WEEK 7 Joint Disorders, Lumbar Spine & SI Joint

Question 1

In the lumbar region, what spinal levels do disc herniations occur 90% of the time?

Answer 1

L4/5 and L5/S1

Next most common disc to be injured is L3/4.

Question 2

What type of pain is experienced in back with disc bulge?

Answer 2

Dull, deep, poorly localized pain.

Question 3

What type of pain happens if disc bulges posterolaterally against nerve root?

Answer 3

Sharp nerve root pain.

Question 4

What pathology do the following mechanisms of injuries belong to: bending forward w/ or w/o rotation, falling onto buttock w/ spine flexed, coughing & sneezing, bearing down for bowel?

Answer 4

Lumbar disc pathology.

Question 5

When injured, the body will protect the lumbar region by contracting large global muscles in response to what?

Answer 5

Inflammation.

Question 6

What are some of the local lumbar muscle groups?

Answer 6

• Multifidus
• Transverse abdominus

Question 7

Which tight muscle groups affect the lumbar region?

Answer 7

• Hip flexors
• Hamstrings

Question 8

Disc will commonly refer pain locally into low back and extend down posteriorly to which region?

Answer 8

Gluteal region.

Question 9

What type of exercises should be done to minimize stress to the disc?

Answer 9

• Lying in hooklying
• Pain-free ROM
• Extension-based

Question 10

What is the term for when repetitive extension reduces leg paresthesias by anterior migration of nucleus?

Answer 10

Centralization.

Question 11

Lumbar DJD occurs in concert with DDD, leading to loss of disc what?

Answer 11

Height.

Question 12

Symptomatic lumbar DJD is rarely found in people under what age?

Answer 12

40 years old.

Question 13

True or False: Walking relieves lumbar disc pathology but aggravates DJD & interforaminal stenosis.

Answer 13

True.

Question 14

How should knees and hips be positioned to relieve lumbar disc pathology & DJD?

Answer 14

Flexed.

Question 15

To improve posture for DJD, there should be progressive thoracic what and shoulder extension/retraction?

Answer 15

Extension.

Question 16

What are some stretches used for lumbar DJD?

Answer 16

• Double knee to chest
• Single knee to chest
• Hamstring
• Piriformis

Question 17

Soft tissue mobilization is done to decrease pain by relaxing muscular tension & increasing what release?

Answer 17

Endorphin.

Question 18

What is the normal response of the body when the space that nerve occupies shrinks, leading to impingement & damage?

Answer 18

Inflammation.

Question 19

In interforaminal stenosis, postural deformities that (open/close) up foramen are seen in highly irritable patients.

Answer 19

Open.

Question 20

True or False: Sitting & bending forward aggravates interforaminal stenosis.

Answer 20

False.

Question 21

True or False: Extension-based exercises are encouraged for interforaminal stenosis since flexion aggravates symptoms but can be used in adjacent regions to decrease stress.

Answer 21

False.

Question 22

What fraction of people with back pain have radiculopathy?

Answer 22

3 out of 10.

Question 23

In how many months do most cases of lumbar radiculopathy resolve?

Answer 23

1-2 months.

Question 24

What is the type of lumbar radiculopathy with inflammation of the sciatic nerve?

Answer 24

Sciatica.

Question 25

Leg length discrepancy contributes to radiculopathy since the (shorter/longer) leg side may have relative ipsi concavity in lumbar spine, decreasing size of foramen.

Answer 25

Longer.

Question 26

True or False: Leg pain is often worse than back pain with radiculopathy.

Answer 26

True.

Question 27

Most radiculopathies involve lower lumbar nerve roots (which levels) leading to symptoms below the knee?

Answer 27

L4-S1.

Question 28

Upper lumbar radiculopathies are not as common but cause pain in which part of the thigh?

Answer 28

Anterior thigh.

Question 29

If herniated disc is the cause for radiculopathy, symptoms will worsen with lifting, bending, lumbar what, and sitting?

Answer 29

Flexion.

Question 30

If stenosis, DDD, or DJD is the cause for radiculopathy, symptoms will worsen with standing, backward bending, & trunk what?

Answer 30

Extension.

Question 31

What is the indicator of decreased pressure on the nerve root?

Answer 31

Symptom centralization.

Question 32

What are some indicators for surgery for patients with lumbar radiculopathy?

Answer 32

- Progressive neurological deficit - Cauda equina syndrome - Bowel/bladder dysfunction - Severe unrelenting pain

Question 33

What type of lumbar ligament tear leads to lumbar segmental instability?

Answer 33

Complete.

Question 34

Approximately what percentage of people with lumbar ligament tear will experience LBP?

Answer 34

80%.

Question 35

What percentage of all back pain cases are attributed to soft tissue injuries, grouped together as sprain/strain?

Answer 35

80%.

Question 36

What is the prognosis for lumbar ligament tears?

Answer 36

Excellent, with over 90% of patients recovering within 1-2 months.

Question 37

In the elderly & the young, where is the weakest point of the ligament?

Answer 37

Ligament-to-bone intersection.

Question 38

In most adults, where is the weakest point of the ligament?

Answer 38

Midsubstance.

Question 39

True or False: Ligament sprain is usually caused by trauma and not overuse.

Answer 39

True.

Question 40

True or False: Pain from ligament sprains tend to have referral into lower extremities.

Answer 40

False.

Question 41

What type of postures will fatigue or overstress a ligament?

Answer 41

Sustained or end-range.

Question 42

Which muscle groups should be worked on in strengthening exercises with ligament sprains?

Answer 42

- Abs - Hip extensors - Hip abductors - Spinal extensors

Question 43

What is the most common injury to the low back?

Answer 43

Lumbar strain.

Question 44

What is the most common lumbar muscle strained?

Answer 44

Erector spinae.

Question 45

A microtear of lumbar muscle or tendon most commonly occurs at which two spots?

Answer 45

- Z-line - Musculotendinous junction

Question 46

A lumbar strain may take how many weeks to heal?

Answer 46

4-12 weeks.

Question 47

Symptoms of a mild lumbar strain usually resolve within how many weeks?

Answer 47

2-3 weeks.

Question 48

In the elderly & young, where is the weakest point of the muscle-tendon-bone complex?

Answer 48

Tendon-to-bone intersection.

Question 49

In most adults, where is the weakest point of the muscle-tendon-bone complex?

Answer 49

Myotendinous junction.

Question 50

True or False: Postural deformities increase the risk of lumbar muscle strain.

Answer 50

False.

Question 51

What is the mechanism for a traumatic strain?

Answer 51

Forced extension usually from a position of trunk flexion or eccentric contractions of lumbar extensors as they resist trunk flexion.

Question 52

Where does pain from lumbar muscle strain radiate to?

Answer 52

Butt.

Question 53

True or False: Passive trunk extension with lumbar muscle strain typically has pain.

Answer 53

False.

Question 54

For lumbar muscle strain, which regions besides spinal/trunk should be included in mobility exercises?

Answer 54

- Hips - Thoracic spine

Question 55

Which lumbar vertebrae is spondylolysis most common?

Answer 55

5th.

Question 56

Which lumbar vertebrae is the second most common for spondylolysis?

Answer 56

4th.

Question 57

What are the three most common spondylolisthetic levels (in order)?

Answer 57

- L5/S1 - L4/L5 - L3/L4

Question 58

Describe the four grades of spondylolisthesis.

Answer 58

- Grade 1: 0-25% slippage - Grade 2: 25-50% - Grade 3: 50-75% - Grade 4: over 75%

Question 59

Which type of spondylolisthesis is true congenital (rare) and has rapidly progressing neuro deficits?

Answer 59

Dysplastic.

Question 60

Which type of spondylolisthesis is from stress fracture with hyperextension and is most common at L5/S1?

Answer 60

Isthmic.

Question 61

Which type of spondylolisthesis is slippage of the superior vertebral segment because of facet arthritis where facets have more sagittal plane orientation?

Answer 61

Degenerative.

Question 62

Which type of spondylolisthesis is caused by acute fracture of facet or pars interarticulatis?

Answer 62

Traumatic.

Question 63

Which type of spondylolisthesis is caused by damage to posterior elements from tumor, metastases, or metabolic bone disease?

Answer 63

Pathological.

Question 64

Which two types of spondylolisthesis are most common?

Answer 64

- Isthmic - Degenerative

Question 65

Which spondylolisthesis has more of a stenotic history (pain with extension, symptoms of radiculopathy or neurogenic claudication)?

Answer 65

Degenerative.

Question 66

A posterior to anterior what force and compression through shoulders in standing can aggravate spondylolisthesis?

Answer 66

Shear.

Question 67

How is radicular pain treated in spondylolisthesis?

Answer 67

Epidural steroids.

Question 68

What are the indicators of surgery with spondylolisthesis?

Answer 68

- >50% slippage - Progressive neuro deficits - Severe restriction of activity - Pain that is not responding to conservative care (after 6 weeks)

Question 69

What is the term for dysfunction of innominate articulations that exclusively create pelvic pain verified by intraarticular anesthetic injections?

Answer 69

SI joint pathology.

Question 70

Which gender is more at risk for SI joint pathology?

Answer 70

Women.

Question 71

What is the most common correlation with the development of pelvic pain?

Answer 71

Pregnancy.

Question 72

True or False: SI joint pain can be related to activities that require opposing innominate motion (ex: posterior vs anterior rotation).

Answer 72

True.

Question 73

SI joint pain is in the what sulcus, medial to posterior superior iliac spine, extending to the buttock & posterior thigh?

Answer 73

Sacral.

Question 74

Which laying positions help relieve SI joint pain?

Answer 74

Crooklying & hooklying.

Question 75

Which muscles are focused on in SI joint pathology rehab?

Answer 75

- Transverse abdominus - Internal oblique - Pelvic floor muscles