Test 1 Flashcards

Question 1

Q

of vertebrae lumbar spine

Question 2

Q

how do lumbar vertebrae differ

Answer

A

larger size

absence of costal facets

*Designed for load bearing upon the VB (anterior elements)

Question 3

Q

Why may there be less / more lumbar vertebrae?

Answer

A

L5 can sacralize/ fuse with S1

can have an extra vertebrae

Question 4

Q

Spinous Process of Lumbar Vertebrae

–shape

–orientation

–its job

Answer

A

large and rectangular
have bulbous tip

almost horizontal
extended posteriorly

provide attachment for fascia, muscles and ligaments

Question 5

Q

What is key characteristic of a lumbar vertebrae:

SP
why important

Answer

A

wide and rectangular spinous processes:

important because of attachments of muscles, fascia, ligaments, WB, maintain lordosis

Question 6

Q

What facet orientation would favor flexion /extension physiological movements?

Answer

A

sagittal plane

we would not be able to do rotation as easily, as rotate open facets on side to which we rotate

Question 7

Q

Which ligament resists flexion of the lumbar spine?

Answer

A

PLL:

restrict flexion

(longest lever arm to resist flexion is the interspinous—skinny but longer lever arm than the supraspinous even though supraspinous is wider)

Question 8

Q

What ligament goes slack as go into flexion?

Question 9

Q

What segments will not add much to lumbar rotation and why?

Answer

A

orientation changes and L5 on S1 is more of a frontal plane,

L4-L5-S1 orientation-we have the lumbosacral ligaments to help support the area

Question 10

Q

Peripheral annular bulge?

Answer

A

NR damage minimal because not pinching nerves

Question 11

Q

Bony Architecture of the lumbar Spine

# vertebra
Differ because of their l____
designed for load-bearing upon ____
___ can sacralize
can have extra vertebrae

Answer

A

Five vertebra
Differ because of their larger size and absence of the costal facets
designed for load-bearing upon the vertebral bodies (anterior elements)
L5 can sacralize: fuse with S1
can have extra vertebrae

Question 12

Q

Lumbar Spinous processes

Size and shape
Orientation
Role

Answer

A

Large and rectangular, Have bulbous tip
Extended posteriorly, Almost horizontal
Provide attachment for fascia, muscles, and ligaments

Question 13

Q

Lumbar TP

Shape
which one is the longest
Which way does L1-L4 face?
Which way does L5 face?
what type of accessory process?

Answer

A

Long and thin except for L5
L3 is the longest (generally)
L1-L4 pass laterally and backwards
L5 passes laterally and then upwards and slightly backwards
Small tough accessory process

Question 14

Q

Lumbar TP:

Which one is not long and thin?

Question 15

Q

Lumbar TP:

Which one is longest?

Question 16

Q

Lumbar TP:

which way does L1-L4 pass?

Answer

A

LATERALLY and BACKWARDS

Question 17

Q

Lumbar TP:

Which way does L5 face?

Answer

A

passes LATERALLY, then UPWARDS, then slightly BACKWARDS

Question 18

Q

Lumbar TP

What type of accessory process?

Answer

A

small and tough

Question 19

Q

Lumbar Articular Process

What type of joint?

what cartilage?

how many processes?

Answer

A

DIARTHRODIAL JOINT with synovial membrane and capsule
Joint surfaces are covered with hyaline cartilage
Superior articular processes
Inferior Articular processes

Question 20

Q

Lumbar Articular Process

What is on the joint surfaces?

Answer

A

Hyaline Cartilage

Question 21

Q

Lumbar Articular Process

What type of joint?

Answer

A

DIARTHRODIAL JOINT with synovial membrane and capsule

Question 22

Q

The facet is a synovial joint and so it will have synovial lining, it is all encased around hylaine cartilage and then encased in the capsule.

sometimes that can fray or desiccate a little and get put into the joint interspace and cause abnormal mechanics so you may not have a movement issue or may due to pain.

may find hypomobility in stiff spine or hypermobility in lax spine.

if have a surgical see what messes up the mechanics of the joint and how to improve them.

Answer

A

The facet is a synovial joint and so it will have synovial lining, it is all encased around hylaine cartilage and then encased in the capsule.

sometimes that can fray or desiccate a little and get put into the joint interspace and cause abnormal mechanics so you may not have a movement issue or may due to pain.

may find hypomobility in stiff spine or hypermobility in lax spine.

if have a surgical see what messes up the mechanics of the joint and how to improve them.

Question 23

Q

What happens if the facet joints are loaded more than the VB?

Answer

A

If facet joints loaded more than VB we need to restore lumbar lordosis to redistribute the weight to the VB

Question 24

Q

What happens if ligamentum flavum becomes lax?

Answer

A

Ligamentum Flavum is more posterior and is elastic but overtime can become lax and fold into the spinal canal and cause compromise of the spinal canal
— degeneration of discs or facets can cause it to lose elasticity, can get into spinal canal and can cause NR dysfunction

Question 25

Q

Superior Articular Processes

Concave or convex?
Orientation:
Mammillary process

Answer

A

Slightly concave
Face medially and posteriorly
Posterior border has rough elevation called the mammillary process

Question 26

Q

Is superior Articular Process concave or convex?

Answer

A

slightly concave

Question 27

Q

orientation of superior articular process?

Answer

A

MEDIALLY and POSTERIORLY

Question 28

Q

Which articular process has the mamillary process? What is it?

Answer

A

Superior articular process

it is a rough elevation on the posterior border

Question 29

Q

Inferior Articular Process
1. Concave or convex?

Orientation:

Answer

A

Slightly Convex

2. Face laterally and anteriorly

Question 30

Q

Articular facets are reciprocally ____ superiorly and _____ inferiorly

Answer

A

Articular facets are reciprocally concave superiorly and convex inferiorly

Question 31

Q

Is inferior Articular Process concave or convex?

Question 32

Q

Orientation of inferior articular process?

Answer

A

LATERALLY and ANTERIORLY

Question 33

Q

Facet Joints: how does alignment change at lumbosacral joints?

Answer

A

Change from SAGITTAL orientation to more CORONAL (frontal) orientation at the lumbosacral joints

Question 34

Q

Lumbar: Vertebral body:

shape and size

is it wider or deeper
is it broader or higher

Answer

A

Large
Kidney shaped
Wider than deep
Broader than high

Question 35

Q

Shape of vertebral canal

Answer

A

shape of equilateral triangle

Larger than thoracic spine

Smaller than cervical spine

Question 36

Q

Where is the vertebral canal largest/smallest?

Answer

A

Thoracic –> Lumbar –>Cervical (largest)

Question 37

Q

Discs make up about ___% of total length of vertebral column

Answer

A

Discs make up about 20-25% of total length of vertebral column

Question 38

Q

Function of the IV Disc (3)

Answer

A

Binds together vertebral bodies
Permits movement within segment
Transmits loads from one vertebral body to the next

Question 39

Q

Disc Material: fluid nucleous propulsus

as sidebend to the right: where will pressure change be greater?

Answer

A

change of pressure will be greater to the left,

Question 40

Q

Disc Material: fluid nucleous propulsus

As go into flexion: where will pressure change be greater?

Answer

A

As go into flexion the change in pressure will be more posterior

Question 41

Q

Disc Material: fluid nucleous propulsus

As go into extension: where will pressure change be greater?

Answer

A

As go into extension he change in pressure will be more anterior

Question 42

Q

Disc Material: fluid nucleous propulsus

Rotation

Answer

A

With rotation get more compressive affect due to annulus criss cross fibers

Question 43

Q

Disc Material: fluid nucleous propulsus

as sidebend to the left: where will pressure change be greater?

Answer

A

change of pressure will be greater to the right

Question 44

Q

Role of ligaments (3)

Answer

A

Principle role is to prevent excessive movement
Principal tensile load bearing elements
Provide information about posture and movement

Question 45

Q

Which ligament has the longest lever arm?

Answer

A

longest lever arm is the:

SUPRASPINOUS LIGAMENT

then the interspinous

and then the PLL

Question 46

Q

Vertebral Motion (2)

Answer

A

The motion segment: two adjacent vertebrae and their intervening disc and associated ligaments
In normal motion segment: these three parts are anatomically linked and mechanically balanced

Question 47

Q

What is a motion segment for vertebrae? (3)

Answer

A

TWO adjacent VERTEBRAE and their intervening DISC and associated LIGAMENTS

In normal motion segment: these three parts are anatomically linked and mechanically balanced

Question 48

Q

Significance of TWO adjacent VERTEBRAE and their intervening DISC and associated LIGAMENTS

Answer

A

Motion segment

In normal motion segment: these three parts are anatomically linked and mechanically balanced

Question 49

Q

Motion Segment : what may occur with age?

Answer

A

With age, degeneration may affect motion segment

with age more difficulty ie excursion of bone in VB or facet or IV foramen can mess up mechanics as well—get a sense of whether there will be a movement issue involved —not changing the bony change but can relieve the stresses

Question 50

Q

Motion segment: how is motion named?

Answer

A

Motion is named by direction of SUPERIOR vertebrae

Question 51

Q

What can occur if there is dysfunction in one part of segment?

Answer

A

Dysfunction in one part of segment may lead to dysfunction elsewhere

Question 52

Q

Flexion: Forward Bending

1) How do the facets glide?
2) Is it roll/glide?
3) what occurs at the facet joint?
4) which ligaments on slack?
5) which ligaments on stretch?
6) where does the nuclear material go?

Answer

A

Inferior facet of superior vertebrae glides anteriorly and superiorly (upwardly) over superior facet of inferior vertebrae
Combination of anterior roll and anterior glide of superior vertebral body
creates an opening at facet joint as inferior facet of superior vertebrae moves superiorly
Slack: ALL
Stretch:
(1) PLL
(2) Ligamentum Flavum
(3) Interspinous Ligament
(4) Supraspinous Ligament
Nuclear material shifts posteriorly (pressure changes)

Question 53

Q

Flexion: Forward Bending

How do the facets glide?

Answer

A

Inferior facet of superior vertebrae glides anteriorly and superiorly (upwardly) over superior facet of inferior vertebrae

Question 54

Q

Flexion: Forward Bending

Is it roll/glide?

Answer

A

Combination of anterior roll and anterior glide of superior vertebral body

Question 55

Q

Flexion: Forward Bending

what occurs at the facet joint?

Answer

A

creates an opening at facet joint as inferior facet of superior vertebrae moves superiorly

Question 56

Q

Flexion: Forward Bending

which ligaments on slack?

Answer

A

Slack: ALL

Question 57

Q

Flexion: Forward Bending

which ligaments on stretch?

Answer

A

Stretch:

(1) PLL
(2) Ligamentum Flavum
(3) Interspinous Ligament
(4) Supraspinous Ligament

Question 58

Q

Flexion: Forward Bending

where does the nuclear material go?

Answer

A

Nuclear material shifts posteriorly (pressure changes)

Question 59

Q

Extension: Backwards bending

How do facets glide?
What happens at the facet? (open/close)
Creates
a) Slack:
b) Stretch:
Nuclear material shifts where?

Answer

A

Inferior facet of superior vertebrae glides inferiorly and posteriorly upon superior facet of inferior vertebrae
Creates “closing” at facet joint
Creates

Slack:

(1) PLL
(2) Ligamentum Flavum

Stretch:
(1) ALL

Nuclear material shifts anteriorly

Question 60

Q

Extension: Backwards bending

How do facets glide?

Answer

A

Inferior facet of superior vertebrae glides inferiorly and posteriorly upon superior facet of inferior vertebrae

Question 61

Q

Extension: Backwards bending

What happens at the facet? (open/close)

Answer

A

Creates “closing” at facet joint

Question 62

Q

Extension: Backwards bending

which ligaments on slack?

Answer

A

(1) PLL

(2) Ligamentum Flavum

Question 63

Q

Extension: Backwards bending

which ligaments on stretch?

Question 64

Q

Extension: Backwards bending

Where does the nuclear material shift?

Answer

A

Nuclear material shifts anteriorly

Answer 59

A

Coupled with rotation
Inferior facet of superior vertebrae slides upward on contralateral side causing “opening”
Inferior facet of superior vertebrae slides downward on ipsilateral side causing “closing”
Example: RSB causes closing, right facet pair and opening left facet pair
Interspace on ipsilateral side approximate
Nuclear material displaced toward contralateral side
Contralateral ligamentum flavum and Intertransverse Ligament are stretched

Answer 60

A

Coupled with rotation

Answer 61

A

Contralateral side opens

Inferior facet of superior vertebrae slides upward on contralateral side causing “opening”

Answer 62

A

Ipsilateral side closes

Inferior facet of superior vertebrae slides downward on ipsilateral side causing “closing”

Answer 63

A

RSB:

causes closing, right facet pair

opening left facet pair

Answer 64

A

Interspace on ipsilateral side approximate

Answer 65

A

Nuclear material displaced toward contralateral side

Answer 66

A

Contralateral

ligamentum flavum
Inter-transverse Ligament

Answer 67

A

Occurs when upper vertebrae slides over lower vertebrae
Shearing forces limit ROM
Direction of rotation is named according to upper vertebrae moving on lower vertebra
Named according to the direction of the body and not the spinous process
Coupled with Side-bending
Rotation causes a gap on the ipsilateral facet joint and compression on the contra-lateral facet joint

Answer 68

A

Occurs when upper vertebrae slides over lower vertebrae

Answer 69

A

Shearing forces limit ROM

Answer 70

A

Direction of rotation is named according to upper vertebrae moving on lower vertebra

Answer 71

A

Named according to the direction of the body and not the spinous process

Answer 72

A

Coupled with Side-bending

Answer 73

A

Rotation causes a gap on the ipsilateral facet joint and compression on the contra-lateral facet joint

Answer 74

A

Example: right rotation of the superior vertebrae separates its INFERIOR FACET from the SUPERIOR FACET of the inferior vertebrae

Answer 75

A

Vertebral Body turns right and spinous process turns left

Answer 76

A

**disc not necessarily moving around because encapsulated by annulus but pressures are changing.

If there is damage to the annulus then the disc material can start to work its way out to the periphery.**

Answer 77

A

normal to see with side bending and rotation.

but we do not expect to see in flexion and extension.

Answer 78

A

a) Occurs throughout the entire spine
b) Lumbar spine—coupling varies with the level and position
c) Many opinions about the direction of coupling: ipsilateral or contralateral side (see next slide)

Answer 79

A

if person is flexing and also side bending we would need to explore this abnormality

Answer 80

A

one that gives the most ease and most ROM, soft end feel (due to configuration of the facet joints)

Movement combinations that result in most ease
Results in greatest ROM and softest end feel
involve one motion being accompanied by another
occurs due to configuration of zygopophyseal joint

Answer 81

A

occurs due to configuration of zygopophyseal joint

Answer 82

A

Coupled Movements:

Answer 83

A

Neutral refers to any position where facet joints are not engaged (idling) and ligaments and capsules are not under tension

Answer 84

A

(1) assume normal standing posture with normal A/P curves
(2) When any part of the lumbar or thoracic spine is in NEUTRAL position:

SIDE-BENDING of a vertebra will be OPPOSITE to the side of the ROTATION of that vertebrae

–sidebend to the right with neutral spine lumbar: rotation will occur to the left

Answer 85

A

Fryette’s First Law: Neutral Mechanics or Type I Mechanics:

Answer 86

A

(1) Facets are ENGAGED (not idle) and ligaments are under tension due to physiological motion that has occurred
(2) SIDE-BENDING and ROTATION occur to the SAME SIDE!
(a) ie if flexed spine, and side bend: the rotation will go to the same side
(3) May be at more risk to injury when non-neutral mechanics are present

Answer 87

A

Neutral spine

SIDE-BENDING of a vertebra will be OPPOSITE to the side of the ROTATION of that vertebrae

Answer 88

A

Engaged facets (ligaments under tension)

SIDE-BENDING and ROTATION occur to the SAME SIDE!

Answer 89

A

May be at more risk to injury when non-neutral mechanics are present

Answer 90

A

Fryette’s Second Law: Non-Neutral Mechanics or Type II Mechanics:

Answer 91

A

Fryette’s Second Law: Non-Neutral Mechanics or Type II Mechanics:

Answer 92

A

Fryette’s First Law: Neutral Mechanics or Type I Mechanics:

Answer 93

A

(1) If motion in one plane is introduced to the spine, motion in the other two planes is thereby restricted

—-if i move a segment, any part of the spine, i will be limiting movements at other parts of the spine because it is so interconnected: if head is rotated to the left you can feel it in the lumbar spine

—-segment to segment it is restricted as well, if you take up slack then less slack is available

Answer 94

A

Fryette’s Third Law: Type III Mechanics

Answer 95

A

Fryette’s Third Law: Type III Mechanics

Answer 96

A

physiological

Answer 97

A

Fryette: in flexion and extension: coupling occurs to the same side

Katlenborn:

a) in Flexion: sidebending and rotation to the same side
b) but in extension: sidebending and rotation to the opposite side

Greenman: it depends on what part of the curve you are looking at

a) Coupling varies, dependent upon A/P curves (most relevant in thoracic spine)
b) Follows Fryette’s Law for the Lumbar Spine: flexion and extension: coupling occurs to the same side

Answer 98

A

in flexion and extension: coupling occurs to the same side

Answer 99

A

FLEXION: sidebending and rotation to the same side

EXTENSION: sidebending and rotation to the opposite side

Answer 100

A

Greenman: it depends on what part of the curve you are looking at

a) Coupling varies, dependent upon A/P curves (most relevant in thoracic spine)
b) Follows Fryette’s Law for the LUMBAR SPINE: flexion and extension: coupling occurs to the same side

Answer 101

A

Katlenborn only agrees that in FLEXION that sidebending and rotation occur to the same side

Greenman

Follows Fryette’s Law for the LUMBAR SPINE:
flexion and extension: coupling occurs to the same side

Answer 102

A

Katlenborn

FLEXION: sidebending and rotation to the same side

EXTENSION: sidebending and rotation to the opposite side

Answer 103

A

[go against normal mechanics—dont go as far, don’t want to stay there-but a patient may have a facet or disc issue and be stuck in that and so have pain]

Movement combination that result in decreased or absent ease
- For example: stand in neutral alignment by sidebend and rotate to the same side / or flex lumbar spine and sidebend and rotate to opposite sides
Non coupled movements: results in least ROM and hardest end feel
Patients may be moving in non-coulee way as a result of pathology

Answer 104

A

Non-coupled movements

Answer 105

A

Non coupled movements: results in least ROM and hardest end feel

Answer 106

A

noncoupled movement

Answer 107

A

noncoupled movement

Answer 108

A

Due to a pathology

Answer 109

A

Ankylosing Spondylitis
Osteoarthritis
Paget’s Disease
Osteoporosis
Spondylosis
Scoliosis
Laminectomy/ Fusion / Chemonucleolysis
Degenerative Disc Disease

Answer 110

A

Spinal Stenosis
Spondylolysis
Spondylolisthesis

Answer 111

A

Fracture
Narrowing of IV Foramen
–multiple causes
(degeneration, bone excursions blocking nerve exits)
Issues with Facet or IV Disc

Answer 112

A

a) Trauma
b) Osteoporosis
c) Fractures secondary to other conditions

Answer 113

A

Please review notes about pathologies and fractures of the spine from HSS course
Review for spine assessment
a) MMT
b) Goniometry

Answer 114

A

Addresses common, non-specific back pain

[injury causes fear to move leads to cascade: fear avoidance with non-specific back pain: ie had a fall and land on butt and have LBP, initially it will hurt and have muscle spasm and protective of movements and avoidance, get immobilization and disuse, causes muscle weakness joint stiffness and loss of cardiovascular fitness, leads to atrophy loss of coordination and musculoskeletal dysfunction]

Answer 115

A

Pain/Injury causes

fear to move leads to cascade:

fear avoidance with non-specific back pain: ie had a fall and land on butt and have LBP,

initially it will hurt and have muscle spasm and protective of movements and avoidance,

get immobilization and disuse,

causes muscle weakness joint stiffness and loss of cardiovascular fitness,

leads to atrophy loss of coordination and musculoskeletal dysfunction (physiological impairment)

Answer 116

A

a) Does patient believe that physical activity and work will affect LBP?
b) Does this fear lead to avoidance of activities?

Waddell: musculoskeletal dysfunction has certain sx, we attend to the sx and label them and are influenced by how we were treated when we were young/how we are being treated to how magnified the pain is

Answer 117

A

Pt with LBP will have limitation in one or more of these clinical tests

Treat the cause: Acute disability proportional to number of objective clinical findings

Treat by disrupting the cycle: with chronic pain, disability is disproportional to the physical findings and it is self-sustaining

spinal tenderness
sit up
Pelvic Flexion
Total flexion
Total extension
Lateral flexion
SLR
Bilateral active SLR

Answer 118

A

Wedell says that patients with LBP with true organic cause, one or more of these tests will be positive.

If they have a lot of the tests being positive or pain is out of proportion for clinical findings then think about a biopsychosocial aspect to the pain.

spinal tenderness
sit up
Pelvic Flexion
Total flexion
Total extension
Lateral flexion
SLR
Bilateral active SLR

Answer 119

A

Do not just say they are a malingerer, think about what the trigger is to get through that barrier (ie social influence at home, anger about accident, loss of work, may need to get a psychologist or social worker on the case) —we identify more than treat a psychological issue

with a malingerer we try to figure it out and get them to a higher level

Answer 120

A

Treat the cause: Acute disability proportional to number of objective clinical findings

Treat by disrupting the cycle: with chronic pain, disability is disproportional to the physical findings and it is self-sustaining

Answer 121

A

Patients with true LBP will have limitations in one or more of these clinical tests. Acute disability will be proportional to the number of objective clinical findings-treat the cause

Answer 122

A

With chronic pain the disability is disproportional to the physical findings and is self-sustaining-treat by disrupting the cycle

Answer 123

A

4/5 variables spinal manipulation likely to work

(1) symtoms DURATION
(2) FEAR AVOIDANCE beliefs
(3) lumbar HYPOMOBILITY
(4) HIP IR ROM
(5) NO SYMPTOMS DISTAL to the knee

Answer 124

A

OVERLOAD of BONY TRABECULAE
(stand in lordosis, support with a lot of extension)
Joint INFLAMMATION and HYPERTROPHY
MICROFRACTURE
DYSFUNCTION
VASCULAR disturbance of bone or soft tissue (nourishments of facets/disc)
DEGENERATIVE process
- —-Degenerative Joint Disease
- —-Meniscoid synovial folds (get in the way)
- —-Normal adaptation to stress
- —-Subluxation (slipping of one facet on the other, can be accompanied by loss of disc height or loss of the movement get stuck in a particular position)

Answer 125

A

1—–Degenerative Joint Disease

2—–Meniscoid synovial folds (get in the way)

3—–Normal adaptation to stress

4—–Subluxation (slipping of one facet on the other, can be accompanied by loss of disc height or loss of the movement get stuck in a particular position)

Answer 126

A

Innervation to disc, medial aspect of posterior ramus innervations structures as well as the sinovertebral nerve innervating the disc—this pain is diffuse and hard to localize because fibers run up a level or down a level—hard to say pain is in one spot

Answer 127

A

Dysfunctional position of facets
—facets can become maligned and create abnormal stress on tissues (capsule, ligament, disc) and abnormal mechanics of motion

Premise of treatment - re-align facets to restore normal mechanics

Answer 128

A

Name by the direction they cannot complete or the one which is symptomatic

eg flexion dysfunction: cannot complete flexion without discomfort or abnormal movement pattern

named by the movement the patient cannot do: if pain with extension it is an extension dysfunction

We need to restore L2 on L3 into flexion or into extension for our mobilizations: realign the facets and make it a more stable system to decrease the stress to decrease the sx

Answer 129

A

re-align facets to restore normal mechanics

Answer 130

A

Instability: hypermobility of motion segment

Premise of treatment: restore balance of the motion segment, teach stabilization techniques
—make sure alignment is proper and then go to stabilization exercises

Answer 131

A

restore balance of the motion segment, teach stabilization techniques

—make sure alignment is proper and then go to stabilization exercises

Answer 132

A

Disc Protrusion
Disc Herniation or Prolapse
Intraspongy Nuclear Herniation (nuclear material goes up into the endplate)

Answer 133

A

annulus fibrosis protrudes CIRCUMFERENTIALLY beyond the peripheral rims of the vertebral bodies but there is no serious nerve root compromise

NO serious NR compromise

Answer 134

A

annulus fibrosis bulges and causes clinical signs—–usually UNILATERAL

Touches a nerve or messes up the mechanics enough to cause the patient some PAIN

Answer 135

A

Displaced material is confined to only a few strands of the annulus fibrosis

Disc is CONTAINED inside ANNULUS

Answer 136

A

Displaced nucleus goes THROUGH ANNULUS annulus and PUSHES the PLL

comes through annulus and pushes into PLL

Answer 137

A

Extruded material LIES FREE IN THE SPINAL CANAL where it can:

(1) Remain trapped between the NR and the disc
(2) Migrates and lie behind the vertebral body in the NR
(3) Migrates to the IV foramen
(4) Migrates to midline, just anterior to the dural sac

Answer 138

A

Peripheral Annular Bulge

annulus fibrosis protrudes CIRCUMFERENTIALLY beyond the peripheral rims of the vertebral bodies but there is no serious nerve root compromise

NO serious NR compromise

Answer 139

A

Localized Annular Bulge

annulus fibrosis bulges and causes clinical signs—–usually UNILATERAL

Touches a nerve or messes up the mechanics enough to cause the patient some PAIN

Answer 140

A

Type 1: Prolapsed IV Disc:

displaced material is confined to only a few strands of the annulus fibrosis

Disc is contained inside annulus

Answer 141

A

Type 2: Extruded IV Disc

Displaced nucleus goes through annulus and pushes the PLL

comes through annulus and pushes into PLL

Answer 142

A

Type 3: Sequestered IV Disc

Extruded material lies free in the spinal canal where it can:

(1) Remain trapped between the NR and the disc
(2) Migrates and lie behind the vertebral body in the NR
(3) Migrates to the IV foramen
(4) Migrates to midline, just anterior to the dural sac

Answer 143

A

(1) Remain TRAPPED between the NR and the DISC
(2) Migrates and lie behind the VERTEBRAL BODY in the NR
(3) Migrates to the IV FORAMEN
(4) Migrates to midline, just ANTERIOR to the DURAL SAC

Answer 144

A

Schmorl’s Nodes: herniation of the nucleus pulposus into the vertebral body

Answer 145

A

herniation of the nucleus pulposus into the vertebral body

Answer 146

A

manage current symptoms and prevent further degeneration (don’t want to get prolapse)

Answer 147

A

centralize the nuclear material: many schools of thought

can do mechanical things to bring nuclear material back to the center location such as extension to fix posterior protrusion

Answer 148

A

encourage movements that don’t cause sx, may need surgery based on MRI

Answer 149

A

Design intervention based on signs and symptoms and known precautions
Manage the pain then the movement problem while respecting the pain and the physiological state of the tissues/person

Answer 150

A

Manage the pain then the movement problem while respecting the pain and the physiological state of the tissues/person

Answer 151

A

difficult to localize: pain transmitting nerves innervate multiple levels

a) Disc
b) Facet
c) Ligament
d) Muscle

Answer 152

A

Radiate from nerve-follow dermatomal pattern

a) Rule out local peripheral nerve involvement
b) Radicular vs Non Radicular Issue
c) Nerve Root vs Peripheral Nerve issues

Answer 153

A

from like-innervated structures

especially thoracic spine and shoulder girdle area, or visceral refer to lumbo-pelvic region

Answer 154

A

Facet school: treat the facet
Cyriax School: treat the disc primarily
McKenzie School: looks at disc and also movement dysfunction as well as postural syndromes—extension, disc, postural, true dysfunction, disc derangement
Osteopathic Approach: muscle energy techniques, mobilizations, manipulations to get the patient back into alignment

Answer 155

A

treat the DACET

Answer 156

A

treat the DISC primarily

Answer 157

A

looks at DISC and also MOVEMENT DYSFUNCTION as well as POSTURAL SYNDROMES—extension, disc, postural, true dysfunction, disc derangement

Answer 158

A

muscle energy techniques,
mobilizations,
manipulations

to get the patient back into alignment

Answer 159

A

NEUROLOGICAL component and dura is stuck and not GLIDING as it should

Answer 160

A

FUNCTIONAL MOVEMENT ASSESSMENT and assess whether normal and restore normal PHYSIOLOGY

Answer 161

A

STRETCH tight structures, STRENGTHEN weak structures

Evaluate and treat to get back to total body better physiological state

Answer 162

A

Neurodynamic Treatment: David Butler
Functional Orthopaedics: IPA
Movement System Balance Theory, Movement System Impairment (Sahrmann)
Back School
Spinal Stabilization
Traction

Answer 163

A

SPECIFIC EXERCISES
- -Extension syndrome
- -Flexion Syndrome
- -Lateral Shift Syndrome
MOBILIZATION
- -Lumbar
- -SI
Immobilization
- -Immobilization Syndrome
TRACTION
- -Traction Syndrome
- -Lateral Shift Syndrome

Answer 164

A

-Extension syndrome
-Flexion Syndrome
-Lateral Shift Syndrome

Answer 165

A

-Lumbar

- -SI

Answer 166

A

–Immobilization Syndrome

Answer 167

A

-Traction Syndrome

- -Lateral Shift Syndrome

Answer 168

A

Movement System Impairment Classification

Answer 169

A

Standardized examination that includes test movements of low back and lower extremities

–Active movements looking for substitutions

–Flexibility tests for muscles related to posture

–Strength/coordination tests for postural control

Answer 170

A

5 Categories:

(1) Lumbar Flexion
(2) Lumbar Extension
(3) Lumbar Rotation
(4) Lumbar Rotation with Flexion
(5) Lumbar Rotation with Extension

[she categorizes lumbar pain based on MOVEMENT TENDENCIES- evaluate you during tasks,

is there a bias i.e. a flexion bias
this allows her to create a program to counteract those tendencies and strengthen and stretch as needed for normal movement pattern
exercise based interventions: stabilization and stretching]

Answer 171

A

Classify based on consistent pattern

Answer 172

A

Goal: alter MOVEMENT and POSTURE of patients that produce inordinate STRESS ON TISSUE CAUSING SYMPTOMS

Answer 173

A

Intervention via exercise
1) Select exercises by those movements which reduce LBP during clinical examination

2) Stabilization exercises as needed
3) Increase extensibility of tight structures that IMPEDE MOVEMENT in certain directions during clinical examination

Answer 174

A

Patient education about postures to avoid

Answer 175

A

Present History
Area: Location of symptoms
Onset
Nature: pain description: pain scales (numerical rating scale, mcgill pain scale)
- –note if there is a mismatch with findings
- –oswestery questionnaire
- -track patient as they go through therapy
Behavior: of symptoms
- –SIN: severity, irritability, and nature
Precipitating/alleviating factors
Effect of rest on symptoms
Particular questions related to
- –Type of mattress, pillow
- –Position of sleep
- -Effect of prolonged sitting
- -Effect of coughing or sneezing—intra-abdominal pressure relates to the intra-discal pressure
Refer to use of standardized indices and disability questionnaires to quantify and track patients perception of the problem
- –Oswestry Low Back Pain Questionnaire
- –Quebec Task Fore Questionnaire
Special Questions (look out for caudal equine syndrome)
- –Trouble with bowel or bladder
- –Numbness in groin area or down leg
- –Recent unexplained weight loss
- –Medications
General Health
Tests- x-rays, MRI, CT scan, bone scan
Past history
Social history
Family history
Level of activity (what is their sport, recurrent sport)

Answer 176

A

onine: The Oswestry Disability Index (also known as the Oswestry Low Back Pain Disability Questionnaire) is an
extremely important tool that researchers and disability evaluators use to measure a patient’s permanent
functional disability. The test is considered the ‘gold standard’ of low back functional outcome tools [1].

Answer 177

A

worse at night or worse with activity or constant throughout the day

Answer 178

A

in which case pain pattern will be stiff in morning better as day goes on and better with movement

Answer 179

A

When is it better?

Answer 180

A

certain activity or movement

Answer 181

A

certain activity or movement such as sitting in flexion pushes the disc back and causes pain)

Answer 182

A

willingness to move-and watch face, mechanics i.e. side bending and neutral spine rotation will be opposite but if rotation to same spine in neutral lumbar spine may have a non coupled movement, always ask where is the pain

Answer 183

A

what should we be sure to include exam? ability to correct the posture and also the UE and LE flexibility tests because we can help her and lengthen hip flexors etc them if they are tight so that stresses are in the proper part of the spine and not the improper parts of the spine. posture is a teaching moment-give education on posture to patient-like overtime you get a text i want you to fix your posture
there is a yarmulke two inches above your head, keep it in there
bend at your hips

Answer 184

A

REVIEW OF SYSTEMS: always remember that systemic or visceral disease can mimic musculoskeletal disorders.
Do a thorough review.

Answer 185

A

Clear the Hip and SI Joints

Review last semester: muscle tests, reflexes, sensation, provocative testing hip, compression and distraction for SI joint.

Answer 186

A

1) Observe moment
2) Check gait
3) Observe body type
4) Observe posture
5) Facial Expressions (associated with movement and at rest)
6) Noticeable Deformities, atrophy or swelling

Answer 187

A

a) Do a complete POSTURAL inspection : sitting, standing etc.
b) Observe patient from POSTERIOR, LATERAL, and ANTERIOR view
c) Check SYMMETRY of bony landmarks

Answer 188

A

(1) what these postures do for their pain: typical and corrected

(2) postural inspection:
head orientation,
scapula and acromion for shoulder height levels, and inferior angles,
heights of pelvis both sides,
knee recurvatum flexion,
feet pronation supination turn in turn out,

look are segments rotated when look from above at birds eye view,

side curves cervical thoracic and lumbar,

lateral shift (something happening pt is trying to get away from vs a scoliosis where there is a compensation along the spine):

Answer 189

A

see the block of the scapula shifted over the block of the pelvis/body:

shifting without much of a compensation (in a scoliosis head and pelvis still aligned with compensation curves along the spine—the scoliotic curves have rotation and rib deformities)

Answer 190

A

a) Condition of SKIN, subcutaneous tissue and MUSCLES
- -skin rolling
- -histamine reaction scratch test [can give a hint as to location of the problem]

b) Check SKIN for TENDERNESS, MOISTURE, TEXTURE, faun’s beard, cafe au lait spots
c) Check subcutaneous tissues for NODULES
d) Check muscles for TENDERNESS, TIGHTNESS, and MSUCLE SPASMS (trigger points)

Answer 191

A

**MUST: study the anatomy of the spine and the muscles ‘

flexibility tests, reflexes,

Answer 192

A

may be a refer of LBP

Answer 193

A

Body of L4 level of Iliac Crests
–a superficial landmark is the SP is directly behind the body

body of L4 is big

–from here we can count up and count down: there will be an interspace, then a wide SP, then an interspace …note if the patient is flexed or extended the interspace will change

Answer 194

A

Spinous Process of L5 is superior-medial to PSIS at 30 degree angle

—L5 is less rectangular and a little more pointy

Answer 195

A

T12: follow 12th rib and count down

T12 SP has less downward slope and more horizontal orientation

Answer 196

A

1) Check by counting up and down
2) if discrepancy confirm with X-ray
3) Lumbarization of S1—results in 6th lumbar vertebra
4) Sacralization: L5 is fused to sacrum

Answer 197

A

Lumbarization of S1—results in 6th lumbar vertebra

Answer 198

A

Sacralization: L5 is fused to sacrum

Answer 199

A

quality of movement
willingness to move
quantity of movement

Answer 200

A

(a) can be smooth and easygoing, can be that they swing around and then go into flexion due to structural barrier or may jutter a bit, may go down smoothly and then a bunch of segments go at once.
(b) If smooth movement then we apply the overpressure and see if it will provoke the systems
(c) since we are interested in lumbar spine the overpressure will be in the lower thoracic region

Answer 201

A

(a) Goniometry: note placement
(b) Bubble goniometer
(c) Measure hand to floor
(d) they make a cervical range of motion device
(e) must report it as an ARC OF MOTION AS A RANGE and not just a single number
(f) Documentation:

Movement Diagram

(1) Forward Bending:
(2) Side bend Left: all the way no pain
(3) back bend: a little bit and then pain
(4) Side bend Right: halfway and experienced pain
(5) Left rotation: where in the arc they have their limitations
(6) Right Rotation:

Answer 202

A

Active ROM
Overpressure
Sustained
Repetitive
Combined

Answer 203

A

Does this position bring pain back to a central position if it was radiating,

is it local, does it create more radiation i.e. if the disc is moved and it peripheralize the pain

if posterior lateral extrusion or protrusion then it may peripheralize ,

if it was peripheral pain and stay in the position may centralize the pain if an anterior protruded disc because it brings the disc more central—

McKenzie: pain centralize, prelipheralize, stay the same

Answer 204

A

go to end range and come back away from it over and over and see what happens to the pain-did it get worse/better/peripheral/central/stay the same—it can help, it can make it worse

APPLICATION to McKenzie Examination, Sahrmann , Treatment Based Classification

–what happens to the pain if you are repeating the task
–McKenzie: understand if it is a postural syndrome, it is a dysfunction, a derangement
–Sahrmann: if there is a lumbar flexion or extension bias
–Treatment based classification: if repeated extension helps, if repeated flexion helps
–McKenzie: flexion, extension, and side-glide in standing and lying

*side gliding in McKenzie instead of sidebending (stabilize thorax against wall and bring pelvis under thorax repeatedly and what happens to the symptoms)

Answer 205

A

APPLICATION to McKenzie Examination, Sahrmann , Treatment Based Classification
—what happens to the pain if you are repeating the task

–McKenzie: understand if it is a postural syndrome, it is a dysfunction, a derangement
–McKenzie: flexion, extension, and side-glide in standing and lying
–Sahrmann: if there is a lumbar flexion or extension bias
–Treatment based classification: if repeated extension helps, if repeated flexion helps

*side gliding in McKenzie instead of sidebending (stabilize thorax against wall and bring pelvis under thorax repeatedly and what happens to the symptoms)

Answer 206

A

Application to Osteopathic Approach:
—what happens with combined movements

—put spine into MAXIMAL OPENING or CLOSING

ie close many lumbar segments physiological extension and sidebending to one side
and rotation away from that side for opening /
max closure with combined movement or the quadrant position and find out if it reproduces the pain may mean a facet issue and not a disc issue /
or some sort of a joint issue - can be systemic or localized problem

use combined movements to maximally open or close the intervertebral foramen

Answer 207

A

0-15 (really it is 0-3/18)

Answer 208

A

.Lumbar –> cervical –> thoracic???

Answer 209

A

cervical –> thoracic –> lumbar ?

Lumbar Spine – B(M) (backward)
so most limited in rotation
flexion/extension & side bending are most available
L5 is the exception

Lumbar Spine: 90 degrees in horizontal plane, and point 45 degrees medially: degree of motion most restricted is rotation (most restricted, it is furthest from plane of motion needed for rotation) but we have flexion, extension, lateral flexion
L5 is a transitional vertebrae is an exception to this rule

Answer 210

A

“bend forward at the waist, come back up” stabilize the pelvis because only want lumbar spine to move: hands at ASIS and forearms at the back of the pelvis so movement in lumbar spine. If want cervical do a chin tuck and roll down. You are behind the patients so show them first. Note ROM and quality: i.e. ROM WNL or jutter into flexion (jutter indicates instability so think about stabilization exercises) when you do flexion or try to stabilize the pelvis forearm in contact with buttock and fingers anterior to ASIS

overpressure: stabilize the pelvis and use lower thoracic for the overpressure

Answer 211

A

“Put your hands flat on the back of the buttocks, arch your back backwards, any pain? come back to neutral” note where most of the movement is coming from. Look for the pivot point. Where does he initiate from. [Extension can be done in prone and only use arms to push up into extension and can be sustained or repeated and ask what this does to the pain—if hard for patient to do in standing or want more of a McKenzie approach]

not overpressure extension

Answer 212

A

“Hands at your side, tilt to the right, come back, tilt the left, come back” Note the arc of movement and the pivot points. Note symmetry. Note if hyper or hypomobility and what region. Side bending to the right was

overpressure: press

Answer 213

A

“criss cross your arms and rotate” stabilize pelvis bump my hip against the side and my hand anterior, or just do ASIS. -compare sides, note quality,

overpressure: get on the lower ribs/T spine (not scapula) and rotate extra

Answer 214

A

Bend forward at the waist, come back with your hands on your pelvis.

Arch backwards then come back

Touch the right knee then the left knee

Criss cross arms and turn right and then turn left

Answer 215

A

frontal plane

not 60 degree thoracic where rotation is facilitated, here it is 60-90 relative to horizontal

Answer 216

A

Closing left and opening right.

Pain on the side to which they side bend:

-the source of the pain can be the facet itself when close the facet and add compressive forces
- can also be some disc involvement whereas that is pinching down on herniated disc –at least inflammatory tissue to you close intervertebral foramen,

Answer 217

A

if patient had pain when sideband L the pain is on the right problem can be

–muscular because stretching irritated muscles,

–facet can be painful because stretch the capsule on that side,

–if there was a posterior lateral disc i am putting more pressure on that disc side.

Answer 218

A

-joint

- -disc herniation-if the disc is lateral to the NR it is pinching down on it

Answer 219

A

Patient bends AWAY from the the herniation because leaning to the same side would elicit pain

Answer 220

A

Disc herniation is lateral to NR as leaves intervertebral foramen —when sideband to the left pinch the NR and create pain

Answer 221

A

Compensate by shifting away from the NR

Answer 222

A

away from the painful side

Answer 223

A

patient posture lean TOWARDS the side of the herniation because tilting away would irritate the root and cause pain

Answer 224

A

Patient bends towards the herniation

Answer 225

A

When patient shifts away from the NR drag the NR and the dura which comes out of the IV foramen with the nerve, over the irritable area, that dragging creates the pain

Answer 226

A

Patient will compensate and shift towards the painful side for some slack so the medial herniation does not so much press on the nerve

Answer 227

A

Postural deviation towards the painful side

Answer 228

A

Articular

2. Disc Herniation LATERAL to the nerve root

Answer 229

A

Articular
Muscular
Disc Herniation MEDIAL to nerve root

Answer 230

A

If herniation is lateral to nerve root postural deviation is to the opposite side

Answer 231

A

If herniation is medial to the NR, the postural deviation is to the same side

Answer 232

A

Goal is to see if muscular contraction reproduces the pain

— do not want to allow any movement, only isometric contractions, not grading the strength: it is selective tissue tension testing to see if the muscle is involved. Should be done in an ideal posture, as good as possible

Answer 233

A

FLEXION: sternum and ask them to bend forward  

EXTENSION: patient seated, resist at lower rib cage for lumbar level, ramp up resistance and ramp off mid back  

LATERAL FLEXION: i have forward backwards stance and my hands are on lateral shoulder  

ROTATION: one hand anterior and one posterior shoulders to fulcrum

Answer 234

A

do MMT because this is not where we grade muscle strength

Answer 235

A

prone and hands in 3 are sides, 4 are behind head, 5 forward -sternum needs to clear the mat to give the grade

Answer 236

A

Normally through physiological range-but here we want to know what happens at the segments = one segment on the other:

passive physiological interververtebral movement testing (PPIVM)

Answer 237

A

To see what happens to the symptoms at segmental level: joint, facet, and surrounding soft tissues capsule and ligaments.
[We want to see segment by segment at each facet pair]

In the lumbar spine, these physiological movements are difficult to perform due to the weight of the body

May give you a sense of multi-segmental problems  

Answer 238

A

Patient Position

-Sidelie
-Neutral spine
-Hips and knees in 90-90

Physical therapist:

-anterior pelvis to hold patient knees
-grasp near ankle
-WS to create the movement

PT action
–find PSIS, base of sacrum, L5-S1 interspace: then i can side-shift

Answer 239

A

Patient Position
Sidelie
Neutral spine:
Hips and knees in 90-90

Physical therapist:

Use my body anterior pelvis to hold patient knees
my arm under the top leg and grasp near the ankle
WS to create the movement

PT action
find PSIS, base of sacrum, L5-S1 interspace: then i can side-shift (
palpate interspace L5-S1

Answer 240

A

patient close to edge of treatment table

palpate L5-S1 interspace glide leg posteriorly to sense closing of each segment

Answer 241

A

–palpate interspace L5-S1 and Sense opening and back to neutral, open and back to neutral, at interspace and move to next interspace

–monitoring finger at interspace above which you do not want to have open yet

Answer 242

A

(it has to be passive)

patient prone, hands on plinth, aligned with patient shoulders

palpate T12-L1 interspace

Pt slowly raises up into extension as PT palpates segmentally down to L5/S1 

Answer 243

A

–Get on brim of ilium

–palpate interspinous space or on right lateral aspect of the two spinous processes or on the left lateral aspect of the two spinous processes —pull towards me sideband left, push and create right sidebending

–Rock pelvis cranially, side bend same direction

–Rock pelvis caudally, sidebend opposite direction  

Answer 244

A

—patient position: sidelying, hip and knees in 90-90

-PT:
grasp both lower legs, pivot patients knees on my thigh crank legs (abduct) to ceiling or to floor which will bring pelvis towards the rib cage :

–Direction:
=Raise patients feet to ceiling, SB to same direction as feet
=Lower feet to floor: SB opposite direction

 **do not want to stretch on rectus femoris

Answer 245

A

patient prone (can have a pillow under), spine neutral

PT supports patient leg (knee flexed for comfort, resting tibia on my forearm)

Palpate interspace L5/S1 and slowly abduct leg to sense (palpate intersperse on top or either side)

Answer 246

A

position as with flexion and extension, patient seated near top of plinth

PT can squat to create SB toward PT

Answer 247

A

named by segment above: L3 left rotation on L4

remember: name by superior vertebra of motion segment, even if inducing rotation from lower vertebra

Answer 248

A

patient prone

PT: hands on iliac crests

(stand with a forward backwards stance and rock forward and back to create the rotation: return to neutral for that segment and go up the chain to the next segment)

(if using right pelvis i sand on left side of the patient for better leverage):

start at L5-S1 interspace, reach around to brim of ilium and ASIS region, palpated, take forward backward diagonal stance, rock myself backwards to bring pelvis with me to get the rotation and maintain that rotation and then i rotate a little bit more and then go to the next segment.
Don’t shift the pelvis left or right, only rock it left and right to feel close on one side and open on the other, back to neutral on that segment etc and work way up the chain.

Lift up RIGHT crest, rotation to LEFT follows up the chain

-Rotate body of sacrum right: L5-S1 left rotation. Then keep rotating right: L4-L5 left rotation.
-Opening occurs on the same side as the named rotation: left rotation L3 on L4 the opening is on the left and closing is on the right

Answer 249

A

Patient knees at 90

Rotate legs to the RIGHT : this creates left rotation of the sacrum etc: you get a relative right rotation of L5 on S1 etc in direction of ankles

–grab the outer leg and tuck in or grab between the two legs
–turn feet to her left so sacrum is going right and L5-S1 going left (Left rotation of L5 on S1)
–Go back to neutral
–Go up to the next segment
–Don’t shift the legs or the pelvis, want a pure rotation as go up the chain

so the direction of the rotation is the direction of the legs — but easier to think of it as where did the sacrum go and work form there

Answer 250

A

Intervertebral motions we cannot make voluntarily-we do this to assess joint motion (because ligaments will not be at maximum tension).

They are named by the direction of the movement

Answer 251

A

we do this to assess joint motion (because ligaments will not be at maximum tension).

Answer 252

A

General Spring Test
Specific P/A pressure on Spinous Process:
P/A pressure on bilateral Transverse Processes:

Answer 253

A

for an overall sense of how the spine is moving from one segment to another *sense overall relative mobility of all motion segments
Assess the degree of play: press down on SP and a little on body of sacrum to get an idea of the relative degree of play as we move up the spine
—we will not say it is definitely 4-5 but we can say when i spring on 4-5 i get a reactive muscle spasm and patient reports pain, or 4-5 is more mobile than 3-4.
Later we will do specific PA, this is just a big picture.
Position patient prone in neutral spine
heel of hand on the SP (thenar, hypothenar, or in between, and reinforce with one hand over the other)
and push SP towards floor with vertical force with a gentle lean of my body.

For sacrum my fingers pointed towards their feet, my heel of hand over base of sacrum, my shoulders over that preparation, and just a gentle spring.

Look for excessive play vs normal play
This gives an idea of how much play we have.

Answer 254

A

Use pisiform area contact, reinforce wrist as needed

find brim of ilium, come across and find L4, pisiform on L4, reinforce my wrist, bring my shoulders over, gentle lean down and back up. 
get pisiform (cushy area) on the segment
reinforce

downward pressure

glide and assess the play (evaluate the slide in the facet at that level)

go to next segment, SP L3, press down, and back up

P/A movement of the vertebrae on upon the other—feel the body glide anteriorly bring the facets down towards the floor

my shoulder is over the preparation for a pure P/A force, do not want to incorporate rotation into it —lock my arms and use my body for a gentle force so that I can perceive the motion

Answer 255

A

note that this method will bow the vertebrae forward

Place middle and index fingers over respective Transverse Processes, use ulnar border other hand to press anteriorly symmetrically

TP tend to stay to the upper half of the vertebrae, fingers on the TP, create a forward tilt in addition to the P/A

As I press on the vertebrae, the vertebrae bows forward, this gives a flexion as well as a P/A—it is a rock forward at the facets (not just an up down), a different kind of play

—-Find the TP, approach brim of ilium and come across to estimate location of L4, the TP is on the upper half so come lateral towards upper half of SP and work my way out above the muscle mass and around and in into where TP would be. Consider persons proportions. Come from outside to inside to find the TP. You feel it as a density, not the same as feeling the SP due to all the tissue around it and it is deeper. Come around a muscle mass and go in towards the VB to find the TP. Find one then go to the other side and find the other
—-A finger on each TP, rest my hand flat
—-Ulnar border of other hand on my fingers
—-A nice downward glide and come back up

Take index and middle fingers and place them passively on the persons back as passive cushions, whole hand flat, the other hand ulnar border on our fingers to create the force towards the floor for the P/A of the transverse processes, bring shoulder over ulnar border hand and glide towards the floor and stay with it as it glides back—sometimes feel the play better on its way back then on its way down

P/A of L3 on L4  

Answer 256

A

gives a sense of opening on one side and closing on the other side

Answer 257

A

direct laterally: lateral force
Forearms parallel to floor for direct rotation, do not want to also be getting P/A, just pure rotation
Press on the lateral side of the SP: push SP away from me so body will turn towards me: press outer side of SP, forearms level to the mat, push away, create a rotation : SP to left, VB to the right

—Find brim of ilium, come across. Push soft tissue out of the way-push it down and forward or push it up and out of the way and get skin out of the way to get thumb against SP, forearms level to the bed, and direct it away from yourself: gentle pressure and recoil it back. Then go up to the next segment.  

Answer 258

A

ie press on right TP of L3, create left rotation of L3 on L4
(to get L5 TP press on PSIS/iliac crest to press on TP of L5 to rotate L5 on S1 to the degree that it is going to happen)

P/A pressure on one transverse process to induce rotation
Put pisiform area on TP and P/A to the floor to create a rotation

Rotate L5 by springing iliac crest

Find TP, put heel of hand on TP, shoulder over, gentle downward pressure, and come back up, to create the rotation.

Answer 259

A

Hand placement as with P/A on TP but span one motion segment

ie still use the fingers of one hand and ulnar border of the other hand to reinforce: create a counterrotation by placing one finger on left L3 TP and right L4 TP so create a rotation at that motion segment. It is a counter-rotation left L3 TP will rotate L3 right, and L4 do a relative left rotation if on the right side TP, to create more of the rotation of L3 on L4 to the right.

On left and right and do dummy hand technique, press to the floor, create a counter-rotation at the motion segment of interest

Finger on TP of vertebrae and on opposite TP of vertebrae below, hand is flat, ulnar border of other hand on top of my fingers, be as vertical as possible, push down to the floor and feel a rotation: top vertebrae away from me, and bottom vertebrae towards me (depends on which side TP she was on)

Answer 260

A

Patient seated on treatment table
Patient is anchored on table, back to me
Compress through the scapula and then load towards the ischial tuberosities from the acromion process
Can also produce downward pressure through the first rib
Keep my elbows low dropping down / r i can be on table and press down from above
Assess how reactive the tissue is, assess if the loading creates a problem or does the loading pick up an instability

Answer 261

A

Grab hold of the patient’s wrists, my elbows on their lower ribs (only want lumbar spine)

Squeeze and go backwards and as I lean backwards I am creating the distraction. I lower back down to the table and then back up.

My anchor is against her lower ribs pushing in, hands are just there, have her up against my chest and I lean backwards to create the distraction.

Answer 262

A

Take away is c-spine rotation most, l-spine has least (b/c orientation of facets)

Answer 263

A

workers compensation case, and if they are not motivated to return to job there is a barrier for their full recovery

Answer 264

A

barriers that related to financial constraints or transportation: ie high co-pay or deductable that will limit their access to PT

Answer 265

A

Signs of serious pathology

Answer 266

A

Pain behaviour (including pain and coping strategies
Emotional response
Beliefs, appraisals and judgements

Answer 267

A

this will pick up FACET issues
can be facet issue: hypertrophic, inflamed,
can be NERVE IMPINGED

Answer 268

A

bring hand down thigh
this will pick up DISC issue if do combo to left and pain at right side: facets are opening and the disc is being posterior laterally
posterior – lateral bulge is most common

Answer 269

A

Arthritis
Bulgingdisc
Mattress

Answer 270

A

hip flexion

Answer 271

A

Knee extension

Answer 272

A

big toe extension (if weak gluteus mediaus also can be sued for L5)

Answer 273

A

PF (peroneous longus and brevis)

Answer 274

A

gastroc/soleus

Answer 275

A

bladder (ask bowel and bowel questions)

foot intrinsics

Answer 276

A

T12

L1, L2, L3

Answer 277

A

L2, L3, L4

Answer 278

A

S2, S3, S4

Answer 279

A

S2, S3, S4

Answer 280

A

inguinal line

Discherniationsare rare for upper lumbar so not usually testedunlessHxindicated

Answer 281

A

anteriorproxthigh

Discherniationsare rare for upper lumbar so not usually tested unlessHxindicated

Answer 282

A

anterior medial thigh-medial knee

Answer 283

A

medial leg

Answer 284

A

lateral leg

Answer 285

A

lateral foot/calcaneus

Answer 286

A

Achilles Tendon

Answer 287

A

Patellar Tendon

Answer 288

A

Note Asia that L2 is medial upper thigh and L3 medial knee, medial malleolus L4, L5 is between first and second big toe on dorsum foot, S1 is lateral posterior calcaneus

Answer 289

A

UMN Lesion

Answer 290

A

0 = absent
1+ = decreased/ hyporeflexive
2+ = normal
3+ = hyperactive
4+ = hyperreflexive

*jendrassik

Answer 291

A

Lateral cutanous nerve of the thigh

–numb with tight jeans, tight belt compressing the nerve

peripheral vs dermatome:
-dermatomal nerve spirals

Answer 292

A

Obterator nerve

Dermatome: different levels that innevrate the medial thigh

Answer 293

A

Peripheral:

proximal: common peroneal nerve

Distal: superficial peroneal nerve

Between the toes: Deep peroneal nerve

L5: down between toes but use other distribution parts to help

Answer 294

A

Sural nerve

S1/S2 lateral foot border and go up calf

Answer 295

A

Peripheral nerve vs. dermatome

Lateral thigh = lateral cutaneous nerve of thigh/ multiple dermatomes

Prox- medial thigh = obturator vs. multiple dermatomes
lateral calf  
--proximal = common peroneal nerve
--distal = superficial peroneal nerve
--deep peroneal nerve btwn toes (L5)

Suralnerve – posterior-lateral calf- more distinct boundaries vs. S1-S2

Answer 296

A

Prone knee flexion bend if upper lumbar lesion compressing nerve root, dermatomal pattern, use DTR, cluster exams to localize distribution

Answer 297

A

Straight Leg Raise
Laseque Sign
Well Leg Straight Leg Raise
Kering Sign: Passive Flexion

Answer 298

A

Prone knee bend

Answer 299

A

Sciatic Nerve: L5, S1, S2

Point is that you have a working hypothesis = something is happening with the nerves
This pulls on the sciatic nerve

Demonstration

-Supine
-Straight leg, bring it up passively stabilize the knee and hold from under the ankle

–>They would say it hurts at a certain ROM
(asterik vs tight hamstring and gastroc)

Pain:

–Sciatic Nerve: L5, S1, S2
–If it is a disc problem = usually pain around 30 degree range
–If state pain when up to 90 – probably not dura because after 90 mechanically there is less stretch on the nerve

Answer 300

A

pSLR(Passive SLR)/Lasegue:

Disc bulge,
limited mobility/neurotension of sciatic nerve

I lift his leg into a SLR: if increase of symptoms before 70 : then lift head up and see if that changes symptoms: increases with cervical flexion (+), otherwise if it doesn’t increase the pain it may just be hamstrings

This test can be used to measure improvements objectively

add DF to get nerve tensions= BraggardsTests

Answer 301

A

30 degrees

Answer 302

A

Stretch sciatic nerve proximally.

L5:
Herniated disc at L4–L5 or L5–S1: pressure on the L5 or S1 nerve roots, stretching the sciatic nerve cause worsening of the lower-extremity pain or paresthesias or both.

Pt lie supine
With the patient’s knee extended, take the patient’s foot by the heel and elevate the entire leg 35–70 degrees from the examining table.

As the leg is raised beyond approximately 70 degrees, the sciatic nerve is being completely stretched and causes stress on the lumbar spine.

(+) increased LE pain/paresthesias on the side that is being examined.

(+ cross response) pain down the opposite leg, significant for a herniated disc.

Laseque Sign:
Tight hamstrings or is of a neurogenic:
1. raising the leg up to the point pain, and then lowering the leg slightly (should reduce pain)
2. Passively DF to increase the stretch on the sciatic nerve. PAIN = NEUROGENIC, no pain = tight hamstrings

Answer 303

A

If they say it is the pain that they get (ex: on their in step): lower leg slightly add dorsiflexion

You would lower the leg down (presumably taking the stretch off the nerve),
Ask the patient if the pain went away
Then put the stretch on it again, but in a different way: take the foot into DF and ask if there is pain

PAIN: sciatic, nerve root, or dura:
the pain would be reproduced in the in step because took the stretch off the hip and applied it again at the ankle

=positive SLR test and a positive Laseque sign

Answer 304

A

= a SLR of the non-affected leg

POSITIVE: contralateral nerve root irritation sits MEDIAL to nerve root 

If symptoms are RELEIVED: contralateral irritation sits LATERAL to nerve root 

This pulls the dura from the other side—want to see if symptoms are still reproduced on the bad leg

Notes: If you pull on an irritated dura on anywhere else, you may produce the symptoms–Dura is like stockings – all connected–Do the SLR on the other test – they would feel it on the opposite side and in the same spot they have pain–This tells you they have serious inflammation

Answer 305

A

Really highly irritated – pull on the dura and get pain from anywhere else

Pull from above: pull from spinal cord level level – passively and gently pull neck into flexion gently

If pain in bad leg this confirms a hot irritable area, when we pull from anywhere

Answer 306

A

Femoral Nerve stretch: L3, L4

Prone
Stabilize Lumbar Spine
Hip in neutral
Bend knee
A point in the ROM where she identifies pain: is it a quad stretch or is it a reproduction of the pain

Positive: reproduction of the pain

Answer 307

A

Hamstrings

Gastroc/Soleus

Answer 308

A

nerves are reacting abnormally based on stretch

Defined by Butler: “abnormal physiological and mechanical responses produced from nervous tissue structures when their normal range of movement and stretch capabilities are tested”

Answer 309

A

“an analysis of the lengthening (stretching) and sliding (gliding) abilities of neural structures”and an analysis of the “ability of the nervous system to cater to changes in interfacing structures”

There is slack which is needed for us to bend and reach: the system evaluates the play by palpations where the interfaces are

–sciatic nerve popping out from between bellies of hamstring muscles
–peroneal nerve back and around medial malleolus
–nerve to dorsum of foot under extensor retinaculum

Answer 310

A

Not the normal sliding and gliding

Patients with adverse tension syndromes give history which involves injury to nervous system – MVA or fall

These injuries increase tension in nervous system

Symptoms are usually worse with tension – increasing maneuvers

–>Resting in bed in the long sitting position: telling you the nerve under tension is reactive and by taking off tension – relieves pain
–>Getting into a car

Pain could be described as anything – burning, tingling, stab: depends on hotness of the nerve and what the original injury is 

Answer 311

A

Neurodynamic testing

Answer 312

A

Adverse Neural Tension

Answer 313

A

Pain 
Burning
Weakness
Paralysis
Paraesthesia

Answer 314

A

Raised shoulder girdle

Hip externally rotated in stance

Forward head posture: puts plexus on slack

Flattened thoracic spine

Answer 315

A

Butler finds adverse tension syndromes are related to chronicity of disorder

System has had time to allow adaptive measures to occur 
But, the nervous system has not been treated sufficiently 

Answer 316

A

Butler finds adverse tension syndromes are related to chronicity of disorder: System has had time to allow adaptive measures to occur  But, the nervous system has not been treated sufficiently 

Therefore, testing will provoke the symptoms when the right tissues are elongated
We elongate the tissues in a selective systematic way to figure out where there is a problem 

Answer 317

A

Butler finds adverse tension syndromes are related to chronicity of disorder:

System has had time to allow adaptive measures to occur 

But, the nervous system has not been treated sufficiently 

Therefore, testing will provoke the symptoms when the right tissues are elongated

We elongate the tissues in a selective systematic way to figure out where there is a problem 

Answer 318

A

Neural tissue is inherently flexible

Assess flexibility, assess the play

Answer 319

A

Pathological mechanisms in injured/diseased tissues may cause decreased mobility of the nervous tissue 

Can be evaluated by neuro-dynamic tests of flexibility: pull on one get symptoms in another

Answer 320

A

perform a series of base tests

Check mobility of selected portions of nervous system to isolate a site where mobility is impaired

(Patient history, observe postures/adaptations to postures, observe selective movement,)

Answer 321

A

Screen for “red flags” indicated need for immediate attention for trauma, neoplasm, infection and inflammation
Tension tests are complex and involve many components. Be careful not to aggravate other structures
Irritability related to the nervous system
Worsening disorders
Presence of neurological signs
Be very cautious, don’t want to pull on a nerve that is not functioning well, not conducting well, can perform the test with caution
Poor general health
Compromise of the spinal cord, e.g., spinal
stenosis
Acute and unstable neurological signs
Cauda Equina lesions
Injury to spinal cord

Answer 322

A

Screen for “red flags” indicated need for immediate attention for trauma, neoplasm, infection and inflammation

Answer 323

A

Tension tests are complex and involve many components. Be careful not to aggravate other structures

Ex: get a positive SLR – don’t irritate the nervous system more once we already have the data we need

Answer 324

A

Irritability related to the nervous system

Answer 325

A

Worsening disorders

Answer 326

A

Be very cautious, don’t want to pull on a nerve that is not functioning well, not conducting well, can perform the test with caution

Answer 327

A

Poor general health

Answer 328

A

Compromise of the spinal cord, e.g., spinal stenosis

Or if they have bowel and bladder issues, do not do the test

Answer 329

A

ACUTE and UNSTABLE neurological signs

If they just started, or if they’re getting worse: acute neuro signs that are documentable -would not test

Sometimes good, sometimes bad – unstable

Answer 330

A

Cauda Equina lesions

Answer 331

A

Injury to spinal cord

Answer 332

A

Warning:
There are inherent dangers in mobilizing the nervous system

You must do a thorough neurological exam assessing for abnormal findings and abnormal reflexes

If getting a headache or getting nauseous then stop the test
Both nerve roots are intertwined with the SNS– don’t want to provoke

Answer 333

A

At what point in ROM do symptoms begin? (Ex: 40 degrees in SLR begin to have sx)
What are symptoms? (Tingling,numbness, burning)
What are symptoms at limit of range? (Specific symptoms)
Are symptoms equivalent to the chief complaint?

Answer 334

A

Helps understand where the barrier might be – what did I put on stretch to create this resistance and when I stretch it a little more and get the symptom from the patient

Maybe they can go little further but have resistance at 30 and an absolute stop at 40 in the SLR, where the resistance helps to understand where the barrier may be

Muscular resistance will feel different: This is almost like an EMPTY END FEEL – they want to pull back from your resistance, They tense up, Slowing down your speed 

Answer 335

A

when is stretch first encountered?

2. What behavior is this resistance?

Answer 336

A

Symptom Response

2. Resistance

Answer 337

A

PASSIVE NECK FLEXION: pons, cord, meninges
STRAIGHT LEG RAISE; tibial, peroneal, sciatic tracts, lumbar sympathetic trunk, lower lumbar roots
PRONE KNEE BEND: femoral tracts, mid upper lumbar roots, meninges, cord
SLUMP: pons, cord, meninges, sciatic tract
UPPER LIMB TENSION TESTS: individual nerves

Answer 338

A

pons
Cord
meninges

Answer 339

A

tibial tract
peroneal tract
sciatic tract
lumbar sympathetic trunk
lower lumbar roots

Answer 340

A

femoral tracts
mid upper lumbar roots
meninges
cord

Answer 341

A

pons
cord
meninges
sciatic tract

Answer 342

A

individual nerves

Answer 343

A

Starting position should be consistent each time

Test symmetry between both sides (start with the good side)

Start with unaffected side

Answer 344

A

Feel for barriers to movement
Note onset of RESISTANCE, PAIN or other SYMPTOMS
Assess QUALITY of movement
Watch for antalgic postures during tests
Test symmetry between both sides (start with the good side)

Answer 345

A

Tension Tests

Answer 346

A

is a neural tension test which is indicated when the patient complains of spinal symptoms.

1. Patient seated, 
knees together, 
Hands Linked behind back, 
Cervical Spine neutral, 
Patient slumps

Maintaining flexed position, bend neck toward chest and overpressure (one finger)

Actively extend knee

Dorsiflex ankle

Slowly release neck flexion

Repeat other leg

You can then ask patient to extend both legs together

Response assessed at each step
Normal Response:
pain area of T8-T9,
pain behind extended knee and hamstring area
Indications: spinal symptoms, to ensure that nervous system moves and stretches properly

Answer 347

A

SET UP 
Patient seated, 
knees together, 
Hands Linked behind back, 
Cervical Spine neutral, 
Patient slumps

4 STEPS
1. Maintaining flexed position, bend neck toward chest and overpressure (one finger)

Actively extend knee
Dorsiflex ankle
Slowly release neck flexion

REPEAT OTHER LEG

You can then ask patient to extend both legs together

Answer 348

A

pain area of T8-T9,

pain behind extended knee and hamstring area

Answer 349

A

patient complains of spinal symptoms.

2. To ensure the nervous system moves and stretched properly

Answer 350

A

Worsening of neurological symptoms can be indicative of pathology secondary to tension in the nervous system.

Answer 351

A

The slump test (Figure 6.61) is a neural tension test which is indicated when the patient complains of spinal symptoms. The test is conducted as follows:

r Patient’s position: The patient is sitting with both lower extremities supported with the upper extremities behind the back and the hands clasped.

r Instruct the patient to “sag.” Overpressure can be added to increase the degree of flexion. Maintain flexion and then ask the patient to bend the neck toward the chest. Overpressure can be added and the symptoms are reassessed. While maintaining the position, instruct the patient to extend one knee and reassess. Then ask the patient to dorsiflex the ankle and reassess. Release neck flexion and reassess. Ask the patient to flex the neck again and repeat the process on the other leg. Finally, both legs can be extended simultaneously.

The test is terminated when the symptoms are produced.

Normal responses can include pain at T8–T9 in
approximately 50% of patients, pain on the posterior aspect of the extended knee, decreased ROM in dorsiflexion, and a release of symptoms and an increase in range when neck flexion is released (Butler, 1991). Worsening of neurological symptoms can be indicative of pathology secondary to tension in the nervous system.

Answer 352

A

Done as an assessment and treatment

Position offers slump from the LEs and legs first

Clinically, the response can be different

Answer 353

A

PATIENT POSITION:
Patient supine: (can put on my acromion) one hand above the knee,
the other hand above/proximal to the malleoli from underneath,
STEPS: if you stand facing the patient, walk up the table: where in the range are symptoms reproduced and is there resistance noted

Place one hand under achilles tendon and other anterior/proximal to knee

Lift leg until perpendicular to bed

WHAT TO LOOK FOR
- Symptom responses
- ROM
- resistance noted

COMPARE OPPOSITE LEG

INDICATIONS
Key tension test
Routine for all spinal and leg symptoms

Answer 354

A

Stretch sciatic nerve/ Herniated disc L4-L5 or L5-S1

pt supine, knee extended, grasp the foot by the heel and elevate the entire leg 35–70 degrees from the examining table.

70 degrees: the sciatic nerve completely stretched = stress on the lumbar spine:

(+) increased LE pain or paresthesias on the side that is being examined.

cross + = pain down the opposite leg = herniated disc

Tight hamstrings = pain posterior part of the thigh, which is due to tightness of the hamstrings: determine with lowering the leg slightly and this will reduce the pain, then passive DF to increase the stretch on the sciatic nerve [Pain = neurogenic and not hamstring]

Answer 355

A

PERONEAL nerve (FIBULAR nerve)

Hands: Keep a hand under malleoli with a forearm resting on the shank to maintain the extension
and the other hand to bring the foot into PF and inversion
Squat then lift up and walk up table
Grab calcaneous and bring to inversion letting metacarpals turn, other hand does the PF

Answer 356

A

further tension to TIBIAL Nerve

rest forarm on shank to maintain knee extension
grab calcaneous for eversion, and DF
pSLR

Answer 357

A

Dorsiflexion/eversion: more tension along tibial tract: TIBIAL Nerve

rest forarm on shank to maintain knee extension
grab calcaneous for eversion, and DF
pSLR

Answer 358

A

tension along SURAL Nerve

rest forarm on shank to maintain knee extension
grab calcaneous for inversion, and DF
pSLR

(The small cutaneous branch arises as the common fibular nerve travels towards the fibular head. The nerve then continues down the leg on the posterior-lateral side, then posterior to the lateral malleolus where it runs deep to the fibularis tendon sheath and reaches the lateral tuberosity of the fifth toe, where it ramifies.[1])

Answer 359

A

Plantar flexion/inversion: tension along COMMON PERONEAL TRACT

one hand on the proximal
Distal position at foot
Come up

Answer 360

A

tension proximal SCIATIC tract

Answer 361

A

further sensitize proximal SCIATIC tract

Answer 362

A

PATIENT POSITION: Supine position with arms at side, legs together
TEST STEPS:
Do upper cervical spine then the lower cervical spine:
—>Upper cervical flexion: PT passively flexes the neck to a ‘chin tuck’ position

—>Lower cervical flexion: PT passively flexes the lower cervical spine

One hand stabilizes chest, or both hands hold neck/head

SYMPTOM RESPONSE: ROM and resistance encountered is noted
NORMAL RESPONSE pulling at cervicothoracic junction
INDICATIONS:
- -All spinal disorders: often positive in patients that have LBP
- -Headache symptoms
- -Arm and leg pain of spinal origin

Answer 363

A

Supine position with arms at side, legs together

TEST STEPS:
Do upper cervical spine then the lower cervical spine:
—>Upper cervical flexion: PT passively flexes the neck to a ‘chin tuck’ position

—>Lower cervical flexion: PT passively flexes the lower cervical spine

One hand stabilizes chest, or both hands hold neck/head

Answer 364

A

TEST STEPS:
Do upper cervical spine then the lower cervical spine:
—>Upper cervical flexion: PT passively flexes the neck to a ‘chin tuck’ position

—>Lower cervical flexion: PT passively flexes the lower cervical spine

One hand stabilizes chest, or both hands hold neck/head

Answer 365

A

SYMPTOM RESPONSE: ROM and resistance encountered is noted

Answer 366

A

NORMAL RESPONSE pulling at cervicothoracic junction

Answer 367

A

INDICATIONS:

–All spinal disorders: often positive in patients that have LBP

–Headache symptoms

–Arm and leg pain of spinal origin

Answer 368

A

The tibial nerve can be stretched by first DF the ankle and EVERT the foot, and then performing a straight-leg-raise test.

The test is abnormal if the patient complains of pain or numbness in the plantar aspect of the foot that is relieved by returning the foot to the neutral position.

Answer 369

A

The peroneal nerve can be stretched by first
PF the ankle and INVERT the foot, and then performing a straight-leg-raise test.

The test is abnormal if the patient complains of pain or numbness on the dorsum of the foot that is relieved by returning the foot to the neutral position.

(peroneal = fibular)

Answer 370

A

Butler believes that hip medial rotation will sensitize COMMON PERONEAL division more than tibial division of sciatic nerve

Answer 371

A

Herniated disc in the L2– L4 region.

The purpose of the test is to stretch the femoral nerve and the L2–L4 nerve roots.

The patient is lying on the side, with the test side up. The test can also be performed with the patient lying prone.

Support the patient’s lower extremity with your arm, cradling the knee and leg.

The test leg is extended at the hip and flexed at the knee.

If this maneuver causes increased pain or paresthesias in the anterior medial part of the thigh or medial part of the leg, it is likely that the patient has a compressive lesion of the L2, L3, or L4 nerve roots, such as an L2–L3, L3–L4, or L4–L5 herniated disc.

You can determine whether the pain is caused by tight rectus femoris or of neurogenic origin by releasing some of the knee flexion and then extending the hip.

If the pain increases with hip extension, it is neurogenic in origin.

Answer 372

A

Patient Prone
Grasp Lower Leg and Flex Knee
Symptom Response and resistance through movement noted
Compare with Opposite Leg

Answer 373

A

Patient prone:

hand under the knee

Then bring him back slowly into hip extension and monitor what they feel

IF they feel something they can lift their head a little bit

Grasp lower leg and flex knee

Symptom response and resistance through movement noted

Compare with opposite leg

Answer 374

A

Femoral Nerve becomes saphenous nerve which is slackened in prone knee bend.

More sensitive test to do in side lying position

Answer 375

A

PATIENT POSITION: Side-lying with the affected leg uppermost
Patient grasps the knee of the lower leg and flexes the neck (creating spinal flexion)
Therapist flexes the knee and extends the hip
If Sx: pt to lift their chin (releasing the tension from the spinal flexion)
=>if symptoms decrease confirm a neurogenic origin to the symptom
Normal response: pulling or pain in area of quadriceps muscle
Indications: used for patients with knee, anterior thigh, hip and upper lumbar symptoms

Answer 376

A

We tuck the patients head down
Patient tucks their knee up to their chest

Reach under the knee and support the leg with forearm

Bring hip into hip extension
If they feel something they can lift their head a little bit

Tell us if it is neurogenic origin to the symptom—confirm the hypothesis of nerve being stretched

Answer 377

A

PATIENT POSITION: Side-lying with the affected leg uppermost
Patient grasps the knee of the lower leg and flexes the neck (creating spinal flexion)
Therapist flexes the knee and extends the hip
If Sx: pt to lift their chin (releasing the tension from the spinal flexion)
=>if symptoms decrease confirm a neurogenic origin to the symptom

Answer 378

A

Indications: sx in

knee,
anterior thigh,
hip and
upper lumbar symptoms

Answer 379

A

Normal response: pulling or pain in area of quadriceps muscle

Answer 380

A

Tensioner

2. Slider

Answer 381

A

Put the nerve under tension at both ends at the same time

Answer 382

A

Put the nerve under tension at one end at a time (in two step process)

Tension and one end and slack on the other end

Answer 383

A

Rhythmical,, steady, consistent, not forceful (like a grade 2, steady and consistent)

Might opt to do sliders first especially in cases where you don’t know how reactive that nerve will be

Then do tensioner when you’re in a more chronic state and want to get more progressive

Can throw someone off if you’re too aggressive with your neural tensions

Answer 384

A

Active movement tests
Repeated and sustained active movement test
Resisted
Passive mobility test
Passive accessory test
Neuro test
Neuro dynamic test

Answer 385

A

Maybe facets probably not moving on each other the way they are supposed to be moving

Concept of: opening and closing

– maneuvers
Open – flexion, sidebending away, rotation toward
Closing – extension, sidebending same side, rotation away

Answer 386

A

flexion, sidebending away, rotation toward

Answer 387

A

Closing – extension, sidebending same side, rotation away

Answer 388

A

Sidelying

Abduct the leg, Stabilize the SP with thumb, put legs in 90-90, block the SP of the vertebrae above,

rotate the legs to the floor or to the ceiling

Stabilize the SP and rock the pelvis to the head or to the feet in a side-lying position

Answer 389

A

PRONE – abduct leg – manually stabilize SP with thumb
Stabilize L3 strongly
Do a grade 3 or 4 oscillation or sustained stretch at that end ROM and get pathological limit closer to the normal limit 

SIDE LYING
Lumbar SB in side-lying
Legs at 90/90, block the SP above the level to be stretched
Rotate legs to the ceiling

SIDE LYING -PELVIS
Side-Lying using pelvis – stabilize level above
Rock pelvis cranially/caudally

SITTING:
use thumb as fulcrum against SP and SB trunk – perhaps for lower T- segments
For a lower thoracic or upper lumbar issue: can stabilize the SP and side-bend over the thumb in a sitting position—hard to make this passive, it would be active or active assistive

Answer 390

A

pelvic flexion,
total flexion,
total extension,
lateral flexion,
straight leg raising,
spinal tenderness,
bilateral active straight leg raising,
and sit-up.

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