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59 Cards in this Set
- Front
- Back
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what does backward bending do to the nucleus
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pushes the nucleus anteriorly
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what does forward bending do to the nucleus
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pushes the nucleus posterioly
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what does side bending do to the nucleus
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pushes the nucleus in the opposite direction
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if the disc is perfectly healthy, what is the reality of the effect of motion on the disc
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there would be no movement of the disc rather it is compressed on one side and stretched on the other
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where must there be disrpution in the disc for there to be actual movment
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disruption of the inner layer of the annulus
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what position gives the lowest intradiscal pressure
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in best sitting posture
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what position gives the worst intradiscal pressure
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bad sitting posture
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Given two positions 1) 180 intradiscal pressure in flexed spine.... or 2) 180 intradiscal pressure in extended spine.... which would we "prefer" our patient to be in
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180 intradiscal pressure in extended spine because it decreases the likelihood of the posterior translation of the disc
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what position would we promote in someone with compression on the nerve root.... why?
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a flexed posture in a non weight-bearing posture
- this opens the foramen to relieve pressure - we compromise with the fact that we can flex, but we decrease the pressure by non weight bearing |
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how do rotation and sidebending correlate in the lumbar spine
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there is no sidebending without rotation and vice versa
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when do side bending and rotation go in the same direction.... and when do they go in the opposite directions
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- opposite direction when near neutral flexion/extension position
- same direction when lumbare spine in flexion or extension BUT Recent literature fails to confirm this! |
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what does the cumulative load disorder theory state
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states that the notion that most back injuries are due to a single event is FALSE (excluding traumatic injuries such as car accident or being hit by a car)
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according to the cumulative load disorder theory, prolonged loading of the spine leads to
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1) decreased imbition of the disc
2) decreased water content 3) decreased disc height 4) changes in ligament rest tension * all resulting in decreased dic nutrition as well as functional instability of the segment |
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according to the cumulative load disorder theory, over time, repetitive adverse mechanical stresses related to lifestyle (including smoking) and aging leads to
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1) microinjuries
2) weakening of tissues 3) decreased tissue tolerance |
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what does the cumulative load disorder theory exmplain about occupational injuries
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explains why both extremes (static sitting/ standing posture and heavy lifting) are associated with low back injuries
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what is the "difficulty" with the cumulative load disorder theory
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the theory states a reasonable activity level would be preferred while on the job, but difficulty being determining the "ideal" load
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how does the quote "the straw that broke the camel's back" relate to the cumulative load disorder theory
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because the cumulative load disorder theory finally concludes that a single precipitating event (even bending forward to lace a shoe) could result in an acute injury due to the progressive load
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what is the major point to think about when reading what the "experts say about the causes of back pain"
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everyone says something different and mostly it depends on the specialty of that expert
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70% of patients with LBP recover within ......
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a few weeks
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90% of patients with LBP recover within....
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6-8 weeks
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how common is it for patients with LBP to have recurrance
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80% will have a recurrence within 2 years
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the natural history of LBP may be positively influenced by
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exercise.... remaining active within the tissue tolerance is much better than bed rest
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what is the period of bed rest that is never recommended for patients with LBP
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no more 2-3 days
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what are the risks for chronicity of LBP
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1) presence of adverse psychological and physical work related conditions
2) secondaru gains (conscious or unconscious) 3) social factors 4) compensation and litigation 5) the instillation of dependency through passive forms of treatment |
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how can we prevent chronicitiy of LBP
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stressing self-management and placing responsibility on the patient to get better
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what are the two large categories that the majority of causes for back pain can be divided into
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1) discogenic
2) non-discogenic |
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what is the benefit to classifying patients in discogenic and non-discogenic categories
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this method guides approach to treatment
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what are the key indicators for discogenic pathologies
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1) positive neurological signs in lower extremities
2) increased pain with activities that involved high intradiscal pressure 3) history of sitting/lifting/forward bending 4) McKenzie: increased pain with FB, decreased pain with BB |
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what is the least reliable neurological s/s for discogenic problems
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referred pain
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what are the positive neurological signs
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weakness, numbness, decreased DTR, also could be 1 nerve root only involved (but must r/o stroke and SCI
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what do you base treatment for patient's with discogenic pathologies on
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the stage or severity of the pathology
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what are the indicators of non-discogenic problems
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1) negative neurological signs (may still have referred pain though)
2) Increased pain with movement |
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what so you base treatment for patient's with non discogenic pathologies on
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identifying the injured structure or mechanical dysfunction and treat accordingly
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what is the goal of the evaluation for the diagnostic patho-anatomical approach
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1) identify the structure)
2) identify the stage/acuteness of the injury 3) identify the cause of the injury |
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what is the goal of the evaluation for the problem oriented approach
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establish a list of problems
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what are the two large categories that the majority of causes for back pain can be divided into
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1) discogenic
2) non-discogenic |
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what is the benefit to classifying patients in discogenic and non-discogenic categories
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this method guides approach to treatment
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what are the key indicators for discogenic pathologies
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1) positive neurological signs in lower extremities
2) increased pain with activities that involved high intradiscal pressure 3) history of sitting/lifting/forward bending 4) McKenzie: increased pain with FB, decreased pain with BB |
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what is the least reliable neurological s/s for discogenic problems
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referred pain
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what are the positive neurological signs
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weakness, numbness, decreased DTR, also could be 1 nerve root only involved (but must r/o stroke and SCI
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what do you base treatment for patient's with discogenic pathologies on
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the stage or severity of the pathology
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what are the indicators of non-discogenic problems
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1) negative neurological signs (may still have referred pain though)
2) Increased pain with movement |
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what so you base treatment for patient's with non discogenic pathologies on
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identifying the injured structure or mechanical dysfunction and treat accordingly
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what is the goal of the evaluation for the diagnostic patho-anatomical approach
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1) identify the structure)
2) identify the stage/acuteness of the injury 3) identify the cause of the injury |
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what is the goal of the evaluation for the problem oriented approach
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establish a list of problems
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what are the two large categories that the majority of causes for back pain can be divided into
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1) discogenic
2) non-discogenic |
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what is the benefit to classifying patients in discogenic and non-discogenic categories
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this method guides approach to treatment
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what are the key indicators for discogenic pathologies
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1) positive neurological signs in lower extremities
2) increased pain with activities that involved high intradiscal pressure 3) history of sitting/lifting/forward bending 4) McKenzie: increased pain with FB, decreased pain with BB |
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what is the least reliable neurological s/s for discogenic problems
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referred pain
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what are the positive neurological signs
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weakness, numbness, decreased DTR, also could be 1 nerve root only involved (but must r/o stroke and SCI
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what do you base treatment for patient's with discogenic pathologies on
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the stage or severity of the pathology
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what are the indicators of non-discogenic problems
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1) negative neurological signs (may still have referred pain though)
2) Increased pain with movement |
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what so you base treatment for patient's with non discogenic pathologies on
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identifying the injured structure or mechanical dysfunction and treat accordingly
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what is the goal of the evaluation for the diagnostic patho-anatomical approach
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1) identify the structure)
2) identify the stage/acuteness of the injury 3) identify the cause of the injury |
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what is the goal of the evaluation for the problem oriented approach
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establish a list of problems
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what is the method of treatment for the diagnostic patho-anatomical approach
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1) treat the structure according to the stage
2) correct the cause of the injury |
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what is the method of treatment for the problem oriented approach
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1) address the problems
2) correct the cause of the injury |
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what is the problem with the diagnostic patho-anatomical approach
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1) not always possible to establish a diagnosis
2) not always guiding for treatment |
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what is the problem with the problem oriented approach
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doesn't specify which of the many problems should be addressed (i.e. bad posture which is a "problem" may or may not be the etiology for an injury)
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