Week 3 Tue 1.26.16 General Obj.exam Flashcards
Name the 13 components of the standard objective examination.
- Observation
- Posture
- Gait
- Balance
- Functional Tests
- AROM
- PROM
- Neurological Screening
- Muscle length test
- Muscle performance
- Screen region/ joints above and below
- Special tests
- Palpations
Differentiate between protective, non-protective, structural and behavioral postural deviations.
-
Non-protective (structural or behavioral)- Long standing scoliosis is a non-protective structural deformity if it is not correctable by movement and attempts to correct it does not alter symptoms.
- A non-protective Behavioral deformity may be due to emotional state, personality, or poor body awareness. This type of posture is correctable actively or passively by the clinician without a change in symptoms, although it may still be relevant to the problem
- Protective posture- is an attempt by the pt either consciously or unconsciously to lessen symptoms. E.g. left lateral shift in a person with LBP is a protective posture. Correction of the shift and and the pts response determine the relevance and may guide the initial intervention.
What is a non-protective (structural or behavioral) postural deviation?
- Non-protective (structural or behavioral)- Long standing scoliosis is a non-protective structural deformity if it is not correctable by movement and attempts to correct it does not alter symptoms.
- A non-protective Behavioral deformity may be due to emotional state, personality, or poor body awareness. This type of posture is correctable actively or passively by the clinician without a change in symptoms, although it may still be relevant to the problem
What is a protective postural deviation?
- Protective posture- is an attempt by the pt either consciously or unconsciously to lessen symptoms. E.g. left lateral shift in a person with LBP is a protective posture. Correction of the shift and the pts response determine the relevance and may guide the initial intervention.
What is upper crossed syndrome? (include 4 parts of typical presentation)
A static standing postural deviation caused by muscle imbalance in the neck-shoulder region.
Typical postural deviations include
- Forward head
- Increased upper thoracic kyphosis
- Anterior translation of the c-spine
- Protracted, elevated scapulae.
Possibly affects all movements of the c-spine and UE.
Briefly describe the pattern of stiffness (4) and weakness (4) in the upper crossed syndrome
stiffness in the
- upper trapezius (UT),
- levator scapulae,
- pectoralis major, and
- sternoleidomastoid
Weakness in
- Deep neck flexors
- Lower trapezius
- Serratus anterior
- Stabilizers of the scapula
What is lower crossed syndrome? (include 3 parts of typical presentation)
A static standing postural deviation caused by muscle imbalance in the lumbopelvic hip region.
Typical postural deviation includes
- anterior pelvic tilt,
- increased flexion of the hips, and
- increase lumbar lordosis.
Briefly describe the pattern of stiffness (2) and weakness (2) in the lower crossed syndrome
Stiffness in the
- Hip flexors or
- Erector spinae
Weakness in
- Gluteal muscles
- Abdominal muscles
Describe the appearance of kyphosis-lordosis posture (what is weak [3], what is tight [3], what could be either [1]?)
Kyphosis-lordosis posture- is similar to the upper and lower crossed syndromes and is associated with
- weakness in the
- neck flexors,
- upper back erector spinae, and
- external oblique (EO);
- stiffness in the
- neck extensors,
- hip flexors, and
- lumbar ES; and
- hamstrings may or may not be weak.
Describe the appearance of flat back posture (what is weak [1], what is tight [1], what could be either [1]?)
Flat back posture- presents with a reduced or absent lumbar lordosis, posterior pelvic tilt, extension of the hip, slight PF of the ankle, a slightly extended cervical spine, flexion of the upper thoracic spine, and straight lower thoracic spine.
- Hip flexors are weak,
- hamstrings are stiff, and the
- lumbar paraspinals may be weak.
Describe the appearance of swayback posture
Swayback posture- presents as a forward head, extended cervical spine, increased flexion and posterior displacement of the upper trunk, flexion of the upper spine, posterior pelvic tilt, hyperextension at the hips with anterior pelvis displacement, hyperextension at the knees, and neutral at the ankles.
Describe the favored sitting position and why it is considered optimal.
- In considering an optimal posture for sitting, lumbopelvic sitting (ie, anterior pelvic rotation, lumbar lordosis, and thoracic relaxation) is favored for the lumbar and thoracic regions because it does not involve end-rage positions and results in preferential activation of local stabilizing muscles without high compressive loads of thoracic extensor spinae (TES).
- The favored posture for sitting is the lumbopelvic posture resulting in a relatively neutral head/neck alignment and diminished cervical erector spinae (CES) and thoracic erector spinae (TES) compared to slump sitting
- Note: Thoracic upright sitting (ie, shoulder blades slightly retracted and thoracolumbar spine extended) results in high compressive axial loads from the TES and EO.
- Note: As expected, Slump sitting results in greater head/neck flexion, anterior head translation and increased cervical erector spinae activity.
- Additional info: Simply telling a pt. to “sit up straight” does not facilitate an optimal position of the spine. There is increased deep neck flexor and lumbar multifidus activity in a therapist-facilitated (ie, manually and verbally) lumbopelvic posture compared to non-facilitated thoracic upright sitting posture.
What happens if you tell a pt to “sit up straight”?
- Simply telling a pt. to “sit up straight” does not facilitate an optimal position of the spine. There isincreased deep neck flexor and lumbar multifidus activity (a good thing) in a therapist-facilitated (ie, manually and verbally) lumbopelvic posture compared to non-facilitated thoracic upright sitting posture.
- You should teach lumbopelvic sitting
List the procedure for assessing the effect of sitting posture correction on spinal symptoms.
- First, the pt.’s unsupported sitting posture is observed with the feet flat on the floor and hips in 80° of flexion.
- Next, the clinician manually assists anterior rotation of the pelvis, which results in neutral spinal posture as follows:
- a) restoration of the normal low lumbar lordosis;
- b) kyphosis in the thoracic spine adjusted with a slight sternal lift or depression;
- c) scapulae sitting flush on the thoracic wall;
- d) head-on-neck posture adjusted with gentle occipital lift away from cervical extension
- The clinician manually repositions the scapulae as needed.
- The pt. is asked to actively maintain this position.
- The effect of postural correction on the patient’s symptoms is assessed to determine relevance. Symptoms may increase, decrease, or remain the same or pt.’s may have difficulty assuming the desired position, perhaps due to impaired spinal mobility.
Should we try to fix all deviations from what is considered “normal” or “ideal” when teaching sitting posture?
Not all deviations from what is considered “normal” or “ideal” should be considered pathological, and some faulty postures should not always be corrected. For example, a pt. w/symptomatic lumbar spinal stenosis necessarily has a reduced lumbar lordosis.
Describe briefly the typical gait of a patient with spinal pain, and the relationship between gait speed and fear related to physical activity. (4 points)
- Most individuals with LBP walk slower, take shorter steps, and have asymmetrical step lengths.
- Altered gait strategies in persons w/LBP may also be affected by factors such as intensity of pain, level of disability, distribution of pain, and fear related to physical activity. In LBP, the level of perceived disability accounts for more variance of walking ability than pain intensity.
- Fear related to physical activity is a strong predictor of gait velocity.
- The 10-meter walk test is an easy, reliable test to measure walking speed. Gait speed of less than 1 m/s (ie, 6 sec to complete a 6-m course) identifies a well-functioning older persons at high risk of adverse health outcomes within 1 year.
Describe how to progressively assess standing balance?
Balance is progressively challenged as follows:
- Eyes Open on a firm, level surface utilizes the visual, vestibular, and somatosensory systems for postural control.
- Eyes Closed on a firm, level surface increases challenge to the vestibular and somatosensory systems through elimination of the visual system.
- Eyes Open on an unstable or foam surface changes the somatosensory input, placing greater reliance on the visual and vestibular systems.
- Eyes Closed on a foam surface requires greater reliance on vestibular input since vision is eliminated and somatosensory is altered.
***all of these are standing with both feet.
Someone 45 or under should be able to do all of these for 30 seconds (I think)
T or F: Individuals w/LBP have poorer standing balance w/altered postural adjustment strategies (reduced hip strategy) and increased visual dependence.
True
Describe the AROM testing procedures (everything)
- Test uninvolved side first and compare to the involved side.
- Explain what you want the pt. to do and ask for a response to the movement.
- The pt. should indicate where in the range symptoms are felt or increased if resting symptoms are present and which symptoms are affected by the movement.
- Establish symptoms at rest prior to movement.
- Assess pain or symptom response – seek to reproduce pt.’s symptoms.
- Note pain rating using the NPRS.
- Note behavior of symptoms through movement: local or referred, type and location, and where in range the symptoms were produced (eg., pain at end-range, mid-range, painful arc).
- Re-establish symptom baseline between tests to prevent a cumulative effect.
- Assess quality of movement by observing from front, back, or sides as needed.
- Note smoothness, ease of movement, and control of movement.
- Note deviations from normal otherwise known as aberrant movements or substitutions.
- Deviations are corrected to observe the pt.’s response. If symptoms change with the correction, then the deviation is relevant to the problem. For example, if lumbar flexion occurs asymptomatically with deviation to the left, relevance is supported if correction produces part or all of the pt.’s symptoms. If no change occurs with correction, the deviation is initially deemed not relevant.
- Note intervertebral movement.
- Assess quantity of movement grossly as normal, hypomobile, or hypermobile.
- Measurement with gravity/bubble inclinometer has acceptable reliability for neck pain and LBP
- If AROM is normal, apply overpressure (OP) and assess the end-feel and the effect on symptoms. Symptoms may stay the same, increase, or decrease.
- If AROM with overpressure is normal and symptoms have not been reproduced, try repeated movements, sustained movements, or combined movements.
AROM testing: which side should you test first?
Test uninvolved side first and compare to the involved side.
AROM testing: What are 4 things should you note when assessing quality of movement?
- smoothness
- Ease of movement
- Control of movements
- Deviations from normal (otherwise known as aberrant movements or substitutions)
AROM testing: If you note any deviations in movement when assessing quality of movement, what should you do? What does the response mean?
Deviations are corrected to observe the pt.’s response. If symptoms change with the correction, then the deviation is relevant to the problem. For example, if lumbar flexion occurs asymptomatically with deviation to the left, relevance is supported if correction produces part or all of the pt.’s symptoms. If no change occurs with correction, the deviation is initially deemed not relevant.
AROM testing: when could you provide overpressure and why?
If AROM is normal, apply overpressure (OP) and assess the end-feel and the effect on symptoms. Symptoms may stay the same, increase, or decrease.
AROM testing: if AROM with Overpressure is normal and symptoms have not been reproduced, what should you do? (3)
If AROM with overpressure is normal and symptoms have not been reproduced, try repeated movements, sustained movements, or combined movements.
Describe Repeated Movement/Motion Testing Procedure (everything)
- Establish baseline resting symptoms and explain what you want the patient to do.
- During the repeated movements, continually ask the pt. about any change in symptom behavior (location or intensity during movement or at end-range).
- This history may provide clues as to the movement that will worsen symptoms.
- Sagittal plane movements are performed first (eg., flex or ext)
- Frontal plane or horizontal plane movements are tested as needed for lateral or rotational directional preference (DP) for the cervical, thoracic, or lumbar spine.
- After 10 to 15 movements or one set, the pt. relaxes and reports current symptoms.
- If the pt.’s response is worsening or peripheralization occurs, the movements are discontinued prior to completing all repetitions. A different loading strategy may be performed in an attempt to obtain centralization or a DP.
- If the pt. is centralizing or getting better, additional repetitions may be required or a different loading strategy performed (eg., moving from extension in standing to extension in lying)
- the pt.’s response is detailed and recorded as centralized, peripheralized, better, no better, worse, no worse, or no effect.
What should you do first when assessing a pt for repeated motion?
Establish baseline resting symptoms
Repeated Motion testing: When should you do sagittal plane movement vs frontal or horizontal plane movements?
- Sagittal plane movements are performed first (eg., flex or ext)
- Frontal plane or horizontal plane movements are tested as needed for lateral or rotational directional preference (DP) for the cervical, thoracic, or lumbar spine.
Repeated Motion Testing: How may times should the pt perform a movement?
- After 10 to 15 movements or one set, the pt. relaxes and reports current symptoms.
- If the pt.’s response is worsening or peripheralization occurs, the movements are discontinued prior to completing all repetitions.
- If the pt. is centralizing or getting better, additional repetitions may be required or a different loading strategy performed (eg., moving from extension in standing to extension in lying)
Repeated Motion Testing: What could you do if the pt’s response is worsening or periphralization occurs?
If the pt.’s response is worsening or peripheralization occurs, the movements are discontinued prior to completing all repetitions. A different loading strategy may be performed in an attempt to obtain centralization or a DP.
Repeated Motions Testing: What is the main thing (s) you should document at the conclusion of the test?
the pt.’s response is detailed and recorded as centralized, peripheralized, better, no better, worse, no worse, or no effect.
Repeated Motions Testing: Define Centralized:
Centralized: Pain in the extremity coming from the spine is abolished, progressively moves in a proximal direction, and remains abolished after testing. At the same time, proximal pain may develop or increase in the spine.
Repeated Motions Testing: Define Peripheralized:
Peripheralized: The opposite of centralized. Pain coming from the spine is produced distally, spreads distally or increases distally, and remains in the extremity after testing.
Repeated Motions Testing: Define “better”
Better: Symptoms decreased or abolished and remain better after testing.
Repeated Motions Testing: Define “no better”
No better: Symptoms decreased or abolished but return to baseline after testing.
Repeated Motions Testing: Define “worse”
Worse: Symptoms produced or increased with movement and remain increased after testing.
Repeated Motions Testing: Define “no worse”
No worse: Symptoms produced or increased with movement but return to baseline after the test.
Repeated Motions Testing: Define “no effect”
No effect: symptoms do not change during or after testing.
What are three subgroups related to mechanical spine pain
- Derangement Syndrome
- Dysfunction Syndrome
- Postural Syndrome
What might help to begin differentiation among the three subgroups related to mechanical spine pain?
The pt’s response to repeated movements
What may assist in determining an initial treatment strategy for pts with mechanical spine pain?
Differentiation among 3 subgroups related to mechanical spine pain (derangement, dysfunction, and postural syndrome), which can start to be determined based on the pt’s response to repeated movements.
What is derangement Syndrome?
What is an alternate name?
Key findings?
- 1 of three subgroups related to mechanical spine pain.
- Also called direction-specific exercise classification
- Key finding is either centralization or peripheralization in response to mechanical loading strategies such as repeated movements.
- Can determine which movements may be good for treatment and which should be avoided.
- As soon as centralization is identified and a directional preference (DP) is observed, no further exam may be needed.
Repeated Motions Testing, Derangement Syndrome: If centralization is identified and a directional preference is observed . . .
No further exam may be needed
What is a directional preference?
A DP is demonstrated by improvements in ROM and pain in one direction that is worse in the opposite direction but does not include centralization or peripheralization.
Derangement Syndrome testing: What should you do in the absence of a response of centralization or peripheralization?
In the absence of a response of centralization or peripheralization, additional testing is required, but DP may be considered for the initial treatment direction. (pts who demonstrate centralization have better outcomes than non-centralizers).
What is Dysfunction Syndrome?
What is another name for it?
What are some key findings?
(5 points total)
- 1 of three subgroups related to mechanical spine pain.
- Also called presentation of spinal pain and mobility deficits.
- Key finding is reproduction of the pt’s familiar pain at end-range possibly due to mechanical loading of adaptively shortened tissue (ie, loss of tissue mobility). On return to neutral the pain is no longer present.
- The symptoms do not get progressively worse or peripheralize and ROM will not change rapidly, suggesting a preliminary hypothesis of spinal pain with mobility deficits that warrants further exam of segmental mobility and other test procedures.
- In general, the provocative limited, end-range movement or movements guide the initial treatment to reduce pain and improve mobility through application of manual techniques and exercise intervention.
What is Postural Syndrome? (5 points)
- 1 of three subgroups related to mechanical spine pain.
- Less common subgroup
- The response to repeated movements is not provocative.
- Theoretically, only sustained postures or positions reproduce the pt’s symptoms as the result of mechanical deformation of normal soft tissues (creep?)
- A postural component rarely presents in isolation but may be a factor in a variety of patients presenting with spinal pain.
What Does PPIVM stand for?
PPIVM = Passive Physiological InterVertebral Movements
What does PAIVM stand for?
PAIVM = Passive Accessory InterVertebral Movements
What type of movements are PPIVM and PAIVM?
Passive accessory movements
What does PAM stand for?
Passive accessory movements
Four points about PAMs
- are necessary for normal physiological movement at any joint. (arthrokinematic type movements)
- Generally cannot be performed actively by the pt, but they can be performed by the clinician.
- Are performed by the clinician initially in the resting position of the joint and graded as hypomobile, normal, or hypermobile with or without pain.
- are used to identify movement impairments and to guide clinical decisions.
What is PPIVM?
- PPIVM = Passive Physiological InterVertebral Movements
- Involve physiological segmental motion palpations in the same planes as AORM such as flexion, extension, lateral flexion, and rotation.
- the big movements that involve several levels/joints
- Involve physiological segmental motion palpations in the same planes as AORM such as flexion, extension, lateral flexion, and rotation.
***Dr Mincer said you palpate an individual level while moving whole spine in large movements like flexion, extension, rotation, etc.
What is PAIVM?
- PAIVM = Passive Accessory InterVertebral Movements
- Involve passive accessory segmental motion testing of gliding motions such as posterior to anterior gliding centrally over the spinous process.
- small movements of the individual joints or levels, like facet joints.
- Involve passive accessory segmental motion testing of gliding motions such as posterior to anterior gliding centrally over the spinous process.
***Dr. Mincer said this was like spring testing
7 Indications from the history for persons with LBP, thoracic pain, or neck pain that raise suspicion of neurological involvement
- weakness
- numbness
- paresthesia (sensation of tingling, prickling, pins and needles)
- Loss of sensation or anesthesia
- Referred or radicular pain into the extremities,
- Bowel and bladder dysfunction
- Complaints of balance or gait disturbances (such as ataxia or wide-based gait)
What are three broad categories that current clinical practice guidelines recommend that clinicians classify pts with LBP into?
- Nonspecific LBP
- LBP potentially associated with radiculopathy or spinal stenosis
- LBP potentially associated with another specific spinal cause
What are 6 neurologic findings that suggest CNS problems?
CNS (pg. 87)
- Bilateral deficits
- (+) Babinski
- (+) Hoffmann’s Sign
- (+) Clonus
- Cranial Nerve screening
- DTR that are hyper-reflexive
What are some neurologic findings that suggest PNS problems?
- Dermatomes/myotomes and peripheral nerve cutaneous nerve distributions (Figure 2-4 and Figure 2-5 from Chapter 2, Table 3-6, or see hand-outs from fall 2014)
- If a peripheral nerve is affected, then only the muscles supplied by that nerve are affected. (Table 3-7 and Table 3-8)
- DTR that are hyporeflexive (most likely at a specific level I think)
Upper Quarter Neurologic Screen Myotomes (from Fall 2014) – because Sara constantly forgets them no matter how many times she has tried to learn them! (8)
- C1/2- Neck flexion
- C3- Neck lateral flexion
- C4- Shoulder elevation
- C5- Shoulder abduction
- C6- Elbow flexion and wrist extension
- C7- Elbow extension and wrist flexion
- C8- Thumb extension
- T1- Hand intrinsics (finger abduction)
Upper Quarter Neurologic Screen Dermatomes (from Fall 2014) - because Sara constantly forgets them no matter how many times she has tried to learn them! (8)
- C1- Top of the head
- C2- Side of the head
- C3/4- Lateral neck and top of the shoulder
- C5- Lateral shoulder and arm
- C6- Lateral forearm, thumb, index finger
- C7- Middle and ring fingers
- C8- Ring and little fingers
- T1/2- Medial forearm and arm
Lower Quarter Neurologic Screen Dermatomes (from Fall 2014) - because Sara constantly forgets them no matter how many times she has tried to learn them! (6)
- L1/2- groin
- L3- anterior and medial thigh
- L4- medial lower leg
- L5- lateral lower leg
- S1- posterior lower leg and lateral foot
- S2- posterior knee
Lower Quarter Neurologic Screen Myotomes (from Fall 2014) - because Sara constantly forgets them no matter how many times she has tried to learn them! (6)
- L1/2- Resisted hip flexion in sitting
- L3/4- Resisted knee extension in sitting
- L4- Resisted ankle dorsiflexion
- L5- Resisted hallux extension
- S1- Ankle plantarflexion
- S2- Resisted knee flexion
What types of neurologic findings necessitate referral?
- Progressive deterioration of neurological signs indicates serious pathology and requires immediate notification of the pt.’s physician (pg. 80)
- A positive Hoffman’s sign in a pt combined with other UMN neurologic signs and symptoms warrants referral to a specialist for appropriate management.Pg 91
***I’m pretty sure if you suspect UMN problems or cauda equina, you should refer (or in some cases be sure the MD is aware of the symptoms – such as when you are treating a pt with a stroke, which is an obvious CNS problem but you will continue to treat).
List the steps of manual Strength Testing
List the steps of manual Strength Testing
- Obtain baseline symptoms; explain and demonstrate a consistent test procedure
- Assess the uninvolved side first for comparison to the involved side
- Ask the pt. to move through the test range against gravity and assess response
- If no symptoms, repeat the motion through the range
- Stabilize and prepare to apply resistance in a smooth and gradual manner
- Say, “Hold, meet my resistance” or, “Hold, don’t let me move you.”
- Use force appropriate to the pt. and the specific muscle group
- Hold the contraction for at least 5 seconds
- Attempt to elicit a maximum contraction
- Observe for substitutions by other muscle groups
- If suspecting fatigue, repeat the procedure 3 to 5 times
MMT: What should you do if you suspect fatigue?
Repeat the procedure 3-5 times
True/False: in MMT, you should use the same force for each pt and each specific muscle group so that you can be completely objective in your measurements?
False. You should Use force appropriate to the pt. and the specific muscle group
MMT: should you assess the involved or uninvolved side first?
Assess the uninvolved side first for comparison to the involved side
Explain the Grading system for MMT (not including +/-)
- 5= normal, able to hold position against strong pressure
- 4= good, able to hold position against moderate pressure
- 3= fair, able to hold position (against gravity), but no pressure
- 2= poor, moves through range w/gravity eliminated
- 1= palpable contraction with no visible movement
- 0= no evidence of muscle contraction
MMT: What should you always document? (3)
- preferred grading system,
- quality, and
- symptom response
MMT: interpret strong and painless
May be normal
MMT: interpret weak and painless
Suggests neurological impairment or disuse
MMT: interpret Strong and painful
Suggests contractile or joint problems
MMT: interpret weak and painful
suggests neurological, contractile and/or joint problem
MMT: interpret bilateral deficits at multiple levels
May suggest a CNS problem
List the steps of DTR procedure (everything)
- Pt. position is relaxed but varies among sitting, supine, or prone
- Explain procedure and test uninvolved side first for comparison to the involved side
- Palpate the tendon of interest
- Use a consistent brisk tap to elicit an observable or palpable response. The tap may be repeated 3 to 6 times to obtain a consistent response
- If unable to elicit a response, a reinforcement procedure known as the Jendrassik’s Maneuver is performed while the reflex is tested, but the exact mechanism by which it works– pt. distraction or decreased descending inhibition– is unknown.
- For the UE: pt. clenches teeth, or squeeze knees together
- For the LE: pt. clasps fingers and pulls apart
DTR: describe how to hit the tendon
How many times can you try?
Use a consistent brisk tap to elicit an observable or palpable response. The tap may be repeated 3 to 6 times to obtain a consistent response
DTR: What should you do if unable to elicit a response?
If unable to elicit a response, a reinforcement procedure known as the Jendrassik’s Maneuver is performed while the reflex is tested, but the exact mechanism by which it works– pt. distraction or decreased descending inhibition– is unknown.
- For the UE: pt. clenches teeth, or squeeze knees together
- For the LE: pt. clasps fingers and pulls apart
Jendrassik’s Manuver for UE
For the UE: pt. clenches teeth, or squeeze knees together (looks away)
Jendrassik’s Manuver for LE
For the LE: pt. clasps fingers and pulls apart (look away)
DTR Corresponding Muscle and Level (3 UE, 4 LE)
- Biceps - C5, C6
- Brachioradialis – C5, C6
- Triceps – C7
- Patellar Tendon – L3, L4
- Medial Hamstring – L5, S1
- Lateral Hamstring – S1, S2
- Achilles Tendon – S1, S2
DTR Corresponding Level: Biceps
C5, C6
DTR Corresponding Level: Brachioradialis
C5, C6
DTR Corresponding Level: Triceps
C7
DTR Corresponding Level: Patellar Tendon
L3, L4
DTR Corresponding Level: Medial Hamstring
L5, S1
DTR Corresponding Level: Lateral Hamstring
S1, S2
DTR Corresponding Level: Achilles tendon
S1, S2
Briefly different normal muscle performance from that of persons with LBP (pg. 95-96)
- Just explain normal muscle performance
- The spine is naturally unstable and depends significantly on the performance of muscle for both static and dynamic stability
- There are 3 Requirements for spinal stability:
- 1) passive stability from the ligaments, discs, joint capsules, bones
- 2) active stability from the muscles
- 3) control strategies guided by the nervous system
- There are 3 Requirements for spinal stability:
- Feed-forward or anticipatory adjustments by the CNS minimize postural disturbances during predictable or voluntary use of extremities
- Feed-backward or reactive adjustments occur after movement via sensory input that activates automatic strategies during unexpected perturbations such as an unstable support surface
What are the three requirements for spinal stability?
- 1) passive stability from the ligaments, discs, joint capsules, bones
- 2) active stability from the muscles
- 3) control strategies guided by the nervous system
Explain Altered muscle performance in Persons with LBP
- Altered muscle performance can occur in the global or local muscles or both
- In the presence of dysfunction and pain, some muscles lose extensibility and become overactive and excessively stiff, whereas others become excessively flexible, inhibited, or functionally weak.
16) Briefly differentiate normal muscle performance from that of persons with LBP.
pg. 95-96 (everything)
- The spine is naturally unstable and depends significantly on the performance of muscle for both static and dynamic stability
- There are 3 Requirements for spinal stability:
- 1) passive stability from the ligaments, discs, joint capsules, bones
- 2) active stability from the muscles
- 3) control strategies guided by the nervous system
- There are 3 Requirements for spinal stability:
- Feed-forward or anticipatory adjustments by the CNS minimize postural disturbances during predictable or voluntary use of extremities
- Feed-backward or reactive adjustments occur after movement via sensory input that activates automatic strategies during unexpected perturbations such as an unstable support surface
-
Altered Muscle Performance in Persons with LBP:
- Altered muscle performance can occur in the global or local muscles or both
- In the presence of dysfunction and pain, some muscles lose extensibility and become overactive and excessively stiff, whereas others become excessively flexible, inhibited, or functionally weak.
Briefly differentiate normal muscle activation from that of persons with LBP. pg. 96
- Altered muscle activity affecting movement and stability of the spine is:
- task dependent
- is related to the individual problem
- and may be highly variable between and within individuals
- Some individuals restrict movement while some move in a poorly controlled manner.
- No consistent pattern emerges, but the CNS generally adopts a strategy of increased stiffness or co-contraction of the superficial trunk muscles to adapt to pain or injury.
Altered muscle activity affecting movement and stability of the spine is: (3)
- task dependent
- is related to the individual problem
- and may be highly variable between and within individuals
What are 7 precautions for neurodynamic testing?
- Aggravation of other tissues or symptomatic pathology. (in addition to neural tissue, other structures are lengthened or compressed during neurodynamic tests. Clinical reasoning is required so that these structures are not injured or aggravated. For example, symptomatic disc pathology is at risk for aggravation during the slump test, and in symptomatic spinal stenosis, the response may occur earlier during testing)
- An irritable or worsening disorder
- Presence of neurological signs
- General health problems affecting the nervous system, such as diabetes
- Dizziness
- Circulatory symptoms
- Inexperience of the examiner
What are 5 contraindications for neurodynamic testing?
- Malignancy or acute inflammatory infection
- Recent onset of or worsening of neurological signs
- Cauda equina symptoms or syndrome
- Spinal cord injury or tethered cord syndrome
- Inexperience of the examiner
List each of the steps involved in the diagnostic process. (8 stages)
Figure 3-37 (seems pretty self-explanatory or like things we have discussed)
Subjective Exam (history)
↓
Working Hypothesis
↓
Objective Exam (tests and measures)
↓
Initial Diagnostic Classification
↓
Intervention
↓
Subjective/Objective Reassessment (within session)
Outcome: better, worse, same
Diagnostic Classification Tested/Clarified
↕
Intervention
Subjective/Objective Reassessment (between session)
Modify as needed
↓
Functional Goals Met
Discharge to Self Care
pg. 104
