Week 1- L-spine Interventions Flashcards
PART 1: INTRO
PART 1: INTRO
Early active physical therapy associated with reduced:
- Work time lost.
- Conversion to ________ LBP.
- Need for lumbosacral _________.
- Physician visits.
- chronic LBP
- injections
Referral rates for patients with LBP from primary care settings ____%.
10.1%
PART 2: BY HEALTH CONDITION
PART 2: BY HEALTH CONDITION
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.
- conservatively, conservatively or surgically
- guarding
- stabilization
Discogenic Pain (Disc Derangement):
- _____ exercises
- Address muscle _________
- _____ intensity/_____ frequency and duration exercises.
- Progress lumbar ________ exercises.
- AROM
- guarding
- low intensity/high frequency
- stabilization
Radiculopathy/Radicular Pain:
- ______ exercises
- Neural ________ (active vs passive)
- Progress lumbar ________ exercises.
- AROM
- mobilizations
- stabilization
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
- central vs lateral
- sustained hold for hypomobile segments and oscillations for muscle guarding/pain
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 ___________/______.
- acute vs chronic
- paraspinal
- low intensity/high frequency
PART 3: INTRO TO CPG FOR LBP
PART 3: INTRO TO CPG FOR LBP
Classifications for L-Spine.
- 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
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
-bed rest
- structural strength
- perception
- LBP
- fear/avoidance
- “normal”
Education should focus on _______ beliefs and resilience with LBP.
-positive
Acute or Subacute LBP with Related Cognitive or Affective Tendencies:
-Interventions strategies include patient ___________ and counseling to address specific classification exhibited.
-education
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.
- 3 months
- education, low-intensity
PART 4: LBP WITH MOBILITY DEFICITS
PART 4: LBP WITH MOBILITY DEFICITS
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 ________.
- 1 month
- manual, mobility, education
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
- end-range
- manual
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
- <16 days
- knee
- <19
- 35 degrees
- hypomobility
symptoms <16 days and no symptoms distal to knee
- 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.
- greatest
- 8x
PART 5: ACUTE LBP WITH RELATED (REFERRED) RADIATING PAIN
PART 5: ACUTE LBP WITH RELATED (REFERRED) RADIATING PAIN
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.
- flexion
- centralized
-education, Subacute or Chronic
PART 6: LBP WITH RADIATING PAIN
PART 6: LBP WITH RADIATING PAIN
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.
- LE
- paresthesias, numbness, and weakness
- nerve root
-education, traction, nerve
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 ____________.
-manual therapy, traction, nerve mobilizations
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 ______________.
- nerve tension
- manual therapy, education
Centralization/Direction-Specific Exercises has ________ evidence and should be considered for patients with LBP and LE symptoms.
-strong
Patients with observed ___________ preference demonstrate decreased pan and medication use when matched to corresponding exercises.
-directional
Intermittent Lumbar Traction has _______ evidence. Should be considered for patients with LBP, lumbar nerve root compression, + Well Leg Raise.
-conflicting
Nerve Mobilization has ______ evidence but tends to be helpful when nerve tension properly assessed.
-weak
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.
- 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
PART 7: MOVEMENT COORDINATION IMPAIRMENT CLASSIFICATION
PART 7: MOVEMENT COORDINATION IMPAIRMENT CLASSIFICATION
