Treatment Based Classification Flashcards
Second Level classification stage 1
oswestry >30
unable to sit > 30 min
Unable to stand > 15 min
Unable to walk > 1/4 mi
Second Level classification stage 2
oswestry 15-30
Able to sit, stand, walk
Unable to perform complex task
No stage 1 findings
Second Level classification Stage 3
oswestry score <15
Able to perform complex tasks
Unable to perform demanding tasks
What does SINSS stand for
Severity, Irritability, Nature, Stage, Stability
Severity
refers to the intensity of symptoms and the extent that they limit normal activity
Examples of severity
pain scale and functional limitations
Irritability
Refers to the ease in which symptoms are produced and the time it takes to settle
Examples of irritability
Symptom onset: immediately on movement vs. after sustained activities.
Symptom relief: “pain goes away immediately when I stand up straight” or “pain persists 10-15 min after stand up straight”
Nature
Refers to the type and extent or degree of injury or illness
Examples of nature
Type: aching, throbbing, burning, stabbing, sharp, dull, deep, superficial, etc.
Symptom behavior: radiating, referred, local, etc.
Tissue and injury: sprain, DJD, OCD, fracture, osteoporosis, multi-tissue trauma, neural tension
Degree of injury: 1st-3rd degree, mild-severe, etc.
Stage
acute, sub-acute, chronic, acute on chronic
Stability
how are the symptoms changing?
better, worse, the same?
Stable or unstable
Criteria for a positive response (5) for manipulation
<16 days no distal symptoms below the knee FABQ WK subscale <19 At least one hypomobile segment prone hip internal ROM > 35
what is the strongest predictive variable for manipulation
duration of pain (<16 days)
History for stabilization
Frequent prior episodes
Extreme fluctuation of symptoms with minimal perturbation
Transient deformity with prior episodes
Positive response to immobilization
Frequent manipulation with short-term, dramatic results
History of trauma or surgery
No clear postural preference
Difficulty with activities requiring extensor muscle activity
recent or ongoing pregnancy, use or oral contraceptives
May have distal symptoms
Physical exam for stabilization
Segmental hypermobility
Instability catch or movement aberrations
Palpable step off
General ligamentous laxity
What is the aberrant motion assessment? for stabilization
painful arc in flexion painful arc on return from flexion gower's sign instability catch reversal of lumbo-pelvic rhythm
Prone posterior-anterior segmental mobility assessment. What are you looking for?
Segmental mobility (hyper-, hypo-, or normal) Pain provocation (present, absent).
Prone Instability Test
- P-A test for pain provocation (identify painful segments)
2. Repeat P-A with hips extended (positive finding- previously painful segments become pain-free)
what are the 4 things that indicate dramatic success with stabilization category (3 or more present)
prone instability test
abberant motions
average SLR >91
Age <40
predicting improvement in stabilization category 4 things (2 or more present)
Prone instability test abberant motions hypermobility FABQ-PA>8 Also look for greater general flexibility or postpartum
What two things help categorize patients into specific exercise
postural preference
centralization with movement exam
What 4 things help categorize patients into traction
Neuro signs
Leg Symptoms
peripheralization with movement testing
crossed straight leg raise
