thoracolumbar Intro-exam 1 Flashcards
Stiff areas may not be painful and IF NOT addressed will usually cause painful ____________ compensations
hypermobile; the least path of resistance
Stiff lower thoracic region and thoracolumbar junction lead to_______________________
hypermobile mid to lower lumbar spine
Mobilize stiff areas for _________ uniform/distributed motion
MORE
Hyper-mobile areas usually are painful bc the axis of motion is __________ controlled
LESS
Stabilize hypermobile areas, particularly of _________and________ muscles to better ________motion
smaller & deeper; control
The orientation of facets determines?
direction and amount of motion
Thoracic MOSTLY ________ plane and favors _________ but ___________ limit SB
frontal plane; SB; ribs
_______spine slightly curved and in the ________ plane favors _______ and ________
Lumbar; sagittal; flx/ext
What facet of joints does MOST of flexion and extension?
Lumbar L1-5
What facet joints does MOST of rot. ?
Thoracic T11-12
________ _________ - MORE than just the strength of superficial and global mm.
controlled mobility
What are the 4 variables for stabilization?
Joint integrity
Passive stiffness
Neural Input
Muscle function
Local muscles: (6)
closer to the axis to motion
often deeper
stabilization > rotary forces**
postural**
aerobic > anaerobic
MORE often type I fibers
Global muscles: (6)
Further away from the axis of motion
Often superficial
Rotatory > stabilization forces
Spurt mm.
Anaerobic > aerobic
MORE often type II fibers
Local mm of the thoracolumbosacral: (4)
psasos- frontal plane stabilizer
pelvic floor and transverse abdominals - increase the contraction of multifidus
Quadratus lumborum
Transverspinalis
If local mm of the thoracolumbosacral are smaller =
higher injury rates and LBP
What happens to local mm. in our patients?
pain, swelling, joint laxity, and disuse
pain, swelling, joint laxity, and disuse of local mm. cause:
-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
Pain, swelling, joint laxity, and disuse of global muscles cause:
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
fiber transformation- type I change to II so what?
filling in the wrong fiber type (filling in with type II when it should be type I)
Normal mm. activity returns spontaneously just because the P! is gone? T or F
False; DOES NOT
Muscle activation of ______% is sufficient to keep stability and is suitable to improve muscular endurance so it__________________
30% : doesn’t take a lot of improvement
What is P! phenotypying?
set of observable charcateristics of an individual resulting from the interaction between the body and the environment
Noceptive:
non-nervous compromise
MSK - including spondylogenic (non-segmental)
Viscerogenic
Neuropathic:
nervous tissue compromise
radicular
radiculppathy
peripheral
Nociplastic:
altered p! perception w/o complete evidence of actual or threatened tissue comprise
Which P! phenotyping is common and produced local as well as referred symptoms from the involved spinal structure?
Spondylogenic
________ P! CANNOT cause visceral dysfunction as some providers claim
Spondylogenic
Spondylogenic P! is MOST often referred where in the LQ
gluteal region and proximal thigh
may go as far as foot
Spondylogenic referred P! is consistent between individuals. T or F
False; inconsistent
Brain perceives the P! as coming from even MORE areas with persistent symptoms is known as
Nociplastic P!
S&S or criteria for “probable” nociplastic P!
possible criteria plus
- sensitivity to sound, light or odor
- sleep disturbances
- fatigue
- cognitive problems
S&S or criteria for “possible” nociplastic P!
≥ 3 months of P!
P! cannot be entrielry explained by nociceptive or neuropathic pathways
non-p!full stimuli causing P!
What is the most accepted Rx for Nociplastic P! along with MET.
JM
How does JM improve nociplastic P!
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.
What is the MET Rx for patients experiencing Nociplastic P!?
Low to mod global aerobic and resistance activities
2-3x/wk.
30-90min per sessions
at LEAST 7 weeks duration
*reorganize homunculus
Is pt. education is important for pts. experiencing nociplastic P!
yes; explain increased sensitivity and misinterpretation to reduce stress/anxiety of misperceived tissue injury
Prognosis of Nociplatic P!
longer recovery
likely NOT full resolution of symptoms
