spondylolysis - posture - exam 1

Question 1

what is spondylosis?

Answer 1

age related joint changes at multi segment levels

Question 2

what is spondylolysis?

Answer 2

bony defect or fracture of pars interarticularis unilaterally or bilaterally

Question 3

what are the causes of spondylolysis?

Answer 3

congenital
repetitive stress, esp ext and rot
direct trauma

Question 4

how prevalent is spondylolysis?

Answer 4

6-12%

Question 5

what level is most affected by spondylolysis?

Answer 5

L5, S1

Question 6

S&S of spondylolysis

Answer 6

acute - fracture S&S plus (+) B torsion test
persistent - often asymptomatic, instability S&S if symptomatic

Question 7

what is spondylolisthesis?

Answer 7

anterior vertebral segment slippage (w or w/o pars fracture)

Question 8

how many types of spondylolisthesis is there? what are the two most common?

Answer 8

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!

Question 9

what are the degrees/grades of slippage?

Answer 9

grade I - 0-25%
grade II - 26-50%
grade III - 51-75%
grade IV - 76-100%

Question 10

S&S of spondylolisthesis

Answer 10

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

Question 11

how does PT treat spondylolysis and spondylolisthesis?

Answer 11

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

Question 12

does the lesion need to heal in order to improve symptoms in spondylolisthesis?

Answer 12

no
symptoms can get better without fracture healing by doing things such as local muscle activation

Question 13

what are Sx indications for spondylolisthesis? outcomes?

Answer 13

confirmed imaging without conservative benefits
83% excellent to good outcome with modified Scott technique vs others (fusion)

Question 14

pt. states “ I woke up and couldn’t turn my neck, or made a quick move”. What could this condition be?

Answer 14

facet joint impingement

Question 15

facet joint impingement is VERY common. T or F

Answer 15

False; rare

Question 16

Facet Joint Impingement: structures involved (2)

Answer 16

meniscoid ; facet joint

Question 17

What does meniscoid makeup and what is it doing in facet impingement syndrome:
-____________for the incongruency of articular surfaces
-facilitate the spread of _______________

Answer 17

synovial, fat, fibrous tissue
compensate
Synovial fluid

Question 18

Pathomechanics of Facet Joint Impingement:

Meniscoid becomes __________ due to ___________ position or quick ___________

associated with______

Answer 18

Wedged
prolonged; movement
instability

Question 19

S&S of Facet Joint Impingement:

Answer 19

woke up or made a quick movement and couldn’t move
acuity with age-related joint disease
underlying instability S&S

Question 20

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:

Answer 20

multifidus; meniscoid
gapping
stabilization
inflammation, symptoms and function

Question 21

common directional preference of extension/hyperextension when a disc change is indicated, what method is often used ______________ (____%)

Answer 21

McKenzie (70%)

Question 22

Evidence shows that Mckenzie Method is better useful for _________ IDD

Answer 22

acute IDD with LE symptoms and centralization occurs

Question 23

Disc changes ALWAYS cause symptoms? T or F

Answer 23

False; not in 2/3 cases

Question 24

Posture: (6)

Answer 24

body types
scoliosis
sway back
flat back
rounded or crouched
FHP

Question 25

Rigid Body Type:
LESS______
LESS_______
LESS_______

Answer 25

L-lordosis
hip motion, especially IR
foot and ankle EV or pronation/higher arches

Question 26

Flexible Body Type:
MORE_______
MORE_______
MORE________

Answer 26

L-lordosis
hip motion especially IR
foot and ankle EV or pronation/lower arches

Question 27

Sprinter body type:
Dancer body type:
Does body type affect/match activity?

Answer 27

rigid
flexible
YES

Question 28

How is scoliosis named?

Answer 28

by side of the convexity

Question 29

What are the two types of scoliosis?

Answer 29

structural - doesn’t go away w/FB (high sens)

functional or postural- goes away with FB; able to modify with PT

Question 30

Scoliosis:
Changes in one area may create compensatory changes in ________ areas

Answer 30

adjacent

Question 31

PT Rx for R thoracic scoliosis:

-MT goal:

-which side:

Answer 31

improve mm. lengths and joint motion

left SB and right rotation = issue
right SB and left rotation = exercises

Question 32

MET goal for R thoracic scoliosis:
-which side:

Answer 32

improving endurance and strength to counter curvature

left SB and right rotation = issue
right SB and left rotation = exercises

Question 33

Swayback characteristics:

Answer 33

increased lumbar lordosis
ant. pelvic tilt
flexible body type

Question 34

Flat back aka _____ spine characteristics:

Answer 34

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

Question 35

Rounded or crouched characteristics:

Answer 35

increased thoracic kyphosis
flattening of lumbar curve
post. pelvic tilt
often associated w/FHP

Question 36

6 lumbar vertebra:

Answer 36

lumbarization

Question 37

4 lumbar vertebra; L5 fuse w/S1

Answer 37

sacralization

Question 38

Load ____ on the lumbar region every anterior inch of FHP

Answer 38

doubles