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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 |
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what is the most prevalent pain complaint? |
low back pain |
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what percent of people experience low back pain in their life? |
50-75% |
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in any given year, what percent of the population experiences low back pain? |
40% |
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at any given time, what percentage of people are experiencing low back pain? |
15-20% of the population |
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how long are most episodes of low back pain? |
brief/less than 2 months |
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what percent of people with an episode of low back pain have relapses? |
50% |
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do a lot of people develop chronic low back pain? |
no |
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in which plane does most of lumbar spinal movement occur? |
sagittal plane |
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in the lumbar spine, what is motion described relative to? |
the vertebra directly below it |
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what is the average forward flexion ROM for the lumbar spine? |
55 degrees |
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what is the average extension ROM for the lumbar spine? |
27 degrees |
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how many degrees of flexion come from the lumbar spine before the hip joins in? |
55-60 degrees |
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in forward flexion, what is normal lumbopelvic rhythm? |
55-60 degrees of lumbar flexion followed by ~54 degrees of pelvic-femoral flexion |
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in the upper 3 lumbar segments, how many degrees of lateral flexion are there? |
10 degrees |
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how many degrees of axial rotation does each lumbar segment have? |
2 degrees |
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what type of translation occurs during forward flexion? |
2-3mm of anterior translation of upper on lower vertebra (posterior in extension) |
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what are type I mechanics? |
occur in spinal neutral (in sagittal plane), lateral flexion and rotation occur in opposite directions |
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where do type I mechanics occur? |
upper/mid lumbar region |
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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 |
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where do type II mechanics occur? |
lower lumbar spine when in neutral |
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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 |
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what is the direction of muscle fibers in the superficial back musculature? |
spinous process --> transverse process |
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what is the direction of muscle fibers in the intermediate back musculature? |
transverse process --> spinous process |
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in relaxed standing static posture, what muscles are most active? |
thoracic back extensors |
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which muscles are more active in unsupported sitting than in relaxed standing? |
thoracic back extensors |
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what muscles eccentrically contract during forward bending? |
back extensors, glutes, hamstrings |
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what muscle group is only active during the first few degrees of forward flexion? |
abdominals |
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what muscles initiate the return from forward bend? |
gluteus maximus and hamstrings |
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which side of the lumbar back extensors are more active during lateral flexion? |
contralateral |
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which side of the abdominals are more active during lateral flexion? |
contralateral |
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what muscles are active in the lumbar region during trunk rotation? |
ipsilateral longissimus/iliocostalis and contralateral multifidus |
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what muscles are active in the thoracic region during trunk rotation? |
symmetrical back extensors, abdominal activity, strong ipsilateral glut med and TFL |
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when is it harder for muscles to fire when lifting a load? |
when the load is far away from the body |
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what is the definition of a herniated nucleus pulposus? |
displacement of disc material beyond the limits of the intervertebral disc space |
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what are the 3 types of HNPs? |
protrusions, extrusions, and sequestrations |
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what is a protrusion HNP? |
distance between the edges of the disc herniation is less than the distance between the edges of the base |
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what is an extrusion HNP? |
distance between the edges of the disc material is greater than the distance at the base |
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which HNP is of chronic, gradual onset? |
protrusion |
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which HNP is of acute onset? |
extrusion |
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which type of HNP is easiest to treat? |
extrusion |
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what is a migration? |
disc material is not separated, but is displaced from the site of extrusion |
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what is sequestration? |
displaced disc material has lost continuity with the parent disc |
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what is the most common location for HNP? |
paramedian |
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what causes the pain in an annular tear? |
well-innervated posterior 1/3 of the annulus |
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what condition is found in 100% of people over 60? |
degenerative disc disease |
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is degenerative disc disease pain worse in sitting or standing? |
sitting (also bending, twisting, lifting) |
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what is facet arthropathy? |
arthritis of the facet joints |
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is facet arthropathy generally bi- or unilateral? |
unilateral |
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is facet joint arthroplasty worse in flexion or extension? |
extension |
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what is the defect associated with spondylolysis? |
pars interarticularis |
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what is the most common location for a scotty dog fracture? |
L5 |
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what is spondylolisthesis? |
forward displacement of one vertebra on another |
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what are the grades of spondylolisthesis? |
Grade 1 - <25% slippage; grade 2 - 25-50% slippage; grade 3 - 50-75% slippage, grade 4 - >75% slippage |
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what is the mechanism for spondylolysis and spondylolisthesis? |
forced extension - could be traumatic or repeated |
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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 |
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what relieves spinal stenosis? |
sitting |
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what is a rheumatologic disorder of the lumbar spine? |
ankylosing spondylitis |
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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 |
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what is functional scoliosis? |
caused by muscle spasm or leg length discrepancy (resolves with correction of symptoms) |
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what is structural scoliosis? |
idiopathic |
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what is congenital scoliosis? |
caused by vertebral anomalies |
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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 |
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what is the surgical treatment for HNP? |
microdiscectomy |
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what is the surgical treatment for degenerative disc disease, spondylolisthesis, scoliosis, and postlaminectomy? |
lumbar fusion |
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why is a laminectomy performed? |
to alleviate pain caused by neural impingement that can result from stenosis |
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is cauda equina syndrome a UMN or LMN issue? |
LMN |
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where does the cauda equina begin? |
L1/L2 |
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are symptoms of cauda equina syndrome bi- or unilateral? |
bilateral |
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what are the signs/symptoms of cauda equina syndrome? |
saddle paresthesia, bowel and/or bladder incontinence and/or retention, sexual dysfunction |
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what is the possible issue in a 30-50 year old? |
disc issue |
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what is the possible issue in a >45 year old? |
osteoarthritis |
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what is the possible issue in a >50 year old? |
stenosis |
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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 |
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what nerve roots are tested with a knee-jerk reflex? |
L3/L4 |
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what nerve roots are tested with a ankle-jerk reflex? |
S1 |
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what is tested with the slump test? |
dural tension - L4, L5, S1/sciatic nerve |
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what is the capsular pattern of the hip? |
IR > ABD > FL > EXT, ADD, ER |
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what is the average ROM for hip IR? |
45 degrees |
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what is the average ROM for hip ABD? |
45 degrees |
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what is the average ROM for hip flexion? |
125 degrees |
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what is the average ROM for hip extension? |
20 degrees |
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what is the average ROM for hip ADD? |
30 degrees |
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what is the average ROM for hip ER? |
45 degrees |
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what nerve roots are tested with the femoral nerve stretch? |
L1, L2, L3 |
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what is the definition of yellow flags? |
signs of psychological distress of socio-economic concerns that play a role in pain |
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what is the rate of returning to work when a person is off for 1 day? |
99% |
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what is the rate of returning to work when a person is off for 1 month? |
80% |
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what is the rate of returning to work when a person is off for 6 months? |
<50% |
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what is the rate of returning to work when a person is off for 2 years? |
0% |
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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) |
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what is the main focus of treatment with someone who has yellow flags? |
active treatment - keep them moving |
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what is the first level of identifying patient classification? |
is the patient appropriate for physical therapy management? |
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what is the second level of identifying patient classification? |
what is the severity of the disability? (staging the patient) |
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what is the third level of identifying patient classification? |
what treatment should be used |
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what type of patients are usually stage I patients? |
acute |
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what type of patients are usually stage II patients? |
sub-acute |
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what are the treatment goals for a stage I patient? |
control pain, improve ability to perform basic mechanical functions, reduce disability (Oswestry score) |
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what are the treatment goals for a stage II patient? |
further reduce disability, correct physical impairments, improve ability to perform complex functional tasks |
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what is the main treatment goal for a stage III patient? |
improve ability to perform demanding activities |
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what percentage of LBP is given a specific pathoanatomical diagnosis? |
15% |
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what are the chances that someone will get cauda equina syndrome from low back manipulation? |
1 in 10 million |