Wk 1- taking a history and WK2 physical AX obs, active mvts, overpressire

Question 1

4 main components of taking a pt hx?

Answer 1

1. outline their hx process
2. know info needed under each heading. eg HPC, sx hx, med hx
3. communication good- rapport. engagement
4. make meaning of info collected. detective- give clues

Question 2

Describe the model of pain and disability? 3 marks

Answer 2

Biopsychosocial model

• Pain is an output rather than an input. Has to be reviewed with our internal models + past experiences. and External environment, as threatened situations can heightened/exaggerate the actual nociception drive to a greater painful perceived experience.

David Butler: “we have pain when we weigh the world and make the judgment that there is danger > safety.

Question 3

Describe pain and LBP disability relationship?

Answer 3

Complex phenomenon.

• LBP related disabilities those lacking self-efficacy and heightened fear of injury
• behaviour reflects their perception to fitness, movement and exercise (rehab).

Question 4

How do we know if our PT test actually work?

Answer 4

We don’t in the clinically environment
has to be done in clinical trials with controlled groups carefully blinded.

cannot interfere from own practice in the clinic. To many external and internal fxs altering the reliability of the tests and validity

Question 5

Draw out Clinically reasoning table and actually try and understand it? be honest yeh

Answer 5

pg 7 or in spinal folder

Question 6

List the 5 steps in clinical reasoning process (5 marks)

Answer 6

1. Functional limitations and problems
2. Is Pt suitable for this pt?
3. What is the dominant pain type?
4. What impairment in function is driving the local sensitivity?
5. What biopsychosocial fxs are maintaining the disorder?

Question 7

STEP ONE FUNCTIONAL LIMITATIONS and PROBLEMS describe?

Answer 7

Central reasoning point: find their functional goals
- good awareness of their situation (eg. sport + work) build engagement + rapport

Goal: bring back fx pain free completion of tasks

Outcome Measure: PSFS (Patient-specific functional scale) 0/10
“What are 3 activities important to you have difficulty performing as a result of this problem”
0 unable to perform
10 pre-injury state

record- re-test in future sessions.

Other OMs
- use back pain disability questionnaire
and Quebec Back pain disability scale

Question 8

STEP 2: is PT suitable for my patient?

= red flags

Answer 8

80% of all LBP present with at least x1 RF
need to be aware don’t jump to conclusions
- made with clinical imaging and blood tests. once conclusive or suspcision able to refer to others. eg. GP

Question 9

List 6 RF’S types give x4 for each

Hint neuro: think of injury to S.C

Answer 9

1. Fracture:
   Acute presentation

• Post trauma
  -multi-directional provocation
  osteoporis risk: family, age (50 and 70+++), steriod use, female,low BMI, metabolic disease.
• bony tenderness
  -high severity

2. Infection risk:
   acute and sub acute presentations

• HIV positive
• Post surgery (invasive procedures)
• immunosuppressed
• Fevers
• Night sweats
• Recent infection (Hx) eg-UTI
• Cirrhosis (liver disease)

3. Cancer:
   sub actute pres

• night pain
• family (hereditary)
• Insidious onset
• Loss of weight unexplained
• Past history of Cancer +++
• Age > 50 yrs
• non-mechanical
• constant pain
• unwell systematically

4. Neurological risk:

acute presentation 
- Bilateral distribution 
- multiple spinal lvl impacted
- bladder, bowel dysfx
- saddle ana and parathesia
sock and glove para and anesthesia
clumsiness 
falls and tripping
hyperreflexia ( UMN lesion) cannot inhibit circuit 
Progressive weakess ++ PAUL BROADLEY 
sever weakness 

5. Inflammatory risk:

persistent episodic pain 
- slow innsidous onset
- morning stiffnes 30 min duration 
-morning worst time 
- wake up seocnd half of night d/t pain 
- eased with activity 
-NSAIDS help +++
- family hx
-infection as a trigger
swollen peripheral jts
- a significant loss of thoracic range 

6. NON SPINAL pathology
   - abdominal aortic aneurysm:
   over 60, syncope, smoker, PVD, abdominal pain
   - renal -kidney stones
   - gynecological
   -

4.

Question 10

True or false? urgent care if CES and abdominal aortic aneurysm

Answer 10

TRUE

Question 11

When can PT be used with other health professionals?

Answer 11

Systemic inflammatory disorder.

PT not the solution but care to maintain physical fx as high as possible within the steady of the disease.

Question 12

STEP 3 (WHAT IS THE DOMINANT PAIN TYPE???)

Question 13

Musck pain divided into 3 types

• Noc…
• Perip…
• ….. Sensitisation

give 2 points for each

Answer 13

a) nociceptive:
- intermittent and sharp with mvt (mechanical)
- localised to the area of injury
clear aggrevating and easing fxs linked to mechanical/anatomical nature.
- Pain described: sharp, burning,
- Night pain
- antalgic (pain relieveing) postures eg. lumbar into post tilt against wall eases. == control issues= lack capacity

b) peripheral neuropathic:
- Hx of nerve injury
- clear dermatomal pattern
- pain with neural provocation tests NDT eg. SLR, median tests

c) central sensitisation
- pain is disproportionate to the nature/triggers
- unpredictable, non mechanical
- biopyschosocial factors heighten the painful output experience. (maladaptive beliefs)- neg feelings, poor coping strategies, fear of mvt, poor self efficacy

Question 14

LIST the 3 CATEGORIES OF DOMINANT PAIN TYPES

Answer 14

1. somatic (nociceptive)
2. Neurogenic (neuropathic pain)
3. Nociplastic pain type (C.S)

Question 15

Define somatic pain type (1 mark)
What are the 2 ASPECTS needed to be investigated when looking at somatic pain patients? (2 marks)

List components of each of these ASPECTS (8 marks) 1 for each

Answer 15

Somatic pain is pain linked with actual damage to somatic structures.

1. INPUT DOMINANT
   - well defined area
   - mechanical
   - position of ease
   - standard hx
   - clear stimulus relationship. PREDICTABLE and CONISTENT response pt loading

2. INVOLVING SOMATIC TISSUE
 Deep
 Aching quality
 Usually dull (though may become severe)
 Static in location
 Expand slowly if stimulus increases
 Aware of where centred but hard to localise boundaries
 Less often below the knee
 Non tender in referred area
 After pain uncommon
 Latent pain uncommon
 Generally closely related to back pain

LBP is the main problem

• Deep aching pain
• LBP can be “Sharp and catching”- careful here
• referred pain is less serve- more localised
• LBP well localised

Question 16

Qualities of referred pain when a SOMATIC problem that matter most when differentiating from NEUROGENIC PAIN (8 marks). LIST x8

Answer 16

 Deep
 Aching quality
 Usually dull (though may become severe)
 Static in location
 Expand slowly if stimulus increases
 Aware of where centred but hard to localise boundaries
 Less often below the knee
 Non tender in referred area
 After pain uncommon
 Latent pain uncommon
 Generally closely related to back pain

Question 17

Can imaging be helpful or bad?

Answer 17

Good- diagnosis for acute and injury that can be backed up clinically.

Bad- false positivies. give a visual objective reason to pt that they are ‘broken’

Therefore, need extreme caution when using imaging on chronic LBP patients due to tendency of false positives.

Question 18

Define neurogenic pain?

List point of INPUT DOMINANT AND NEURAL TISSUE INVOLVED - 3 EACH

• ** all input dominant are the same***
  hint: neural tissue split into two parts and give x1 association

Answer 18

Neurogenic pain: pain from a lesion along the peripheral nervous system eg. nerve. Meaing the pain experience is from:

a) input domiant mechanisms
b) nervous tissue is the primary tissue

INPUT domiant PAIN patient:

• well defined area
• clear anatomical pattern
• mechanical
• pain experience proportionate to the internsity of stimulus load
• position of ease

Neural TISSE INVOLVED:

1. LEG PAIN IF:
   - deep and aching
   - cfelt along the path of the nerve
   - dragging pain
   - pulling pain
   - clumping along nerve path

associated with mild-non dermatomal parathesia

== RADICULAR PAIN ONLY

2. LEG PAIN IF:
   - sharp and shooting
   - stabbing
   - burining
   - gripping pain
   - felt in sensory distribution of pain

associated with LOCALISED altered alloydynia, hyperalgesia, para + anathesia, weakness

=== ONLY RADICULOPATHIC PAIN

Question 19

Don’t be too quick to jump to neurogenic pain if radiating pain from a somatic type patient. Likely can be non-neural structure in the back.

But if nerve sensitisation: INVESTIGATE :
 1. quality 
2. distribution 
3. behaviour 
of this referral nerve pain 

MATTERS> somatic back pain. why? generally leg nerve pain is worse than LBP somatic pain. leg pain common to radiate below knee

KEY:

• localised - somatic
• referred pain + LBP (loacalised) investigate if neurogenic pain is a contributor

Question 20

DIFFERENTIATE with central and lateral canal problems give example

either degenerative or acute- in lecture watch

Answer 20

Central CP:
eg. acute central canel MEDICAL EMERGENCY: cauda equina syndrome

Lateral canal problem:
Need to identify nerve root the nerve is sensitised from.

Question 21

Define neoplastic pain.
What are the two categories of nociplastic pain?

• neuromodulatory dysfunction
• psychological maladaption

Answer 21

Follows the ideology of central sensitisation, where the input dominant mechanisms are not the primary driver, rather the scruntisation pathways altering the internal models of an invidual. Leading to greater Prediction error (PEM) which catastrophises the original stimulus to a great painful experience.

Nociplastic pain type:

1. Neuromodulatory pain
   - Perisitrent high levels of pain
   - never pain free
   - extreme fatigue
   - cannot sleep in pain free state
   - widespread alloydnia
   - widespread hyperalegisa
   - spontaneous pain
2. Psychological pain (A-E)
   - emotions driver the pain
   - anxiety and depression major driver
   - negative attitudes and expectations (fear of mvt)
   - unhelpful self behaviours: increased rest, withdrawl of activity, social withdrawl, drug and alchol use to cope
   - rely in passive reatements
   - POOR family and friends network

Body image- social media
mood anger, beliefs brought up with dealing with injury
negative headspace/thoughts/expectations
= inpit mechanisms play a role but the PSYCH maladaption is PRIMARY DRIVER

BOOM BUST APPROACH !!!!!!

Question 22

Give an outcome measure to identify central sensitisation/nociplastic patients

hint questionnaire

Answer 22

Central sensitisation inventory

Question 23

STEP 4: WHAT IMPAIRMENTS (ROM, STRENGTH ETC) IS DRIVING THIS ‘PROBLEM’

TIP:

• step 4 “what impairment driving this”= only used on INPUT DOMINANT PROBLEMS
  1. Somatic
  2. neurogenic

not neoplastic because biopsychosocial factors are the primary driver

Question 24

Found it’s neurogenic pain. involvement of the peripheral nervous system.
NOW
need to find neural tissue is compromised with loss of conduction (motor and sensory loss). give us two types of pain from this stated below. answer

Difference between radicular and radiculopathy pain? 5 marks

Answer 24

OPTION 1: 
Radicular and radiculopathic pain:
-Features: 
1. Nerve trunk 
2. dysaethestic pain (damage to the nerve) = 

• present with P&N and numbness
• BOTH compressive and stretch sensitive (palptation and NDT +++)

EG. disc prolapse = nerve trunk and cause dysaethetic pain

2. OPTION 2
   ONLY radicular pain

Features:

1. Nerve trunk pain
   - less symptoms or vague on P&N

Present:&raquo_space;> Stretch sensitive
why? mechanical dysfunction
Physical tests of Nerve function. NDT. + slump test. slider and gliders

Question 25

SOMATIC pain type OPTION 2 for STEP 4; “why impairment is driven this problem”

LIST THE 4 sub categories of somatic pain for step 4

Answer 25

1. Benign specific spinal pathology
2. Acute severe pain
3. impaired control
4. impaired mobility

Question 26

Describe benign specific pathology?

mgt described in wk 11

Answer 26

Not serious problem requiring immediate attention. follow triage response

EG> acute stress fractures

• spondylolysis - WK 11 lecture
• “Spondylosis is an umbrella term used to describe pain from degenerative conditions of the spine”

Spondylolisthesis is a spinal condition that causes lower back pain. It occurs when one of your vertebrae, the bones of your spine, slips out of place onto the vertebra below it. Most of the time, nonsurgical treatment can relieve your symptoms. If you have severe spondylolisthesis, surgery is successful in most cases.

• surfers back

Question 27

2. Acute severe pain. describe presentation

Black box analogy

Answer 27

manage as pain dominant presentation

MGT:
general reassurance, education, advice, load mgt, sensible advice on RX 9hot, cold, taping and light massage

• Trial error approach but with low risk:
  1. Black box- careful investigate if mvt is easing or aggrevating
  if EASING: prescribe more of this mvt
  if aggrevating: prescibe TEMPORARY avoidance eg. tape to avoid mvt ~wk 6?

Main way to make progress: SUBJECTIVE INTERVIEW- correct language and questions
- find why mvts that give good response

Question 28

MECHANICAL PROBLEMS: impaired control and impaired mobility
pts will be:

1. medically well
2. Pain is input dominant + adaptive pscyh
3. neural tissue not sensitised - CLEARED
4. No sign of benign specific spinal pathology eg. stress fracture or spondylolysis

Question 29

If mechanical the back doesnt like going in a specific movement. Have to find that movement and record it.

What loading directions to we investigate in mechanical pts

Answer 29

1. flexion loading +- unliateral bias
2. extension bias+- unilateral bias

3, unilateral bias - uncommon as primary problem

Question 30

Why do patients 95% have a unilateral bias?

Answer 30

Compensatotory measure. avoiding the position that is bring on their ‘pain’
- belief of pain to avoid, sign that it is damage reinforces this position, which can actually cuase physical changes. but really that postion is calling out with nociception with a lack of mobility or capacity

Question 31

What are the 3 MECHANICAL problems a patient can present with?

still under the somatic umbrella fyi

Answer 31

1. Impaired mobility

A2. Tight control
A3. Loose control

Question 32

Describe impaired mobility

• what is the primary impairment?
• what is constrainted?
• How to treat?

Answer 32

Primary impairment is lack of movement into the provactive direction. EG. avoid flexion
- EXCESSIVELY passively constrained

-treatment: loading into the porvactive position.
with use of stretching, mobilisation techn and mobilising exercises. with time it will improve.

Question 33

describe tight control

• what is the primary impairment?
  -what is constrainted? why?
  What direction is most common?
  -How to treat?
• what tests will be positive ie. they fail

Answer 33

PRIMARY IMPAIRMENT is: problems with active elements of movement
- excessively actively constrained
why? fear of mvt, guarding, protective muscle activation before to induce strengthening response.

FLEXION MOST of time
- complain of pain @ mid range position after forward bending. Isometric hold in flexed lumbar positon

Problem due to excessive activity of the muscle group, doesnt have the capacity to take all the load.
Why? compensatory strategies used which loads the spine further.
Behaviours= avoiding, breath holding, excessive muscle recruitment to mask the actual muscle and ROM of the spinal segement.

SIJ “excessive force closure

They will have positive flexion control tasks. so will have excessive spinal extension

Question 34

describe loose control

• what is the primary impairment?
  -what is constrainted? why?
  What direction is most common?
  -How to treat?
• what tests will be positive ie. they fail

Answer 34

Motion is lacking control greatly. lack or excessive control at provocative directions

why- lack of muscle performance

unfavourable to move them into provactive direction = make worse
Aim: bring out of that position by unloading them & improve control (strength of back)

“Insufficient force closure” called with SIJ

pt compains pain at end range.

ABOVE target area:
movement is excessive into the painful provactiev position.

BELOW target area:
lack mobility when tested in opposite direction (strength)

Pt fail active control tests eg. Kneel rock back to up
Back (lumbar) same direction as hip moving into more hip extension
trick movements
- lumbar arching into extension- lacks control- strength,neurocoor, skill, power

Question 35

draw out the table with each of their characteristics of:

1.impaired mobility

2.IMPAIRED CONTROL :
tight control
loose control

Answer 35

IMPAIRED Mobility:
- older age
- less episodic 
- less intense
-morning pain 
-relief with stretching
- eased with warm up
==== improves mvt into the provactive direction 

Impaired control
TIGHT CONTROL:
various in age
 less episodic 
mid range pain 
fearful anxious - breath holding, avoiding 
relief with relaxation- dry needling, massage
describe tightness 
poor beliefs in stability 

LOOSE control: sounds like u AL
-episodic - during REPEATED mvt eg. kicking with swimming LBP
younger age
more intense
ramp down is quicker
feel stuck
post trauma
post pregnancy 
painful arc point pain comes and goes
back going into spasm

Question 36

CONTRIBUTING FACTORS STEP 5: WHAT BIOPSYCHOSOCIAL FXS ARE MAINTAINING THIS PROBLEM

• describe
• input dominant or central pain states (somatic or neural)
• LIST the 3 categories of step 5 biopsych

Answer 36

• most confusing, phenomonen

BOTH
difference= emphaisis is different. Internal models A-E engine that fuels the self perpituating cycle

1. physiologucal contributing factors
2. functional contributing factors
   - local
   - remote
   - general/lifestyle
3. Psychosocal contributing factors

Question 37

Describe these 3 sub categories of biopsych

Answer 37

1. physiologucal contributing factors:
   - Age
   - Genetics
   - Loading Hx

Neurophysiology:
chemical factors. altered neurotransmitters.
- structural changes on cellular lvl and activity lvl @ S.C, higher cortical regions, sub cortical areas.
EG. AP threshold of depolarisation lowered so AP intiated at lower stimulus. - see in alloydnia, hyperalgesia
- reinforces the self perpituating cycle of central sensitisation

2. functional contributing factors
   - local: something wrong functional at source of symptoms @ lumbar or SIJ

• remote: what oher areas functionally contributing to this primary problem. @HIPS and thoracic spine
• general/lifestyle: ergonomics, sport and hobbies, issues with technique, sleep, diet, obesity, alchol and drug use, smoking

3. Psychosocal contributing factors
A: attitudes and beliefs
B: behaviours
C: Compensation issues
D: diagnostic issues
E: emotions 
F: family issues 
W: work issues

Lecture most watch wk 7??

Question 38

What are the 6 yellow flag questions to ask?

Answer 38

These six questions have been suggested as the key yellow flag questions to ask

1. Have you had time off work in the past for musculoskeletal problems?
2. What do you understand is the cause of your problem?
3. What are you expecting will help you?
4. How is your employer, co-workers and family responding to your problem?
5. What do you currently do to cope with your pain?
6. Do you think you will be able to return to your normal level of activity? When?

Question 39

DRAW out the web diagram of developing a diagnosis

Answer 39

PG 27

Question 40

Tight control vs loose control on SIJ force closure? note the difference.

Answer 40

Tight control: Excessive force closure @ SIJ

Loose control: insufficient force closure @ SIJ

Question 41

WK 2 PHYSICAL EXAM- OBSERVATION and FUNCTIONAL TAST

Question 42

Don’t bring attention to their impairment function. This will exaggerate and reinforce their perception of their condition. (negative impact on scrutinising pathway)

Be patient, give sandwhich feedback. This not as mobile as, but i can see great potential, if the exercise program I give is followed, I’ll guide you on the best path for your recovery.

Question 43

Informal observations
1. PAIN BEHAVIORS AND WILLINGNESS TO MOVE

WHAT DO YOU EXPECT IN THESE TYPES OF PTS

Answer 43

Any notable displays of ilness and poor health- over weight, diabetic (pump)

WHile waiting: do they look comfortable or in distress

during Hx talk- are they animated freely or protective or careful (so willing to share)
- types of language used. excuse, repetition of an event see to blame. eg. this would of never happen if i got tackeled like on this day etc

• When moving to they predict pain prepare themselves or are COMFORTABLE
• compare with phys ax:
  1. any pain behaviour clues!
  2. Waddell’s signs- behaviour signs= posture, wincing, ahhing, noises excessive, breath holding

Question 44

EXTREME signs see in observations include

1. bruising or swelling
2. Postural abnormatlies
   a) locked
   b) listed
   c) Scoliosis

give details on each

Answer 44

1. see in acute soft tissue injury- direct blow or flexion trauma
2. locked: flexed and side bent away from pain-
   - compensation- less pain in that position than moving back to neutral

LISTED:
- direction of the shoulder
shorten of lateral trunk to one direction- compensation strategy
- initial adaptive strategy intially but becomes maladaptove if kept too long.
- only way to see what happen is with correction of posture = RECORD

Hint- if they have pain if brought into midline- NOT READY

3. Scoliosis:
   - lateral deviation of the spinal vertebral column
   - cam see in idiopathic adolescents
   - refer immediately to a orthopaedic consultant

Question 45

Formal obs- static postural analysis: What dot points are you looking out for on your checklist during this ax?

Answer 45

1. Look at spinal curves- are they excessive : kyp, scolosis, lordotic, flat back (H.S shortening/over active HF/s lengthen. Sway back NOT HIP MOBILITY ISSUE- H.S is reason shorten/overactive + extension of lumbar + slight posterior tilt.
2. alignment of body segments -Post, ant, lateral
3. muscle form and activity- normal, excessive or insufficent muscle activity
4. Subtle deformities:
   - maladaptive (scoliosis and lordosis)
   - adaptive: Listed (initial)
5. LL and thorax muscle capacity and mobility ax
6. ask do show sitting posture- compare

Question 46

COMAPRE THE 4 TYPES OF POSTURES

• USE NORMAL AS THE COMPARATOR
• KYPOHOTIC-LORDOTIC
• FLAT BACK POSTURE
• SWAY BACK POSTURE

Answer 46

PG 45

Question 47

READ BREFLY OS ALOGNMENT OBS IN ANT, POST, LATERAL VIEW OF POSTURE

Answer 47

PG 46

Question 48

LIST TYPES OF DYNAMIC SCREENING EXS/TESTS WE CAN GIVE A PT?

• don’t overcomplicate it, what ‘true’ performance

Answer 48

single leg stand- eye on balance, weight sift, is spine side bending and any hip add/abd

short knee bends: 1/4 of a squat:

• LL alignment from front.
• back and hip from side: any excessive lumb ext, flexion or hip activity?
• compare on ascent vs descent
• breath holding cautious: see in more imparied control “TIGHT”

3. single leg knee bend:
   - more complex to just add more stress if not getting a clear picture of their response
   need to be shallow depth
   any hip drop, spinal flexion/lumbar/side flexion to maintain balance

-

Question 49

2 Lower limb capacity tests: “test the muscle capacity in performing a succinct mvt”

• double leg half squat
• single leg …

Answer 49

DL 1/2 squat:

• 1/2 is enough for depth
• feet width apart
• lift arms in front as squat
• tell them do what see how many can do stop till fatigue if do 15 and looks fine stop need to progress

2. progression
   single leg 1/2 squat- use chair infront for support

• aim hold lightly, if can do without chair more valid on capacity and control of muscles
• not as deep as DL
  look for spine and hip movement ant, lat and post vie
• do 20 reps if ok, pass on

Question 50

A diagnostic process must be….

1. Plausbile:
2. Reliable
3. … testing what we think is the problem
4. ….. gives direction with our treatment
5. helpful…. lead to better

Answer 50

1. Plausible: fits with current understanding of the condition
2. Reliable: such that we would get a reasonably similar answer each time we assess the person
3. Valid: such that what we think is going on is actually going on
4. Useful: directly informs our treatment
5. Helpful: lead to better patient outcome

Question 51

Why should we avoid pathoantomical emphasis approach?

Answer 51

doesn;t narrow done physio treatment.
costs> benefits.

gives an anatomical reason for pt to focus on and scrutinise with poor judgment, attitudes and assumptions which only act as a catalyst to further reinforce their sense of irreversibility.

aim to keep the level vague and go in too much detail with PT. dont use catasphroic jargon. give langauge terms of contrabiluty, reversibility and encourgae active empowerment t make change.

Question 52

WHAT are the purpose of active movements

Answer 52

gather info on:

1. ROM: P2 or R2
2. Symptoms response: Pain lvl, at what range of motion, what type of pain- deep, ache, dull, central but boundaries are hard to localised. onlt during motion, no after pain, no latent pain. inetneisty slowy increase with load or neuro:
   - Radicular: only nerve felt, pulling, dragging pain, deep aching, heaviness

radiculopath: PNs, , burining, snesation, shooting, stabbing, felt at dermatomal pattern
associated; alloyd, para, anathesia, hyperalgesia, is latent pain, after pain

3. quality of movement:
   - perfomance of mvt- favoruing a side ue to mobility or capacity issue?
4. effect of movement modification on: 1,2,3
   range of motion, pain, quality of control mvt
   - does intiate new sensitivity
5. change ins 1 & 2 with repetition - test the endurance capacity

15- 20 reps
- better or worse
does fx improve with repetition eg, warm up inflamm.

Question 53

describe relative flexibility?

Answer 53

When a targetted area of problem has reduced ROM due to being stiffer, the adjacent segments are less stiff to “compensate” to maintain the function.

give cluesw when you use more movements, so same response compared to the norm

is a helpful adaptive approach initally, but when the compensatory mechanisms fails to maintain fx, this brings on increased pain due to the stability system is unab el to maintain the fx of the movement.

Question 54

Describe verbal how u would test tell the pt to do these test.

PT position and pt position
what are u looking for
where are u looking and palpating ?

quality of motion
- how to add sensitivity, functionality, repetitions

how do we add more stress on these segements? what can the PT do?

Answer 54

1. Flexion
2. extension
   - can block with plinth get true motion
3. side bending
4. rotation left and right
   fold arms, stablsie pelvis the PT ask to rotate, observe from behind= over pressure only in sitting

look out for thorax side bending if so indicating restricted lumbar rotation is limited

5. side gliding
   combo of low lumbar side flexion and rotation
   - guidnace hand on hip and shoulder, pt hip shoulder with apart
   eg. side to glide to left= cause right side lumbar flexion ADD reps to active control it tests

ASTERICKS mean to investigate for yourself or another pT who picks up ur note

how do we add more stress on these segements? what can the PT do?:
OVERPRESSURE:
- PT to recognise their end feel, is spasm present, small ossicilations @ EOR helpful, compare to other side and comapre,

Question 55

LOOk breifly at overpressure techniques

• PT placement hands and position
• pt position

PG 70-74