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68 Cards in this Set
- Front
- Back
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What are the two types of radicular pain?
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intraspinous and extraspinous
extraspinous- caused by piriformis most commonly |
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What are the 6 main causes of Non-radicular pain?
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Trauma (muscle/somatic dysfunction)
chronic/sub acute DJD- (spondylolysis) Referred pain. (AAA) Infection Neoplasm (cancer) |
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What is the most common presentation of Disocgenic (radicular) pain.
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acute
constant, sharp, shooting dermatomal radiation/unilateral increased by cough improved when lying down |
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What is the most common cause of dicogenic LBP?
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irritation of a nerve root.
(affects sensory dermatome, motor, and deep tendon reflexes) |
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What is a major warning sign in Discogenic LBP?
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progressive motor deficit/ or bowel and bladder dysfunction with saddle anestesia.
May be Cauda Equina Syndrome |
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What are the most common disks involved in Herniated Nucleosis Pulposis?
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L4-L5 and L5-S1
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What percent of 20-80 years old have a bulging or protruding discs that are asymptomatic?
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52% HALF!
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What is the most common type or location of a hernated nucleus pulpois (HNP)
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Posteriolateral heniation at L4-L5
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What are the symptoms of cauda equina syndrome?
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bilateral extremity sensory loss, loss of rectal sphincter tone, loss of bowel/bladder function, saddle anesthesia, severe lower extremity motor weakness
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what is the treatment for cauda equina syndrome?
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emergent surgical decompression
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What is the most common cause of cauda equina syndrome?
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50% occur secondary to a tumor
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What are Dr. Greenmans Principles?
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Postural tonic muscles respond to dysfunction by becoming hypertonic/shorted/spastic
Dynamic/phasic muscles respond to dysfunction by- inhibition, hypotonicity, weakness |
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What is the first test on low back pain treatment?
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start with the straight leg raise test
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What does the Straight Leg Raise test examine?
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this test for nerve root irritation, below 60 degrees of inclination.
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What Tests the L1-L2 motor nerve root?
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The psoas raise!
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What tests the L3 motor nerve root?
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The quadriceps muscle kick out
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What test the L4 motor nerve root
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Tibialis anterior (dorsiflexion of the foot)
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What tests the L5 motor nerve root?
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Externsor Hallucis Longus
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What tests the S1 motor nerve root?
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Gastrocnemius muscle, plantar flex the foot
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What are the muscle strength grades?
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grade 0 - muscle is flaccid; no tone
grade 1- tone without any movement grade 2 – movement without gravity, but not against gravity grade 3 – movement against gravity, not against resistance grade 4 – slightly diminished strength against resistance grade 5 – full strength against resistance |
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What nerve does the Patellar deep tendon reflex test?
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L4
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What nerve does the achillies deep tendon reflex test?
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S1
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What is a normal DTR reflex grade?
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+2/4
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What does the Patrick test look for?
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his is used to look for hip pathology
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What is the motion mnemonic for the Patrick test?
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FABER: Flexion, abduction, external rotation
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What does the Thomas test look for?
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a tight psoas muscle. (lay on back, hug knees, and then let one down- look for spacing in lower back and behind the knee (aka unable to lower leg to table)
Tight on the extended side! |
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What is motion for a Still technique to fix a flexed lumbar segment?
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Pt supine
Flex the leg on affected side (side of ease, posterior transverse process) Adduct the leg (with knee flexed) Compress in a vector to the segment NOW! in one motion- abduct leg, and push inferior to straighten leg back out. Note: the release is felt as the knee is push inferior |
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How do you do the Still technique for an extended lumbar segment?
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this is the same as the flexed treatment, except you start out with the leg ABducted, rather than adducted.
You then swing TO the midline undercompression, and push inferior |
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What types of techniques are still techniques?
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these are direct positional techniques
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What are the 4 tennants of performing the Still technique?
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Must start treamtment in exaggerated rest postion.
Must carry the tissue through the area of restriction must maintain compressive force mustt have specific diagnosis |
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Where does the still force vector run to?
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this runs from the point of compression to and through the dysfunctional tissue
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What are the 4 steps of still technique?
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determine where the joint or tissues move most easily
move to position of exaggerated ease. introduce force vector though tissue of no more than 5 lbs using force vector as a lever, carry the affected tissue towards and through the initial restriction (should be a palpable release) |
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What are the contraindications of still technique
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Adavanced bone wasting diseases
fractures radiculopathy pt says no facet syndrome |
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How does Facilitated positional release work?
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this resets the gamma loop
with a sudden decrease in load, the spindle fibers no longer feel tension, reset, and the muscle relaxes (counter stain?) |
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Steps of F P R for dummies?
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Diagnose
Put region/joints to neutral Monitor Add facilitating force (compression) -reduces gamma gain Add indirect balancing in all 3 planes Hold 3-5 sec Return to neutral Reassess |
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How is still cervical technique done?
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place PT in position of ease (aka diagnosis) (also, place hand on posterior segment)
apply compressive force Then move to restrictive barrier (opposite of diagnosis) magic! |
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How Do you perform anterior right innominate Still?
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right side, pt supine
put hand on lower pole SIJ flex hip Adduct or abduct as needed compress THEN! Completely flex and adduct, then extend out to neutral |
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How you perform a Posterior left innominate?
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stand of left side
hand on SIJ Flex to greater than 90 degrees, and Adduct across midline. Compress abduct and extend |
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How do you Still a Right superior shear?
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grab right ankle, externally rotate leg
compress internally rotate w/ gentile traction |
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How are sacral Still diagnoses made?
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named from free superior axis. seated flexion does superior portion, and ILA test find freer lower portion
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How do you treat a diagonal right right SI dysfunction using still?
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supine, flex knees and hips together
hip flex to 90 degrees. side bend to restricted axis (Left, superior pole of restricted side) compress and lower feets |
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What is the motion for treating a unilateral Left SI dysfunction?
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flex up the right hip
hand on SIJ Abduct right leg Compress, Adduct across midline swing into position |
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What does a A-P lumbar spine X-ray show?
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lumbar scoliosis
unlevel sacral base functional short leg |
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What does a lateral lumbar spine X-ray show?
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loss of lumbar lordosis
degenerative joint disease |
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What does a L-S junction spot view X-ry show?
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spondylolisthesis L5-S1 grade 3/4
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What dose a oblique lumbar X-ray view show?
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Spondylolysis (scottie dog neck)
spinal stenosis |
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What does reciprocal inhibition affect?
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Ipsilateral flexor inhibits the extensor
and enhances the contrlateral extensor and inhibits the flexor |
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how do the erector spinae get affected by somatic dysfunction? upper and lower components
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uppers get tight
lowers get inhibited |
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what two muscles does the somato-somatic reflex affect?
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Iliopsoas and QL
these both get tight |
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How does the priformis usually respond to dysfunction
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it will get tight
called double devil, as its gets tight and can cause sciatic entrapment |
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how do the gluteus muscles respond to dysfunction
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they get inhibited
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How do the quadriceps respond to dysfunction?
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rectus femoris gets tight
vastalis get inhibited |
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how do the hamstrings respond to somatic dysfuntion?
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these get tight
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how does the IT band respond to dysfunction
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it gets tight
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how does the tibialis anterior/ fibularis respond to dysfunction
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it gets inhibited
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how does the gastrocnemius, soleus respond to somatic dysfunction?
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this gets tight
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how does a hypertonic iliopsoas affect the glutes?
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this will inhibit them (T12-L2)
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What is the dirty half dozen?
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Short leg/pelvic tilt
non-nuetral mechanics of lumbar spine pubic dysfunction innominate shear restriction of anterior sacrum muscle imbalance between trunk and LE |
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What are the 4 stages of proprioceptive balance assessment?
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arms down eyes open
arms crosses eyes open arms down eyes closed arms crossed eyes closed must be steady for 30 seconds |
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What is the "short foot"
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this is the foot that can curl the arch up.
Janda suggestd that all retaining be done with the 'short foot' |
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What does active trunk rotation control test for?
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this tests for imbalance between lumbar mutlifidi and hip external rotators.
also between abdominal obliques and lumbar erector spinae |
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How do you diagnose dysfunction of the pelvic clock in 6/12
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have the pt rock the pelvis to this position, whichever goes further is the non dysfunctional side (which ASIS that is)
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How do you diagnose the dysfunction of 3/9 on pelvic clock?
what does it show? |
this shows which side the SI is dysfunctional on.
this is shows by which ASIS moves further- this is the non dysfunctional side |
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Note! for pelvic clock, it is used to diagnose lumbar dysfunction. essentially, if you cannot move it in a particular direction, the diagonosis is the opposite of the way your moving it (note the pelvis moves the opposite way of the sacrum, when tilting the sacrum to 12, the spine attempts to move the same way it would as extending the spine)
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NOTE
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What does the passive hip abduction and external rotation look at?
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this tests imbalance between adductors and abdominals.
Tilt to 12. drop legs open. not dysfunctional IF pt can hold the 12 position |
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How does the pelvic tilt/heel slide test work?
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flatten lumbar spine on table.
extend legs from bent position. if the lumbar spine lifts up- note tight iliopsoas, inhibited abdominals |
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What is the significant finding in the hip abduction firing pattern?
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late firing of gluteus medius (should fire FIRST)
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what is the signifiicant finding in hip extension firing pattern?
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late firing of gluteus maximus (should ONLY be second to hammies)
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