turn my neck, or made a quick move”. What could this condition be?
facet joint impingement
facet joint impingement is VERY common. T or F
False; rare
Facet Joint Impingement: structures involved (2)
meniscoid ; facet joint
What does meniscoid makeup and what is it doing in facet impingement syndrome:
-____________for the incongruency of articular surfaces
-facilitate the spread of _______________
synovial, fat, fibrous tissue
compensate
Synovial fluid
Pathomechanics of Facet Joint Impingement:
Meniscoid becomes __________ due to ___________ position or quick ___________
associated with______
Wedged
prolonged; movement
instability
S&S of Facet Joint Impingement:
woke up or made a quick movement and couldn’t move
acuity with age-related joint disease
underlying instability S&S
PT Rx: Facet Joint Impingement
-may need isometrics to use attaching __________to pull ___________out of the way
-_____________manipulation
-___________ to address the cause
-what 3 things often improve on its own before a patient comes to PT:
multifidus; meniscoid
gapping
stabilization
inflammation, symptoms and function
common directional preference of extension/hyperextension when a disc change is indicated, what method is often used ______________ (____%)
McKenzie (70%)
Evidence shows that Mckenzie Method is better useful for _________ IDD
acute IDD with LE symptoms and centralization occurs
Disc changes ALWAYS cause symptoms? T or F
False; not in 2/3 cases
Posture: (6)
body types
scoliosis
sway back
flat back
rounded or crouched
FHP
Rigid Body Type:
LESS______
LESS_______
LESS_______
L-lordosis
hip motion, especially IR
foot and ankle EV or pronation/higher arches
Flexible Body Type:
MORE_______
MORE_______
MORE________
L-lordosis
hip motion especially IR
foot and ankle EV or pronation/lower arches
Sprinter body type:
Dancer body type:
Does body type affect/match activity?
rigid
flexible
YES
How is scoliosis named?
by side of the convexity
What are the two types of scoliosis?
structural - doesn’t go away w/FB (high sens)
functional or postural- goes away with FB; able to modify with PT
Scoliosis:
Changes in one area may create compensatory changes in ________ areas
adjacent
PT Rx for R thoracic scoliosis:
-MT goal:
-which side:
improve mm. lengths and joint motion
left SB and right rotation = issue
right SB and left rotation = exercises
MET goal for R thoracic scoliosis:
-which side:
improving endurance and strength to counter curvature
left SB and right rotation = issue
right SB and left rotation = exercises
Swayback characteristics:
increased lumbar lordosis
ant. pelvic tilt
flexible body type
Flat back aka _____ spine characteristics:
aka straight spine
-flattening of normal curves
-the greater portion of persistent LBP pts. due to less dissipation of forces
-post. pelvic tilt
-rigid body type
Rounded or crouched characteristics:
increased thoracic kyphosis
flattening of lumbar curve
post. pelvic tilt
often associated w/FHP
6 lumbar vertebra:
lumbarization
4 lumbar vertebra; L5 fuse w/S1
sacralization
Load ____ on the lumbar region every anterior inch of FHP
doubles
