WEEK 2: LUMBAR Flashcards
CPR FOR MANIPULATION
- acute (less than 16 days)
- no symptoms beyond knee
- FABQ less than 19
- hip med rotation over 35 deg
- hypomobility of L spine with spring testing
CPR for stabilization
- young (below 40)
- SLR > 91 (bendy)
- abherrant motion “catch”
- positive prone instability test
- post partum (+ASLR, tender over long dorsal ligament, tender over pubic symph)
If patient has:
pain, mm guarding
pain worse in AM, better as day goes on
-pain with coughing/sneezing
-pain with flexion, SB
DISC! extension preference.
*acute phase, early 20-30s when degenerative changes happen due to dehydration of disc
If patient has…
1. symptoms distal to butt
2. symptoms centralize w extension, peripheralize w flexion
3. directional preference for extension
EXTENSION DIRECTION PREFERENCE
If someone is:
-older than 50
-directional preference for flexion
-imaging evidence for stenosis
DIRECTIONAL FLEXION EXERCISE BUCKET
Visible frontal plane deviation of the shoulders relative to the pelvis
Directional preference for lateral translation movements of the pelvis
lateral flexion exercise
What will be worse for early disc patients, SLR or slump?
SLR 30-60 degrees and slump are EQUALLY BAD
*hip flexion–>lumbar flexion
*lumbar flexion!
If someone has…
pain with mm guarding all motions
-pain worse in AM and NIGHT
-pain with transitional movements
hypermobility early, then hypomobility later
-impaired extension
flexibility or repetitive lifting HURTS
facet impairment!
usually more 30s, facet more involved
SLR vs slump in stenosis!
SLR more positive than slump!
slump=lumbar flexion
NERVE ROOT COMPRESSION FROM BONES/FACETS
If someone has pain better in AM, worse at end of day, leg pain from longtime walking/standing, and pain with extension…
STENOSIS (50+)
If ___ mm is overactive, due to guarding/tightness, it can cause hip, leg, knee or lateral glute pain!
QL! causes facet compression
3 legs of stability stool
- active mm
- passive ligament/joint
- neural CNS control
If someone has symptoms distal to butt (nerve) AND
1. gets worse with extension, or positive crossed SLR
TRACTION
If someone has nerve symptoms, AND
1. directional preference
2. centralization of symptoms with flex or ext
specific exercise DIRECTION
If someone does not have nerve symptoms, BUT patient has centralizing symptoms with direction
specific exercise! AND/OR manip/stabilize
If someone has symptoms less than 16 days and no nerve symptoms…
MANIPULATION
If someone has 3 or more of these:
1. SLR over 91
2. positive prone instability
3. catch/abherrant movement
4. younger than 40
5. postpartum
STABILIZATION
If someone has:
1. red flags
2. med problems that are bad
3. leg pain with neuro deficits
MEDICAL MANAGEMENT
If someone has
1. medium/high psychosocial risks
2. low psychosocial risks with LEG PAIN
3. minor comorbidities
REHAB/PT
If someone has
1. low psychosocial risks
2. mainly LBP only
3. minor comorbidities
self care!
If someone has a flexion preference, they usually have….
what posture?
more ___ROM
more extension ROM, limited FLEXION
flexion feels better!
flat spine, lordotic/kyphotic
What should you avoid/educate about for flexion preference
- avoid overhead/extension
- standing on one leg
- sit with knees above hips
- endurance good
5.
patient presents with flexion or flattened spine. they prob have
extension preference! limited extension ROM
*lumbar flexion syndrome
hamstring stretch is good for…
extension preference in subacute phase with opposite leg extended to restore FLEXION AS TOLERATED
