Syndromes Flashcards
Altered Muscle States
- Spasm
- Hypertrophy
- Involuntary Muscle Holding
- Chemical Muscle Holding
- Voluntary Muscle Holding
- Disuse atrophy
- Wasting and Fibrosus
- Adaptive Shortening (normal tone)
- Fibrositis:
- Myalgia
Involuntary Guarding
Caused by injury or dysfunction
S/S include hypertonicity, protective muscle guarding with loss of “free” motion, elevated resting tone and abnormal elastic response to stretch
Treat the cause of the impairment
Chemical Muscle Holding
Caused by sustained involuntary guarding and could lead to a compartmental syndrome
S/S include doughy to touch, limited ROM
Treat with heat and massage to promote circulation to remove irritants and waste; exercise; think compartmental syndrome multifidus
Voluntary Muscle Guarding
Caused by pain or fear of pain and often follows involuntary or chemical muscle states
S/S include slow and guarded motions, can see trunk move as a whole
Treat once more serious pathologies, such as a fracture is ruled out; give reassurance and encourage movement
Adaptive Shortening
Caused by chemical muscle holding or slouched posture
S/S include NORMAL tone*, shortened length, loss of ROM, altered posture with increased lordosis secondary to psoas shortening
Treat with myofascia stretching
Facet Dysfunction
(1) Synovitis/Hemarthrosis (Strain)
(2) Stiffness
(3) Painful entrapment
(4) Mechanical block
(5) Chronic facet arthrosis
Synovitis/Hemarthrosis (Sprain)
Caused by awkward movement of catch or gross trauma
S/S: good but guarded movement, involuntary and voluntary muscle holding
Treatment:
- Lumbar: rest, soft corset, careful movement
- Cervical: rest, soft collar, careful movement - circular, interferential for swelling
- Codman principles to acute neck = diaphragmatic breathing, slow circumduction, circles within circles
Restriction/Stiffness
Caused by resolved synovitis hemarthrosis, not symptomatic
S/S: NONE, stiffness does not hurt; lowered tolerance to insult hence strain & associated pain if from current strain of the joint or neighboring hypermobile joints may become symptomatic if unstable
Treat with manipulation
Painful entrapment
Caused by an awkward movement in an eccentric range
S/S: unstable to slide inferior articular process down, head held away from painful side
Treatment:
- cervical: multifidus isometric manipulation
- lumbar: multifidus isometric manipulation or rotational manipulation over bolster
Mechanical block
Cause can be idiopathic, loose body or impaction
S/S: sudden onset, block to motion, relatively pain free
Treatment:
- cervical: strong manual traction with SB away and ROT to the blocked side
- lumbar: rotational manipulation over a bolster to further open up affected side
Chronic facet arthrosis
Caused by poor posture, trauma or overuse
S/S: dull ache, local pain, stiffness
Treat with posture, mobilize adjacent areas
Sacroiliac dysfunction
(1) Sprain strain
(2) Hypermobility
(3) Displacement
(4) Ligamentous weakness
(5) Instability
(6) Disc dysfunction
Ligamentous weakness
Caused by repeated minor strains, obesity, poor posture, vibration
S/S: pain on assuming fixed position, pain relieved by changing position, relieved by “cracking back” increasing weakness, supraspinous and S/! ligaments sensitive to touch
Treatment:
- early: exercise, stabilization, posture, back school
- later: pre discal rest/controlled activity, corset, braces, taping, instruction in first aid (ex: BB if injury was to occur)
Instability
Definition: instability is where the osseo-ligamentous structures and the neuromuscular control systems are unable to hold a spine in neutral and during motion against buckling and slippage/shear.
Caused by ligamentous stress and strain from sports and poor posture, lack of NM training and exercise, surgical such as laminectomy or fusion (above), and medical/surgical such as with cymopapain
Characterized by ligamentous weakness/laxity, muscle weakness and neuromotor atrophy, fatigue, poor posture, pain on assuming fixed position and chronic pain
Treatment:
- ensure slow continuous improvement
- muscle endurance, body awareness with motor control, diet and nutrition, motivation, frequent rest for disc nutrition, education on stability/overload and on movement/exercise
- exercises: abdominal setting with TA, multifidus, quadratus lumborum, quads, glutes
- MT to joints and myofascia
Cervical Spine Stabilization
Posture: atlas moves posterior with forward head
- keep all ROM activities within range
Avoid BB, neck rolling, isometrics as they can cause translation/slippage and aggravate instability
Treat by strengthening longus coli and multifidus strengthening
Disc dysfunction - Paris Tx Classification
(1) Pre-prolapse - instability
(2) Immediate injury - tear/herniation
(3) Acute & Sub-acute Prolapse
(4) Settled prolapse
(5) Chronic disc disease
Pre-prolapse
Hx: dull muscular ache on sitting (chemical muscle holding), has need to get up and move around, hx of self cracking, LBP occasionally radiating into buttock, no frank neuro signs
Physical: many instability signs, Grade 5/6 PIVM
Tx: stabilization, back school, manipulation, instruction for first aid
Immediate injury - tear/herniation
Hx: hx of pre-prolapse, sudden unguarded motion resulting in acute/deep pain usually from flexion and maybe with torque, patient may report “tearing” or “giving out”
S/S: sudden deep pain, can refer to buttocks, very guarded movements
Physical: avoid FWB and rotations, neuro signs will be negative for first 30 min, usually happens outside clinical setting
Tx: GOAL to heal outer annulus
- immediately into lordosis & stay for min 2 weeks; prefer 3-4
- support & reinforce behavior with taping or corset
- tx as acute prolapse if lordosis cannot be achieved without causing peripheralization
- gentle stabilization exercises
- myofascial techniques
Acute & Subacute prolapse
S/S: classic neurological signs, fatigue, disability Acute: days 1-4 - aim for lordosis - minimal bed rest to avoid disc swelling - attempt BB - medical palliative measures - education Subacute - day 4 and improving - initiate movement - myofascia manipulation - corset, stabilization - avoid aggravating prolapse
Settled prolapse
3 - 4 weeks, slow improvement, ambulatory
- Begin positional distraction with caution, treat as a home program WITHOUT rotational component
- Stabilization
- Lifestyle, healthy back regime
GOAL: prevent chronicity by encouraging activity and managing any fear avoidance behaviors
Chronic discogenic back pain
Hx: serious debilitating back pain with history of neuro signs and possibly failed surgery or other treatments
Physical: sad, depressed patient on meds; often obese, unfit, unhealthy, ROM restricted secondary to pain, PIVM combo restrictions and instability, myofascial restrictions with poor tone/condition
Tx: lifestyle education, stabilization, positional distraction if neuro signs, “careful” neuro mobs, manipulation, fitness training/work hardening, counseling
Spondylolisthesis - Type I
Fatigue fracture of pars-articularis - spondylolisis
S/S: step on standing (appears one level higher than defect), if unstable it will disappear when lying, hypertonicity at affected level, ligamentous dull ache, rotational component if one sided that can be palpated in standing
Caused by repeated overload, combo torque motion that involves extension and rotation
Common in weightlifters, gymnasts, divers
Tx: stabilization, manipulation to joints above and myofascia to psoas
Spondylolisthesis - Type II
Degenerative - facet arthrosis and tropism
Caused by congenital tropism which is the alteration of facet planes from mostly coronal to sagittal, degeneration process leading to facet arthrosis and overload in these conditions.
S/S: step will appear at the level of the slip, x-ray must be in standing and loaded at the end of the day
Treatment: same as type I, stabilization and manipulations to usually joint above and myofascia to psoas
*lordotic posture can make spondy worse, therefore look for tight hip flexors and stretch in prone or supine with leg off table
Spondylolisthesis - Type III
Isthmic spondylolisthesis Pars interarticularis (isthmis) lengthens allowing vertebra to slip forward, precipitating factors include childhood obesity S/S: x-ray may show elongated pars/isthmus or show fracture of pars therefore the stretch of pars (initial cause) is often missed Treatment: same as types I and II as well as weight control