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102 Cards in this Set

  • Front
  • Back

what ranking does low back pain have as one of the most expensive medical conditions?

3rd

what is the most prevalent pain complaint?

low back pain

what percent of people experience low back pain in their life?

50-75%

in any given year, what percent of the population experiences low back pain?

40%

at any given time, what percentage of people are experiencing low back pain?

15-20% of the population

how long are most episodes of low back pain?

brief/less than 2 months

what percent of people with an episode of low back pain have relapses?

50%

do a lot of people develop chronic low back pain?

no

in which plane does most of lumbar spinal movement occur?

sagittal plane

in the lumbar spine, what is motion described relative to?

the vertebra directly below it

what is the average forward flexion ROM for the lumbar spine?

55 degrees

what is the average extension ROM for the lumbar spine?

27 degrees

how many degrees of flexion come from the lumbar spine before the hip joins in?

55-60 degrees

in forward flexion, what is normal lumbopelvic rhythm?

55-60 degrees of lumbar flexion followed by ~54 degrees of pelvic-femoral flexion

in the upper 3 lumbar segments, how many degrees of lateral flexion are there?

10 degrees

how many degrees of axial rotation does each lumbar segment have?

2 degrees

what type of translation occurs during forward flexion?

2-3mm of anterior translation of upper on lower vertebra (posterior in extension)

what are type I mechanics?

occur in spinal neutral (in sagittal plane), lateral flexion and rotation occur in opposite directions

where do type I mechanics occur?

upper/mid lumbar region

what are type II mechanics?

occurs when the spine is in a non-neutral position in the sagittal plane, lateral flexion and rotation will occur in the same direction

where do type II mechanics occur?

lower lumbar spine when in neutral

what are type III mechanics?

when motion is introduced in one direction in the vertebral column in one direction, motion in all other directions is reduced

what is the direction of muscle fibers in the superficial back musculature?

spinous process --> transverse process

what is the direction of muscle fibers in the intermediate back musculature?

transverse process --> spinous process

in relaxed standing static posture, what muscles are most active?

thoracic back extensors

which muscles are more active in unsupported sitting than in relaxed standing?

thoracic back extensors

what muscles eccentrically contract during forward bending?

back extensors, glutes, hamstrings

what muscle group is only active during the first few degrees of forward flexion?

abdominals

what muscles initiate the return from forward bend?

gluteus maximus and hamstrings

which side of the lumbar back extensors are more active during lateral flexion?

contralateral

which side of the abdominals are more active during lateral flexion?

contralateral

what muscles are active in the lumbar region during trunk rotation?

ipsilateral longissimus/iliocostalis and contralateral multifidus

what muscles are active in the thoracic region during trunk rotation?

symmetrical back extensors, abdominal activity, strong ipsilateral glut med and TFL

when is it harder for muscles to fire when lifting a load?

when the load is far away from the body

what is the definition of a herniated nucleus pulposus?

displacement of disc material beyond the limits of the intervertebral disc space

what are the 3 types of HNPs?

protrusions, extrusions, and sequestrations

what is a protrusion HNP?

distance between the edges of the disc herniation is less than the distance between the edges of the base

what is an extrusion HNP?

distance between the edges of the disc material is greater than the distance at the base

which HNP is of chronic, gradual onset?

protrusion

which HNP is of acute onset?

extrusion

which type of HNP is easiest to treat?

extrusion

what is a migration?

disc material is not separated, but is displaced from the site of extrusion

what is sequestration?

displaced disc material has lost continuity with the parent disc

what is the most common location for HNP?

paramedian

what causes the pain in an annular tear?

well-innervated posterior 1/3 of the annulus

what condition is found in 100% of people over 60?

degenerative disc disease

is degenerative disc disease pain worse in sitting or standing?

sitting (also bending, twisting, lifting)

what is facet arthropathy?

arthritis of the facet joints

is facet arthropathy generally bi- or unilateral?

unilateral

is facet joint arthroplasty worse in flexion or extension?

extension

what is the defect associated with spondylolysis?

pars interarticularis

what is the most common location for a scotty dog fracture?

L5

what is spondylolisthesis?

forward displacement of one vertebra on another

what are the grades of spondylolisthesis?

Grade 1 - <25% slippage; grade 2 - 25-50% slippage; grade 3 - 50-75% slippage, grade 4 - >75% slippage

what is the mechanism for spondylolysis and spondylolisthesis?

forced extension - could be traumatic or repeated

what is spinal stenosis?

narrowing of the lumbar spinal canal, nerve root canals, or intervertebral foramina that may encroach on nerve roots of the lumbar spine

what relieves spinal stenosis?

sitting

what is a rheumatologic disorder of the lumbar spine?

ankylosing spondylitis

what does the PT focus on in a patient with ankylosing spondylitis and why?

extension and maintaining erect posture so the person doesn't fuse in a flexed position

what is functional scoliosis?

caused by muscle spasm or leg length discrepancy (resolves with correction of symptoms)

what is structural scoliosis?

idiopathic

what is congenital scoliosis?

caused by vertebral anomalies

what does PT do for someone with scoliosis and what can it not do?

relieves symptoms (which don't always occur) and it cannot be fixed structurally

what is the surgical treatment for HNP?

microdiscectomy

what is the surgical treatment for degenerative disc disease, spondylolisthesis, scoliosis, and postlaminectomy?

lumbar fusion

why is a laminectomy performed?

to alleviate pain caused by neural impingement that can result from stenosis

is cauda equina syndrome a UMN or LMN issue?

LMN

where does the cauda equina begin?

L1/L2

are symptoms of cauda equina syndrome bi- or unilateral?

bilateral

what are the signs/symptoms of cauda equina syndrome?

saddle paresthesia, bowel and/or bladder incontinence and/or retention, sexual dysfunction

what is the possible issue in a 30-50 year old?

disc issue

what is the possible issue in a >45 year old?

osteoarthritis

what is the possible issue in a >50 year old?

stenosis

what is the Trendelenberg test?

tests hip abductor strength on the standing leg, see if contralateral pelvis drops when foot is lifted off of the ground

what nerve roots are tested with a knee-jerk reflex?

L3/L4

what nerve roots are tested with a ankle-jerk reflex?

S1

what is tested with the slump test?

dural tension - L4, L5, S1/sciatic nerve

what is the capsular pattern of the hip?

IR > ABD > FL > EXT, ADD, ER

what is the average ROM for hip IR?

45 degrees

what is the average ROM for hip ABD?

45 degrees

what is the average ROM for hip flexion?

125 degrees

what is the average ROM for hip extension?

20 degrees

what is the average ROM for hip ADD?

30 degrees

what is the average ROM for hip ER?

45 degrees

what nerve roots are tested with the femoral nerve stretch?

L1, L2, L3

what is the definition of yellow flags?

signs of psychological distress of socio-economic concerns that play a role in pain

what is the rate of returning to work when a person is off for 1 day?

99%

what is the rate of returning to work when a person is off for 1 month?

80%

what is the rate of returning to work when a person is off for 6 months?

<50%

what is the rate of returning to work when a person is off for 2 years?

0%

what are the 5 signs of a yellow flag according to Waddell?

superficial or non-anatomic tenderness, simulation, distraction (SLR sitting/supine), regional disturbance (not neurologically correlated), overreaction (inappropriate to illness)

what is the main focus of treatment with someone who has yellow flags?

active treatment - keep them moving

what is the first level of identifying patient classification?

is the patient appropriate for physical therapy management?

what is the second level of identifying patient classification?

what is the severity of the disability? (staging the patient)

what is the third level of identifying patient classification?

what treatment should be used

what type of patients are usually stage I patients?

acute

what type of patients are usually stage II patients?

sub-acute

what are the treatment goals for a stage I patient?

control pain, improve ability to perform basic mechanical functions, reduce disability (Oswestry score)

what are the treatment goals for a stage II patient?

further reduce disability, correct physical impairments, improve ability to perform complex functional tasks

what is the main treatment goal for a stage III patient?

improve ability to perform demanding activities

what percentage of LBP is given a specific pathoanatomical diagnosis?

15%

what are the chances that someone will get cauda equina syndrome from low back manipulation?

1 in 10 million