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MSK 2 > treatment based classification > Flashcards

treatment based classification Flashcards

1
Q

criteria for manipulation

A

no symptoms below the knee

recent onset of sym (<16 days)

low FABQW score

hypomobilty of the lumbar spine

hip internal rotation ROM (>35)

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2
Q

criteria for stablization

A

younger (<40)

greater flexibility

instability catch or aberrant movements during lumbar flexion and extension

positive prone instability test

postpatrum things

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3
Q

aberrant movements

A

deviate
from the typical or expected movement
pattern, are associated with low back dysfunction

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4
Q

criteria extension

A

symptoms distal to the buttock

sym centralize with lumbar extension

sym peri with lumbar flexion.

directional perference of extension

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5
Q

criteria flexion

A

older then 50

directional preference for flexion

imaging for lumbar spinal stenosis

stiff achy back

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6
Q

criteria lateral shift

A

visible frontal plane deviation of the shoulders relative to the pelvis

directional preference for lateral translation movements of the pelvis

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7
Q

traction criteria

A

signs and symptoms of nerve root compression

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8
Q

Symptoms of Radiculopathy

A

Tingling or numbness in the fingers or hand.

Weakness in arm, shoulder or hand.

Decreased motor skills.

Loss of sensation.

Pain associated with neck movement or straining.

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9
Q

Instability catch

A

any sudden acceleration or deceleration of trunk movement or movement occurring outside the primary plane of motion

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10
Q

Transversus Abdominis action

A

“Support & compress abdominal viscera; assist in forced expiration, decreases infrasternal angle
“

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11
Q

Rectus Abdominis action

A

Flexes vertebral column; can posteriorly rotate pelvis when thorax is fixed

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12
Q

Quadratus Lumborum

A

Fixes last rib so diaphragm acts more efficiently during inspiration;

hikes hip;

ipsilateral side bending when pelvis is fixed

Acting bilaterally forms guy wire support to stabilize lumbar spine in frontal plane”

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13
Q

Blocked Extension Principle

A
  • Flexion worsens status
  • Not able to test “Extension Hypothesis”
  • Typically, not a “Mobilization Principle” candidate
  • Pt: flex brought on their initial problem; we need to restore their ext to get them to centralize
  • You cannot go into extension – this motion is blocked
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14
Q

Unstable Status (“Volatile”)

A
  • Rapid worsening with any flexion movement or position
    – Flexion – peripheralization
  • May or may not achieve a rapid improvement with extension
    Pt: have inflammation that is interplaying with mech issues
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15
Q

Stable Status (“Mechanical”)

A
  • Gradual improvement with sustained or repeated extension postures
    – Clear extension bias
  • Status will worsen with sustained or repeated flexion
  • Pt: have acute LBP and fall in line with textbook def
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16
Q

multifudus

A

Extension

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17
Q

Iliocostalis Lumborum, pars Lumborum
and
Longissimus Thoracis, pars Lumborum

A

Back extension, creates posterior shear forces to counteract anterior shear forces

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18
Q

External Abdominal Oblique action

A

“Support & compress abdominal viscera;
assist in forceful expiration
Acting bilaterally:

flexes spine

Lateral fibers: acting bilaterally, posteriorly rotates pelvis; acting unilaterally, laterally flexes spine
Anterior fibers: acting unilaterally, flex & contralaterally rotate spine”

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19
Q

malaise

A

geneally feeling unwell often accompanied by fatigue and diffused pain

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20
Q

what are myotomes testing for

A

you are looking for muscle weakness of a particular group of muscles.

Results may indicate lesion to the spinal cord nerve root, or intervertebral disc herniation pressing on the spinal nerve roots.

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21
Q

emergent medial red flags

A

extensive neurological involvement

non MSK conditions - red flags

fracture or something that need imaging work up

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22
Q

symptom modulation

A

preventing worsening status - moderating factors

signs of active inflammation

treatment:
- directional preference
- manipulation
- traction
- active rest

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23
Q

movement control - stage 2

A

impairment driven - improve dynamic movement control

improve basic functional movement patterns, break faulty compensatory patterns

the symptoms are now under control

treatment:
- flexibility exercises
- stabilization exercises
- sensorimotor exercises

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24
Q

functional optimization - stage 3

A

return to work or sport - increase functional capacity and tolerance

symptoms are low

treatment:
- strength and conditioning exercises
- work or sport specific tasks
- aerobic exercises
- general fitness exercises

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25
Q

radiculopathy from an acute disc herniation - history and age

A

30 - 55

acute or reccurrent episodes

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26
Q

radiculopathy from an acute disc herniation - pain pattern

A

pain and or numbness radiating towards LE below the knee

normally increases with lumbar flexion

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27
Q

radiculopathy from an acute disc herniation - neuro exam

A

sensory and/or motor changes

diminished/absent deep tendon reflexes unilat

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28
Q

radiculopathy from an acute disc herniation - ROM

A

guarded and limited

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29
Q

spinal stenosis
- age and history

A

> 60

insidous onset of chronic progressive LBP

more recent onset of LE pain

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30
Q

spinal stenosis
- pain patterns

A

LE symptoms increase with ext and are relieved by flexion

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31
Q

spinal stenosis
- neuro exam

A

sensory and motor changes

32
Q

spinal stenosis
- ROM

A

pain and limited ext

33
Q

what is the start back for

A

screening for yellow flags

34
Q

ospro is for what

A

screening red flags

35
Q

what is the oswestry

A

standard screening for low back pain

36
Q

ospro-YF

A

looking at specific yellow flags

fear avoidance, depression, anxiety

37
Q

what is the most significant neurological sign

A

babinski

38
Q

what does peri mean in term of low back pain

A

pain or paresthesia moves distally away from the spine

para is produced previously where it was not seen

sym increase and sustain for at least 30 secs

39
Q

what is centralization

A

pain or para moves centrally - towards the spine

paresthesia that was present is abolished

sym is diminished or abolished

any movement that causes ccentralization should be included in treatment

40
Q

what is paresthesia

A

an abnormal sensation, typically tingling or pricking (“pins and needles”), caused chiefly by pressure on or damage to peripheral nerves.

41
Q

status quo

A

neither centralization or peri is produced

there is a tranisent increase of decrease in pain pbserved with movement

if this is seen - think of doing moblization, traction, or immoblization

42
Q

what is active rest

A

when the pt inflammation is so bad that most movement leads to pain

only ADLs for 48 -72 hours

this is a acute issue

may be using modalities to get pain under control

43
Q

what is a right lateral shift

A

the shoulder are shifted right and the pelvis is going left

44
Q

what is directional perferance

A

situation in which movement in one direction improves pain and limitation of ROM

45
Q

when do you have the most intradiscal pressure

A

standing with flexion more when you add a weight

supine<standing<sitting

46
Q

internal disc distruption

A

with the internal arch of the internal disc is disrupted even though its external apperence remains noraml

47
Q

why do people get injured in the fully flexed position

A

support responsibilities shift from the muscle to the disc

leads to creation of shearing force

48
Q

disc herniation and fully flexed spine

A

posterior protustion due to annular failure associated with a fully flexed spine

49
Q

pathomechanics of a lateral shift

A

disc herniation

protective muscle spasm

segmental instablity

50
Q

lumbar radiculopathy history

A

presence of sciatica

LE pain greater then back pain

dermatome distribution of pain

51
Q

weakness seen with lumbar radiculopathy

A

PF, DF, great toe extension, quads

L4, L5, S1, S2

52
Q

what is Ischemia

A

when blood flow is restricted to a part of the body

53
Q

do people with spinal stenosis have pain when seated

A

normal no
are in pain when they are up on their feet

54
Q

lumbar spinal stenosis population

A

greater then 65

55
Q

do people with spinal stenosis have pain with flexion or extension

A

extension

56
Q

traction in extension criteria

A

younger

worsen with flexion

ISQ with extension

prefer to stand and walk compared to sitting

alternative: auto-traction to extend

57
Q

traction in flexion criteria

A

older

worsen with extension

ISQ with flexion

prefer sitting vs standing and walking

alternative: de weighted ambulation

58
Q

the flexion principle - what kind of spine

A

stenotic, degenerative,

59
Q

flex prin - type of spine

A

flat back, sway back, hyperlordoic

the load is going to the posterior segments

60
Q

flex prin - special cases

A

spondylothesis

adherent nerve roots syndromes

61
Q

what is the mechanism of onset for flex principle

A

no specific mech
often has a gradual onset

62
Q

flex prin - demographic

A

stiff achy back - often with radiating features

variable but late 50s and older

exhibit claudicant behavior - sense of weakness when standing, they do not want to get on their feet

63
Q

what is the common path of degeneration in the back

A

the disc degenerates and then the facets joints

64
Q

what is lumbar spinal stenosis

A

any narrowing of the lumbar spinal canal, nerve root canal, or intervertbral foramen that produces compression on the neural elements

65
Q

primary lumbar stenosis

A

the bone did not form consistent with expectations

66
Q

secondary spinal stenosis

A

degenerative chnages

post op changes

fracture

tumor

systematicc disease

67
Q

what makes up degenerative stenosis

A

facet joint arthrosis

ligamentum flavum thickening

intervertebral disc bulging

spondylolethesis

68
Q

structural component of spinal stenosis

A

degenerative changes

degenerative spondylolethesis

69
Q

what does flexion do to CSA

A

it increases CSA -loading

70
Q

what does extension do to CSA

A

decrease CSA - unloading

71
Q

narrowing and spinal extension

A

greater structure narrowing of the spinal canals –> greater narrowing during ext

72
Q

Myelopathy

A

an injury to the spinal cord caused by severe compression that may be a result of spinal stenosis, disc degeneration, disc herniation, autoimmune disorders or other trauma.

73
Q

shopping cart sign and graded treamill

A

both of these are putting in pt in flexion their preferred position

the shopping cart is also supporting their trunk wieght

74
Q

are we treating spinal stenosis with flexion pt

A

no more treating the impairments caused by the stenosis

75
Q

surgery and spinal stenosis

A

complication rates are high

76
Q

what is the treatment program for flex prin pt’s

A

flex oriented exercise

de-weighted treadmill

ex for individual impairments

MSK 2 (15 decks)

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