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60 Cards in this Set
- Front
- Back
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How many joints does a motion segment consist of?
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3. 2 facet joints and 1 intervertebral joint
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Which vertebral body defines the motion of a segment?
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Superior. ie. rotation R of L3-L4 means L3 is rotating R on L4.
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Levels of spine - greatest to least amount of movement in spine?
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Cervical > Lumbar > Thoracic > Sacral
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Arthrokinematics of vertebral joints.
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Glides. Ant/Pos, Lateral. Compression and distraction
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"Problem areas" of the spine
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Transition points. C7-T1, T12-L1. L5-S1. B/c of different orientations of facets
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Function of IV discs?
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Absorb shock, stiffen under loading, disperse weight evenly on bone below
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What happens to IV disc with aging?
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Loses water due to cleaving of aggrecan. Facet joints bear more weight and shearing forces increase
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Fryettes Laws
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1. In neutral, side bending and rotation occur to opposite sides (type 1 motion)
2. In closed, side bending and rotation occur to same side (type 2 motion) 3. If you take up motion in 1 plane, you decrease motion in other planes (called "locking up the joint") |
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What is the only thing we know for sure as far as coupled motion goes?
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In the cervical spine, side bending and rotation occur to the same side (Fryette's an idiot)
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What steps can you take to evaluate a patient when he is "not being watched"
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How they are sitting in waiting room, walk behind them, ask them to pick a seat
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RED FLAGS you have to ask about with any back pain pt?
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Bowel and bladder, saddle signs
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LBP forms
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Fear avoidance back questionaire (FABQ), Oswestry, Rollen-Morris
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What should you observe as far as posture goes in standing?
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Gross - curvatures, LLD, tilted pelvis, PSIS and shoulder levels
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Most likely vertebrae involved with spodylolithesis
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L4 women L5 men
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When do we perform a nuero screen?
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S/S below knee. If below buttocks it's a toss up
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What conditions would you expect a positive slump test?
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disc problem and adherent N root
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Waddell signs
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1. push top of head down
2. rotate hips over feet 3. sitting SLR 4. supine with legs straight - lift one |
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What do different degrees for SLR indicate?
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<25 = tumor 25-70 = disc lesion or nerve root irritation >70 = hamstring
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Conditions patients usually have pain in extension?
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Stenosis, spondylosis, spondylolisthesis
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Conditions pts usually have pain in flexion?
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Disc problems, facet lock, adherent N root
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Shape of L4-L5 and L5-S1 IV discs
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wedge shaped - much smaller posteriorly to give us angle with the sacrum
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Why is disc herniation especially a problem in the low back for men?
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PLL becomes very thin and discs can herniate POS-LAT
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How can the supraspinous ligament become injured?
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streched at end range flexion or pinched with extension. Common in athletes who do a lot of extension.
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Closed-pack position of lumbar spine and why?
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Full ext b/c max congruency of articular surfaces, max tautness of ligs, no further motion can occur
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Open pack position of lumbar spine
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Anything but extension
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ankylosing spondylitis x-ray
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can't find the outline of the facet jts, everythig fused, owl beaks may be all "connected"
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Tumor on x-ray
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2 sides aren't the same. The outline of the vert body isn't complete. One side looks over exposed and one side looks underexposed
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What can a lateral view xray tell us
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shape of vert bodies, curves, vertebral body fx, disc space, L5-S1
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What red flag items must you ask a pt with LBP?
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Bowel and bladder
Saddle sign Recent sig weight loss |
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What are we watching for when pt is doing repeated movts in standing?
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ROM, inc. or dec.?
Deviations and "catch's" Pain - where? changing? Pivot points |
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Special tests in standing for LBP?
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AROM
Lateral shift Prone instability Test for spondylolithesis Waddell sign |
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Tests to perform in sitting for LBP?
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Rotation if necessary
Neuro screen Slump test Quadrant test Waddell |
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Tests to perform in supine?
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Flexion in lying
SLR Waddell Gapping/compression if need to |
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Tests to perform in prone?
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Extension in lying
Palpation PAs |
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Risk factors for LBP
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Men, 35-45 yo is when first episode
Inactivity (not BW) Weekend warrior Hereditary Black women Cig smoking = inc osteoporosis |
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How does spondylolysis occur?
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RSI that starts as a stress fx and then something takes it over the edge
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Tx for spondylolysis?
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Pt education is a biggie - these ppl are not going to stop education. Educate on not extending spine during activity.
Check core strength FIL 10 reps qh (?) |
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Grades of spondylolithesis
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25% (1), 50% (2), 75% (3), 100%(4), 100% and displaced down (5)
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What tests are positive with spondylolithesis
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EIS = painful w/ radicular s/s
Quadrant test is positive (but not for intended purpose) Test for spondylolisthesis - make sure to check the vertebral segment below |
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What happens if you have a grade 5 spondy?
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B&B issues - fusion son
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When may the quadrant test be positive in a pt. w/ DJD?
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oseophytes right in the way of IV foramen
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When is DJD evident on radiographs?
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33% bony changes... MRI will be more sensitive
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Tx for DJD
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Core strength, AROM in lying
Moist heat if they prefer Aquatic therapy Pt education - walk, don't run Constraint posture - so get up and move every 15 mins PAs - uni or bi. 30 grade 4's perhaps |
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What is stenosis a narrowing of?
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spinal canal and/or IV foramen
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Sleep education for pt. with stenosis
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Safety pins in stomach so they don't roll over onto it b/c extension causes radicular s/s
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Tx for stenosis
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Pt education - avoid extension
Stool for pt to put foot on when do dishes Aquatic therapy, core strenghtening Form of DJD so don't push em' hard |
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How will a pt. with Adherent N root perform FIS?
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Deviate to side of pain to dec stretch on nerve
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What age does facet locks NOT occur?
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old age b/c of OA
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4 stages of disc herniation
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1. Bulging
2. Herniation - all but maybe 1 layer torn. 3. Excrusion - nucleus extrudes out PROBLEM b/c nucleus is acidic to N root 4. Sequestration - Parts come off and become encapsulated. |
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5 stages of irritaiton to the nerve... as in disc herniation
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1. sharp shooting pain
2. Tingling - pins/needles 3. Numbness 4. Reflex changes/mm weakness 5. Atrophy |
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Tx for disc lesion
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EIL 10 reps qh (assuming centralization in ext)
Call 24 hours later. If still centralizing - do it for 48 hours and call back Do it for 4x/day for a week Start to add FIL |
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How do we figure out if a lateral shift is relevant?
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Correct and have them do 5 EIS - if it got better, it is relevant. They need to do the HEP: 5 manaul correction and 5 EIS qh while awake. Progress to prone press ups
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When should you send back to doctor for disc herniation?
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If not centralizing within 3 visits and tried traction
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tx post laminectomy?
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Pelvic tilts - thats it.
Later add core ex's |
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What objective measures should you do for instability?
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FIS is difficult coming back up
Prone instability test Check joint play in prone ROM excessive mm weakness |
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Characteristics of chronic LBP?
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>6 mo's
Life revolves around pain Pain out of proportion to what they do b/c so focused on pain |
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Tx for chronic LBP?
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Team approach
ACTIVE - fuck yo pain |
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Components of work hardening program?
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How many times lift container in 2 mins
How far can walk holding container in 2 min Table to chair and then carry Table to floor and then carry Turn, lift, set from table to table Fast walk Overhead work - ladder, screws |
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Quick screen for lumbar
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ROM in standing w/ over pressure
Quadrant test PA mobs |
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How do we test to see if a LLD means anything?
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Phone book. Does motion look better?
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