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S6- MSK 2 > Week 1- L-spine Interventions > Flashcards

Week 1- L-spine Interventions Flashcards

1
Q

PART 1: INTRO

A

PART 1: INTRO

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2
Q

Early active physical therapy associated with reduced:

  • Work time lost.
  • Conversion to ________ LBP.
  • Need for lumbosacral _________.
  • Physician visits.
A
  • chronic LBP

- injections

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3
Q

Referral rates for patients with LBP from primary care settings ____%.

A

10.1%

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4
Q

PART 2: BY HEALTH CONDITION

A

PART 2: BY HEALTH CONDITION

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5
Q

Spondylolysis/Spondylolisthesis:

  • Initial management commonly __________ with spondylosis. Spondylolisthesis can be treated _________ or _________.
  • Activity modification and address muscle __________.
  • Stretching of shortened hip musculature.
  • Progress lumbar __________ exercises.
A
  • conservatively, conservatively or surgically
  • guarding
  • stabilization
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6
Q

Discogenic Pain (Disc Derangement):

  • _____ exercises
  • Address muscle _________
  • _____ intensity/_____ frequency and duration exercises.
  • Progress lumbar ________ exercises.
A
  • AROM
  • guarding
  • low intensity/high frequency
  • stabilization
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7
Q

Radiculopathy/Radicular Pain:

  • ______ exercises
  • Neural ________ (active vs passive)
  • Progress lumbar ________ exercises.
A
  • AROM
  • mobilizations
  • stabilization
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8
Q

Lumbar Spine Stenosis:

  • Consider implications of ______ vs ______ canal stenosis.
  • Activity modifications avoiding ones that place higher sustained loads on involved structures.
  • Joint Mobility (thrust and non-thrust): sustained hold mobilizations for __________ segments and oscillations for ___________/______.
  • Muscle Performance: coordination training, strengthening, endurance
A
  • central vs lateral

- sustained hold for hypomobile segments and oscillations for muscle guarding/pain

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9
Q

Z-Joint Arthropathy:

  • Consider implications of ______ vs ______.
  • Address muscle guarding.
  • ________ coordination training as indicated.
  • _____ intensity/_____ frequency and duration exercises.
  • Sustained hold mobilizations for __________ segments and oscillations for ___________/______.
A
  • acute vs chronic
  • paraspinal
  • low intensity/high frequency
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10
Q

PART 3: INTRO TO CPG FOR LBP

A

PART 3: INTRO TO CPG FOR LBP

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11
Q

Classifications for L-Spine.

A
  • Acute or Subacute LBP with Mobility Deficits
  • Acute, Subacute, or Chronic LBP with Movement Coordination Impairments
  • Acute LBP with Related (Referred) Radiating LE Pain
  • Acute, Subacute, or Chronic LBP with Radiating Pain
  • Acute or Subacute LBP with Related Cognitive or Affective Tendencies
  • Chronic LBP with Related Generalized Pain
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12
Q

CPG: Education:
Should Avoid:
-Extended ________
-Detailed pathoanatomic causative analysis

Should Include:

  • ________ strength of the human spine
  • Neuroscience of pain _________
  • Generally favorable prognosis associated with ____
  • Pain coping strategies that address _____/_________
  • Early return to “_______” activities
  • Improved activity levels
A

-bed rest

  • structural strength
  • perception
  • LBP
  • fear/avoidance
  • “normal”
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13
Q

Education should focus on _______ beliefs and resilience with LBP.

A

-positive

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14
Q

Acute or Subacute LBP with Related Cognitive or Affective Tendencies:
-Interventions strategies include patient ___________ and counseling to address specific classification exhibited.

A

-education

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15
Q

Chronic LBP with Related Generalized Pain:

  • “Low back and/or low back–related lower extremity pain with symptom duration of more than __ months.
  • Generalized pain not consistent with other impairment-based classification criteria presented in these clinical guidelines.
  • Presence of depression, fear-avoidance beliefs, and/or pain catastrophizing”.

-Intervention strategies include patient _________ and ____-intensity prolonged exercise activities.

A
  • 3 months

- education, low-intensity

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16
Q

PART 4: LBP WITH MOBILITY DEFICITS

A

PART 4: LBP WITH MOBILITY DEFICITS

17
Q

Acute LBP with Mobility Deficits:
-Acute low back, buttock, or thigh pain (duration of __ month or less).

-Intervention strategies include _______ therapy procedures, therapeutic exercise to improve or maintain spinal ________, and patient ________.

A
  • 1 month

- manual, mobility, education

18
Q

Subacute LBP with Mobility Deficits:

  • “Subacute, unilateral, low back, buttock, or thigh pain”
  • Symptoms reproduced with ___-_____ spinal motions and provocation of involved lower thoracic, lumbar, or sacroiliac segments.
  • Presence of 1 or more of: restricted thoracic ROM and associated segmental mobility, restricted lumbar ROM and associated segmental mobility, restricted lumbopelvic or hip ROM and associated accessory mobility.

-Interventions include ______ therapy to improve mobility, ther-ex for mobility, focus on preventing recurrent LBP episodes

A
  • end-range

- manual

19
Q

Patients with LBP who are likely to benefit from spinal manipulations.

  • Duration of symptoms ___ degrees of IR ROM.
  • _____mobility in the l-spine.
  • FABQ score ___ degrees of IR
  • ________ in the lumbar spine
A
  • <16 days
  • knee
  • <19
  • 35 degrees
  • hypomobility

symptoms <16 days and no symptoms distal to knee

20
Q
  • Individuals meeting CPR who received manipulation demonstrates ________ improvement in disability.
  • Exercise only group __x more likely to experience worsening of disability (ODI) at 6m f/u.
A
  • greatest

- 8x

21
Q

PART 5: ACUTE LBP WITH RELATED (REFERRED) RADIATING PAIN

A

PART 5: ACUTE LBP WITH RELATED (REFERRED) RADIATING PAIN

22
Q

Acute LBP w/ Related (Referred) Radiating Pain:

  • “Low back pain, commonly associated with referred buttock, thigh, or leg pain, that worsens with ______ activities and sitting.
  • Low back and lower extremity pain that can be _____________ and diminished with positioning, manual procedures, and/ or repeated movements.
  • Lateral trunk shift, reduced lumbar lordosis, limited lumbar extension mobility, and clinical findings associated with the subacute or chronic low back pain with movement coordination impairments category are commonly present”.

-Interventions include ther ex, manual therapy, traction to promote centralization and increase mobility, patient ________, and progression to interventions consistent with the _______ or ________ LBP w/ Movement Coordination Impairment intervention strategies.

A
  • flexion
  • centralized

-education, Subacute or Chronic

23
Q

PART 6: LBP WITH RADIATING PAIN

A

PART 6: LBP WITH RADIATING PAIN

24
Q

Acute LBP with Radiating Pain:

  • “Acute low back pain with associated radiating pain in the involved ________”.
  • Lower extremity _________, _________, and __________ may be reported.
  • Symptoms are reproduced or aggravated with _______ to _____ range spinal mobility, lower limb tension/straight leg raising, and/or slump tests.
  • Signs of ______ ______ involvement (sensory, strength, or reflex deficits) may be present”.

Interventions include patient ________ in positions that reduce strain or compression, manual or mechanical _________, manual therapy to mobilize articulations and soft tissues adjacent, ________ mobility exercises in pain free range.

A
  • LE
  • paresthesias, numbness, and weakness
  • nerve root

-education, traction, nerve

25
Q

Subacute LBP with Radiating Pain:
-“Subacute, recurring, mid-back and/or low back pain with associated radiating pain and potential sensory, strength, or reflex deficits in the involved lower extremity”.

-Interventions include _______ therapy, manual or mechanical ________, and nerve ____________.

A

-manual therapy, traction, nerve mobilizations

26
Q

Chronic LBP with Radiating Pain:

  • “Chronic, recurring, mid-back and/or low back pain with associated radiating pain and potential sensory, strength, or reflex deficits in the involved lower extremity.
  • Symptoms are reproduced or aggravated with sustained end-range lower-limb _________ tension/straight leg raise and/ or slump tests”

-Interventions include ______ therapy and ther-ex to address thoracolumbar and lower-quarter nerve mobility deficits as well as patient ______________.

A
  • nerve tension

- manual therapy, education

27
Q

Centralization/Direction-Specific Exercises has ________ evidence and should be considered for patients with LBP and LE symptoms.

A

-strong

28
Q

Patients with observed ___________ preference demonstrate decreased pan and medication use when matched to corresponding exercises.

A

-directional

29
Q

Intermittent Lumbar Traction has _______ evidence. Should be considered for patients with LBP, lumbar nerve root compression, + Well Leg Raise.

A

-conflicting

30
Q

Nerve Mobilization has ______ evidence but tends to be helpful when nerve tension properly assessed.

A

-weak

31
Q

Sciatic Nerve Mobilization:

  • Can be _______ or ________.
  • Common position is sitting.
  • Give an example of nerve glider/slider while sitting.
  • Give an example of a tensioner while sitting.
A
  • passive or active
  • ankle PF with neck flexion, followed by ankle DF with neck return to neutral
  • ankle DF with neck flexion, followed by ankle PR with neck return to neutral
32
Q

PART 7: MOVEMENT COORDINATION IMPAIRMENT CLASSIFICATION

A

PART 7: MOVEMENT COORDINATION IMPAIRMENT CLASSIFICATION

S6- MSK 2 (21 decks)

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