Thoracolumbar Spine VI- Hypermobility/Instability/ ARJC COPY Flashcards
The four variables of stabilization?
1.
2.
3.
4.
joint integrity (cartilage)
passive stiffness (ligament)
neural input
muscle function
What are the two types of instability?
function and mechanical
Abnormal movement of spinal segments under loaded conditions, results in P!/disability that changes the ______ ______
instantaneous AOM
_______ instability- instability that CAN be stabilized with m. activity and/or positioning
Functional
Hypermobility is more prevalent in biological _______
females
What are some causes of hypermobility/instability?
Traumatic or recurrent sprains i.e., IDD
Age-related disc changes
Repetitive ext activities like gymnastics, dance, power lifting
Creep due to persistent poor posturing
Adjacent joint hypomobility
Generalized hypermobility is a ______ ______ order
connective tissue
Hypermobility is MOST common at the ___-____ level and more common in the ____ and _____ planes
L4; S1
frontal
sagittal
With hypermobility, the _____ is less controlled
AOM
Benign Joint Hypermobility Syndrome if:
____ major criteria present
___ major and ____ minor criteria present
_____ minor criteria present
2; 1; 2; 4
Which type of instability has:
Predictable P!
Spine and referred P!
Possible paresthesia’s from nociplastic pain due to sensitization
NO clear directional preference
Functional
_______ Instability:
↓ed P! with positional changes and support
↑ed P! with:
Prolonged positions
Prolonged and repetitive
- Forward bending
- Arching
- Strenuous activities
- Possibly, sudden motions
- Catching
- Easy self manipulation
Functional
With functional instability:
Hx- often < ____ years of age
ROM- if acute, there will be limited and P!ful _________
40
abberant motion
With functional instability, the ROM is primarily limited and painful with _____ because of increased _______ _______ shearing followed by ______
EXT
anterior vertebral
SB
With functional instability and FLX may be limited with UE assistance returning from FB… what is this called?
Gower’s sign
With hypermobility, ______ ROM is more notable than _______ ROM particularly in ___-______ vs WBing
Passive
Active
Non- WBing
With hypermobility, combined motion will have an _________ block
inconsistent
If it’s NOT acute, it’s often WNL or excessive except for _______ that may still be limited with creasing
EXT
Signs of aberrant (deviating) AROM with functional instability:
P!ful ____ of motion, primarily in sagittal plane
Uncoordinated _______ primarily in sagittal plane
________ sign
_____/_____ compensations
Positive if ≥ ___ present
arc
motion
Gower’s
LE/Pelvis
1
With functional instability:
Resisted/MMT- if ____ may be P!ful
Most often _____ and ______ bc the global muscles are not affected
acute
strong; painless
With functional instability, neuro tests will be __ except possibly a ______ with pinwheel sensation and brisk DTRs
-
hyperesthesia
With functional instability, there will be P! with ____ _____ and there are mixed findings with _______ depending on severity
PA pressures
distx
With functional instability and accesory motion, there is possible ________ if the ________ joint is stuck
Possible adjacent hypomobility with
- ___ rotation
- ____ jt. motion
- _____ hyperextension
hypomobility; hypermobile
T10
SI
Hip
Special Tests for hypermobility:
Possible + prone LE _____ test
+ segmental _______
( _______ shear)
+ ______
extension
stability; anterior
ASLR
LBP can lead to an excessively recruited ______
This muscle maintains_____ in standing
Psoas
lordosis
An excessively recruited Psoas can further add to the __________ and anterior shearing MOST often occuring with ______ hypermobility/instability
hyperextension; lumbar
With functional instability, there will be _____ local muscles and you should focus on _______ by activation or positioning
inhibited
stabilization
With mechanical instability:
It has _________ pattern of provoking activities
_______ symptoms with MORE frequent _____
______ pain with even _____ and _____ ADLs
unpredictable
Worsening
episodes
increased; trivial; lesser
With mechanical stability, the + stability tests won’t stabilize fully with ________ and/or _____ _______
repositioning; muscle activity
With functional and mechanical instability PT Rx:
Rx like ______ laxity
POLICED
______ education to activate local mm. (chair support)
___- to increase adjacent joint hypomobility
_______/taping prn
ligamentous
postural
JM
Bracing
With MET for functional and mechanical instability, there should be emphasis on ________ with local muscles
Addition of _____ exercises provided greater pain and disability improvements
________ is CONTRAINDICATED
stabilization
hip
Hyperextension
Age-related joint changes is aka…
- 2.
3.
- DJD
- OA
- Spondylosis- if multiple spinal levels
Age-related joint changes is MOST common at __-____ level, it progresses along with ______
L4; S1
ARDC
Age-related joint changes is _______ and MORE common in _______ individuals
degenerative; older
With age-related joint changes, there are rarely _____ tears
Typically, in younger active individuals
Involves high _____ forces
acute
shear
What are the causes for age-related joint changes?
Prior trauma
Age
Genetics
Other diseases (Ex. RA)
Sedentary lifestyle with underloading
What re the 5 components of a synovial joint?
articular cartilage
fibrous capsule
synovial membrane
synovial fluid
synovial membrane
With age-related joint changes:
The _____ cartilage thins and that causes the joint space to ____
articular; narrow
With age-related joint changes: _______ bone is overloaded and injured including marrow with greater load
subchondral
With age-related joint changes:
_______ or _____ can form due to excessive bony stress
osteophytes; spurs
With age-related joint changes:
The ______ capsule slackens then thickens and stiffens
fibrous
With age-related joint changes:
_______ membrane produces less ______ fluid and nutrients
synovial; synovial
With age-related joint changes:
There can be _______ tissue inflammation (i.e., ligaments, capsule, mm, etc.)
periarticular
With age-related joint changes: Persistent P! and inflammatory response partly due to…
_____ on other tissues like bone
Increased local _______ sensitivity for greater P! transmission fostering inflammation
Local production of nitrous oxide leads to MORE interstitial _______ and excess collagen (_____ ______)
Blood being released from bone ______
inflammation; joint fibrosis; marrow
Age-related joint changes lumbar symptoms:
______ onset
P! with with ______ extended positions, particularly ______, and possibly sleeping, why?
Gradual
prolonged; standing
squeezes out synovial fluid w/o allowing refill
With age-related joint changes involving lumbar region, there will be _____ stiffness or after ______ positions < _____ mins
morning
prolonged
30
With age-related joint changes involving lumbar region, there will be P! and limitation typically while ____ or _____ or lying on stomach
Standing; Walking
With age-related joint changes involving lumbar region, there could be possible paresthesia’s due to?
stenosis and a narrow vertebral foramen
With age-related joint changes involving lumbar region, what might you observe about the patient?
possible fwd bent in standing/walking
ROM for age-related joint changes signs:
P!ful and _____
P! with ____/______SB/ and _____ROT
It is typically ____ side
_____ pattern of restriction
limited
EXT; ipsi; contra
one
capsular
With age-related joint changes involving lumbar region combined motion will have a _______ block often into the _______ quadrant OR opposing quadrants
consistent; extension
With age-related joint changes involving lumbar region, resisted/MMT depends on _____
acuity
With age-related joint changes involving lumbar region and stress tests:
Likely P! with ______ (if added while in EXT, Ipsi. SB, and contralat ROT)
PA _____ and unilateral ______ likely P!ful
_______ relieving if acute
compression
glides; torsion
distx
With age-related joint changes involving lumbar region, neuro tests are often ______ but could be _____ for radiculpathy if spurring creates _______
negative
positive
stenosis
With age-related joint changes involving lumbar region, the accesory motion will indicate ________
hypomobility
Know this
With age-related joint changes and PT Rx:
there is greater focus on improving ______ of cartilage and ______
POLICED
Patient _____ on weight management and avoiding _______
Assistive _____/orthotics to unload involved ______ (Ex. cane/ waist wrap)
______ for P!
integrity; mobility
education; provocation
devices; cartilage
JM
With age-related joint changes PT Rx:
MET for: ultimate focus on improving _____, ________ integrity, and _________ benefits
motion; cartilage; neuromuscular
With mechanical instability, MD Rx in rare cases of severe shearing/slippage:
Prolotherapy for stabilization into _______ ligaments along with PT
______ fusion
iliolumbar; spinal
