thoracolumbar Intro-exam 1

Question 1

Stiff areas may not be painful and IF NOT addressed will usually cause painful ____________ compensations

Answer 1

hypermobile; the least path of resistance

Question 2

Stiff lower thoracic region and thoracolumbar junction lead to_______________________

Answer 2

hypermobile mid to lower lumbar spine

Question 3

Mobilize stiff areas for _________ uniform/distributed motion

Answer 3

MORE

Question 4

Hyper-mobile areas usually are painful bc the axis of motion is __________ controlled

Answer 4

LESS

Question 5

Stabilize hypermobile areas, particularly of _________and________ muscles to better ________motion

Answer 5

smaller & deeper; control

Question 6

The orientation of facets determines?

Answer 6

direction and amount of motion

Question 7

Thoracic MOSTLY ________ plane and favors _________ but ___________ limit SB

Answer 7

frontal plane; SB; ribs

Question 8

_______spine slightly curved and in the ________ plane favors _______ and ________

Answer 8

Lumbar; sagittal; flx/ext

Question 9

What facet of joints does MOST of flexion and extension?

Answer 9

Lumbar L1-5

Question 10

What facet joints does MOST of rot. ?

Answer 10

Thoracic T11-12

Question 11

________ _________ - MORE than just the strength of superficial and global mm.

Answer 11

controlled mobility

Question 12

What are the 4 variables for stabilization?

Answer 12

Joint integrity
Passive stiffness
Neural Input
Muscle function

Question 13

Local muscles: (6)

Answer 13

closer to the axis to motion
often deeper
stabilization > rotary forces**
postural**
aerobic > anaerobic
MORE often type I fibers

Question 14

Global muscles: (6)

Answer 14

Further away from the axis of motion
Often superficial
Rotatory > stabilization forces
Spurt mm.
Anaerobic > aerobic
MORE often type II fibers

Question 15

Local mm of the thoracolumbosacral: (4)

Answer 15

psasos- frontal plane stabilizer
pelvic floor and transverse abdominals - increase the contraction of multifidus
Quadratus lumborum
Transverspinalis

Question 16

If local mm of the thoracolumbosacral are smaller =

Answer 16

higher injury rates and LBP

Question 17

What happens to local mm. in our patients?

Answer 17

pain, swelling, joint laxity, and disuse

Question 18

pain, swelling, joint laxity, and disuse of local mm. cause:

Answer 18

-decreased and delayed motor performance and control of local mm.

-Inhibition preferential to type I fibers

-local mm. atrophy, specifically multifidus and strength declines along with loss of every other mm. function

Question 19

Pain, swelling, joint laxity, and disuse of global muscles cause:

Answer 19

increased and inefficient activity of global mm. (external abdominal oblique, erector spinae)

atrophy leads to fatty infiltration (fills in with the wrong fiber type) = > 50% of mm. cross-sectional area is fat in local and global mm. in those >60

Question 20

fiber transformation- type I change to II so what?

Answer 20

filling in the wrong fiber type (filling in with type II when it should be type I)

Question 21

Normal mm. activity returns spontaneously just because the P! is gone? T or F

Answer 21

False; DOES NOT

Question 22

Muscle activation of ______% is sufficient to keep stability and is suitable to improve muscular endurance so it__________________

Answer 22

30% : doesn’t take a lot of improvement

Question 23

What is P! phenotypying?

Answer 23

set of observable charcateristics of an individual resulting from the interaction between the body and the environment

Question 24

Noceptive:

Answer 24

non-nervous compromise
MSK - including spondylogenic (non-segmental)
Viscerogenic

Question 25

Neuropathic:

Answer 25

nervous tissue compromise
radicular
radiculppathy
peripheral

Question 26

Nociplastic:

Answer 26

altered p! perception w/o complete evidence of actual or threatened tissue comprise

Question 27

Which P! phenotyping is common and produced local as well as referred symptoms from the involved spinal structure?

Answer 27

Spondylogenic

Question 28

________ P! CANNOT cause visceral dysfunction as some providers claim

Answer 28

Spondylogenic

Question 29

Spondylogenic P! is MOST often referred where in the LQ

Answer 29

gluteal region and proximal thigh
may go as far as foot

Question 30

Spondylogenic referred P! is consistent between individuals. T or F

Answer 30

False; inconsistent

Question 31

Brain perceives the P! as coming from even MORE areas with persistent symptoms is known as

Answer 31

Nociplastic P!

Question 32

S&S or criteria for “probable” nociplastic P!

Answer 32

possible criteria plus
- sensitivity to sound, light or odor
- sleep disturbances
- fatigue
- cognitive problems

Question 33

S&S or criteria for “possible” nociplastic P!

Answer 33

≥ 3 months of P!
P! cannot be entrielry explained by nociceptive or neuropathic pathways
non-p!full stimuli causing P!

Question 34

What is the most accepted Rx for Nociplastic P! along with MET.

Answer 34

JM

Question 35

How does JM improve nociplastic P!

Answer 35

stimulates descending inhibitory P! mechanisms (more endorphins)
induces presynaptic inhibition
—limit P! transmission by A-delta and C-fibers
—better overriding of P! by A beta stimulation
reduces dorsal horn excitability
decreased inflammatory mediators.

Question 36

What is the MET Rx for patients experiencing Nociplastic P!?

Answer 36

Low to mod global aerobic and resistance activities
2-3x/wk.
30-90min per sessions
at LEAST 7 weeks duration

*reorganize homunculus

Question 37

Is pt. education is important for pts. experiencing nociplastic P!

Answer 37

yes; explain increased sensitivity and misinterpretation to reduce stress/anxiety of misperceived tissue injury

Question 38

Prognosis of Nociplatic P!

Answer 38

longer recovery
likely NOT full resolution of symptoms