Spine--Lumbar

Front 1

What conditions may have pain radiating down the leg?

Back 1

Adherent nerve root (neuro neg)
Disk herniation (neuro +)

Front 2

What conditions may radiate to the butt?

Back 2

Spondylolethesis
Facet Lock
Disk herniation (early stage)
Adherent nerve root

Front 3

What does the quadrant test do?

Back 3

Compromise the nerve root by shutting down the intervertebral foramen

(+) Disk herniation

Front 4

What conditions will cause pain with walking?

Back 4

1) Spondylolysis/Spondylolithesis if extending
2) Facet Lock
3) DJD if for long periods of time
4) Adherent Nerve Root (maybe)

Front 5

What conditions will cause pain with sitting?

Back 5

1) Disc herniation
2) DJD
3) Spondys if upright

Front 6

What position do spondys prefer?

Back 6

Lying down in fetal position or slouched in chair

Front 7

What position do instability prefer?

Back 7

Lying down

Front 8

What position do facet lock pts prefer?

Back 8

Sitting or lying b/c they can find their position and stay there.

Front 9

What position do DJD pts prefer?

Back 9

Walking or moving around to prevent stiffness

Front 10

What position do disk herniation pts prefer?

Back 10

Walking decently, best lying down in recliner or with knees bent

Front 11

What position do adherent nerve pts prefer?

Back 11

Standing, sitting or not moving

Front 12

Describe adherent nerve root pts

Back 12

1) Doesn't move too much/stationary
2) Avoids slouching or bending over
3) Modalities don't make a difference
4) Moves toward side of pain/not straight forward
5) Has back, leg and maybe foot pain (Neuro=neg)

Front 13

What does a (+) SLR indicate?

Back 13

Stenosis or dura strain on nerve root.
Adherent nerve root

Front 14

What does a (+) quandrant test indicate?

Back 14

1) Disk herniation/nerve root impingement
2) DJD--osteophyte
3) Spondys EXT only

Front 15

What tests do you use on disk herniation pts?

Back 15

1) Neuro screen
2) Reflexes
3) Check FLEX/EXT in lying to get better centralization
4) Quadrant (+)

Front 16

Disk herniation MOI

Back 16

1) Was fine and then I locked up by one incident
2) Overuse

Front 17

What diagnoses may a pt compensate by pushing up on their leg?

Back 17

1) Instability
2) Disk herniation

Front 18

MOI of DJD/Spondylosis

Back 18

Gradual onset over time

Front 19

Treatment for Spondylolysis/Spondylolithesis pts

Back 19

1) Wait out fractures for 6-8wks with no EXT.
2) Modify daily activities/work to flexion position (walk, jog)
3) Modalities of whatever feels good to the pt
4) Treat in EXT which comes from the level above spondy (stabilize the spondy while EXT

Front 20

What are 2 impairment goals for Spondylolysis/Spondylolithesis pts?

Back 20

1) Increase ROM in EXT
2) Decrease radiating symptoms

Lift weight in ext

Front 21

What are 2 functional goals for Spondylolysis/Spondylolithesis pts?

Back 21

1) Return to sport or activity without pain
2) Return to work or school without pain

Front 22

Treatment for instability pts

Back 22

1) Strengthen core
2) Soft tissue massage for muscle spasms and guarding (treat 1st)
3) Kinesiotape for proprioceptive feedback to activate extensors

Front 23

What are 2 impairment goals for instability pts?

Back 23

1) Decrease hypermobility in lumbar
2) EXT out of FLEX without compensating

Front 24

What are 2 functional goals for instability pts?

Back 24

1) Return to sport/activity without pain
2) Return to work/class without pain

Front 25

MOI for facet lock

Back 25

1) Bad position without moving for a long period of time
2) Overuse, not a particular event

Front 26

Limitations in standing with facet lock

Back 26

1) Full FLEX/limited EXT
2) Limited FLEX/full EXT

Hurts at end range with all 10 reps and will compensate toward side of pain

Front 27

What diagnoses will pts compensate toward side of pain?

Back 27

1) Adherent nerve root
2) Facet lock (see pivot point)

Front 28

Tests you can do for facet lock

Back 28

1) Check for muscle tightness
2) Check core strength

Front 29

Treatment for facet lock

Back 29

1) Palpate and do central PAs and unilateral PAs. Mobe until you feel motion. (Can do grade 4s or 5s)
2) Advise pt they will be sore and to take NSAIDs, ice or heat
3) HEP to keep segment mobile

Front 30

Describe DJD pain

Back 30

1) Gradual onset in older adults
2) Morning stiffness, decrease pain t/o day and worse at night
3) Limited in all directions
4) No radiating pain
5) Sitting is painful

Front 31

Tests for DJD pts

Back 31

1) Imaging--MRIs will show confirmation of hallmarks
2) Might get (+) quadrant test due to osteophyte
3) Test core strength

Front 32

Treatment for DJD pts

Back 32

1) Strengthen core
2) Use moist heat
3) Aquatic therapy
4) Mobes 4, not 5s of central/unilateral and walk around
5) Slowly return to normal activities--walking first before any running so it won't flair up (if run, run on soft surfaces, no hills)
6) Exercises over a ball or unweight in supine
7) Seat should be motion sensitive and adjustable, can give lumbar roll.
8) Get up every 30-60 min if chair does not move

Front 33

Treatment disc herniation pts

Back 33

1) Tx in the directional preference (most likely EXT)
2) Press ups in prone 10 reps every hr awake. In 24hrs call to say if centralized symptoms, and if so keep doing it for 48hrs and can decrease frequency
3) 5 reps EXT, 5 reps FLEX, 5 reps EXT
4) Must give lumbar roll or lay on belly
5) Give "Treat your own back," book since they will most likely have more episodes. Tx immediately with directional preference.
6) If no directional preference, do traction

Front 34

Treatment for adherent nerve root pts

Back 34

1) Stretch soft tissue using low load, long duration of 30-60s x 4-6/day. Do more to get better faster.
2) Stretch at work, can cut back on frequency after 3 days, but keep stretching for 6wks
3) Keep up with normal activities (walking, running)
4) Core strengthening

Front 35

Tests for adherent nerve root pts

Back 35

1) (+) Slump test
2) (+) SLR
3) Imaging (-)

SLR in supine between 25 and 70 degrees disc/nerve problem