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24 Cards in this Set
- Front
- Back
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Low back pain:
... to ... % of adult population will have an incidence of disabling lower back pain in their lifetime. It is the highest cause of limited activity under the age of ..., and the ... highest between 45-65 years of age. 80 % of low back pain is ... in nature. ... correlation of disability and X-ray images. |
60 TO 80
45 third idiopathic (idiot-pathic) No |
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Most of these people don’t radiologically have a good reason for their back pain.
Get an ... so that we can assess if there is neurological impingement. |
EMG
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Return to work rates:
If disabled 6 months- ...% return If disabled 12 months- ...% return If disabled 24 months- less than ...% return |
50
24 2 |
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The ‘Dirty Half Dozen’:
-... mechanics of the lumbar spine -... dysfunction -... shear dysfunction of innominate -Sacral ... restriction -Muscle ... between trunk and lower extremity -... leg/pelvic tilt syndrome |
Non-neutral
Pubic Superior anterior nutation imbalance Short |
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Strength test for ...– big toe (dorsiflex)
Patellar reflex – ... Achilles reflex – ... |
L5
L4 S1 |
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Straight leg raising:
Looking for posterior back pain (sacroiliac pain) If pain in legs and no pain in back, most likely not a.... |
nerve entrapment
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UNLEVEL ILIAC CREST AND TROCHANTER:
Confirmed by ... or other imaging. Consistent with previous studies averaging 65% in patients with low back pain. |
postural X-ray
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NON-NEUTRAL LUMBAR SPINE MECHANICS
More ... lesions were found Most had multiple dysfunctions Clustered at ... and ... |
flexed
L4 and L5 |
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segmental diagnosis:
make sure to ... the lesion |
isolate
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If pt. comes up on elbows and it gets more prominent, it’s a ... lesion. If we bend them forward and it disappears, it’s a ... lesion.
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flexion
flexion |
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INNOMINATE SHEAR DYSFUNCTION:
Twice as common in ... than in .... |
females
males |
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Key points:
... motion occurs during the walking cycle, depending on which phase of gait we are in. When we place weight on our left foot the sacrum rotates to the ... on the ... oblique axis. The lumbar spine sidebends ... to keep our right leg in motion. This motion is normal, however, when this motion is limited or fixed in a non-neutral position dysfunction occurs. |
Torsional
left left left |
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Key points:
As usual, we diagnose the sacrum based on the position of ease with the anterior superior aspect of ... as our reference point. ... is stated first with the ... stated 2nd. Seated flexion test determines the motion of the sacrum upon the ilium. This test is performed in the seated position to take away lower extremity muscle influences. The side which is positive is the side of dysfunction. |
S1
Rotation axis |
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Most tests in medicine are ... if disease or dysfunction is present.
The Spring test determines if the base of the sacrum is able to move ... or if it is stuck .... Pressure applied from posterior to anterior on the lumbosacral junction should initiate ... sacral base motion. |
POSITIVE
FORWARD BACKWARDS FORWARD |
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A board like resistance or “lack of spring” to the LS junction determines that the sacrum is stuck ....
This is a ... Spring Test. Able to move sacral base forward with pressure = normal response/negative spring. Unable to move sacral base forward with pressure = abnormal motion response/positive spring. |
BACKWARDS
positive |
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Which way is the sacrum rotated:
Check the ... positions. Which one is deep/anterior and which one is shallow/posterior. Check the ... positions. Which one is deep/anterior and which one is shallow/posterior. Which way is the anterior superior aspect of the sacrum facing. This is the ... of rotation. |
sacral sulcus
inferior lateral angle DIRECTION |
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Which axis is engaged:
Determine the position of the sacral base Is the base forward or backward? Perform the ... test. If the sacrum is rotated left and the sacral base moves forward? (– )Spring. It can only do this about a ... axis. ... on ... sacral torsion. If the sacrum is rotated left and the sacral base resists forward motion / stuck backwards? (+) Spring. It can only do this about a ... axis. ... on ... sacral torsion. |
spring
left Left on left right Left on right |
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which axis is engaged
If the sacrum is rotated right and the sacral base moves forward? (–) Spring. It can only do this about a ... axis. ... on ... sacral torsion. If the sacrum is rotated right and the sacral base resists forward motion / stuck backwards? (+) Spring. It can only do this about a ... axis. ... on ... sacral torsion. |
right
right on right left Right on left |
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look at slide 41-43
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ok
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What is a shear:
The slippage of one sacroiliac joint about a vertical axis with translation of the sacral base. Unilateral Sacral Flexion: ... spring test Sulcus ... on same side as inferior, sl. posterior ILA Positive seated flexion test on ... sulcus side |
Negative
deep deep |
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Unilateral sacral extension:
The slippage of one sacroiliac joint about a vertical axis with translation of the sacral base. ... spring test Sulcus is ... on the same side as an superior, anterior ILA Positive seated flexion test on ... sulcus side. |
Positive
shallow shallow |
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Muscle imbalance:
Greater than 95 % of population had significant muscle imbalance between ... and .... Primarily tight hip flexors, tight piriformis, tight adductors, weak abdominals, weak gluteus maximus and medius. Poor proprioceptive balance and trunk rotator control. These folks need to have strengthening and stretching in addition to your treatments |
trunk and lower extremities
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What is the most commonly occurring frequency of the dirty half-dozen?
a) none b) three or more c) all six |
b) 3 or more (about 57%)
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Non-operative care is:
a) conservative b) active and agressive |
b) active and aggressive
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