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63 Cards in this Set
- Front
- Back
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Which part of the spine is the strongest? The The spinal cord extends from where to where? |
Lumbar Brainstem to L1/L2 levels were the cuada equine fill space below that |
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What are the 6° of motion of the spine |
Flexion and extension Side bending Rotation Anterior/posterior shear Lateral shear Compression/distraction |
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Facet joint orientation of cervical, thoracic, lumbar |
Cervical: frontal plane with oblique angulation towards transverse plane(45°)
Thoracic: frontal
Lumbar: start in sagittal and go to frontal |
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Stability muscles of lumbar and cervical |
Lumbar: abdominal muscles, multifidus, erector spinae, thoracolumbarfascia, QL
Cervical: rectus capitus anterior and lateralis. Longus colli and longus capitus |
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Best muscle to fire for lumbar stability |
Transverses Abdominus |
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Three systems of stability |
Inert structures like bones, ligaments, joints Stability muscles Neurological control |
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What is the neurological input for stability |
The feedforward control, anticipating a load to maintain stability |
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Additional effects on stability |
Breathing Limit function and position Intra-abdominal pressure/valsalva manuever |
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Postural fault Postural pain syndrome Postural dysfunction |
Bad posture but no impairments
Pain from mechanical stress of faulty posture, no impairments( but could lead to)
Adaptive shortening of soft tissues and muscle weakness are involved, prolonged poor posture habits or trauma |
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Problems with lordotic posture Caused by? |
Increased anterior pelvic tilt and hip flexion Stretched, week abdominal muscles Can be caused by faulty posture, pregnancy, obesity |
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Problems with relaxed or slouched posture ( swayback) |
Increased lordosis, increased kyphosis, forward head. Stretched and weak abdominals |
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Flat back posture |
Decreased lumbosacral angle Decreased lumbar lordosis, hip extension, posterior tilt of pelvis Week lumbar extensors and hip flexors |
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Sources of symptoms for scoliosis (5) |
Shear, stenosis, facet compression, disc disease, muscle fatigue |
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Scoliosis named for what side? Rib hump when? What happens to leg? |
Convex side With forward bending Appearance of shortened leg |
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A few problems with scoliosis? Treatment of scoliosis? (4) |
Weakness, neurologic impairment, internal organ distress
Static stretching of tight side Strengthening of stretched side Core and scapular stabilization Rod placement in severe cases |
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Management of postural alignment |
Chin tucks/axial extension to decrease forward head posture Scapular retraction Pelvic tilt and neutral spine Work on thoracic spine ( proper bras, breathing) |
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What is a herniation? Protrusion? Prolapse? Extrusion? Sequestration? |
Herniation: any change in the shape of the anulus that causes it to bulge beyond normal
Protrusion: nuclear material is contained by the outer layers of the anulus and supporting ligamentous structure
Prolapse: Frank rupture of the nuclear material into the vertebral canal but remains confined
Exstrusion: Extension of nuclear material beyond the confines of the posterior longitudinal ligament, escapes into the disc
Sequestration: nucleus lodged within epidural space, totally busts out |
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Where is the vascular supply for the intravertebral disc's? When can pain occur? |
Vascular supply from vertebral bodies above and below the disc
Pain only if outer rings are affected |
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Is disc degeneration normal as we age? What do the discs like? |
Yes Fluid, they are hydrophilic |
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Which part of the spine has the least amount of problems? What is the tightest area of the nervous system? |
Thoracic, only 15% of cases T6 because of high number of dural ligaments |
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Rules of threes for thoracic vertebrae |
T1-T3: spinous process at same level T 4–T6: spinous process half a level below T7-T9: spinous process one whole level below T10: One whole level T 11: half A level below T 12: same level |
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What runs through the cervical transverse foramen
How many degrees of rotation at C1 on C2 |
Vertebral artery 45° |
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Movement of head on C1 C1 on C2 C2-C7 Thoracic Lumbar |
Flexion extension Rotation Side bend, rotation, flexion extension
Thoracic: primarily flexion and extension with some rotation
Lumbar: flexion and extension but nearly no rotation |
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What is disc bulge and disc protrusion? |
Bulge: nuclear material bulges into inner annulus
Protrusion: nuclear material bulges into outer annulus and annulus bulges outward |
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Compressive forces on lumbar spine Supine Standing and bending forward Seated and flex position Standing Bending forward and flexed posture and lifting |
Supine: less than 25% bodyweight Standing and bending forward: 150% Seated in flexed: 85% Standing: 100% Bending forward while lifting: 275% |
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What is spondylosis? Can progress to? |
Degenerative disc disease Can progress to foraminal stenosis and spinal stenosis |
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How much space does the nerve take up in the foramen? |
33% It narrows as we age |
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What is spinal stenosis? Can lead to? Common in who? What aggravates? |
Narrowing of spinal canal Can lead to claudication Common in men 55 and older Lumbar extension is worse, walking is worse |
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How to treat stenosis |
Focus on flexion with leg pain, tight hamstrings Core stabilization Educate on activity modification (proper lifting) Breaks from standing Flexion exercises Limit overhead activity |
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What is spondylolisthesis? How do u get it? Grades? What types of exercises? |
A spinal fracture, can be pars defect or acquired by trauma
Grade I: 0-25% slipped forward Grade II: 25-50% Grade III: 50-75%
Do flexion based exercises |
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What to avoid with compression fracture Focus on what? How does it often occur? |
Avoid flexion Focus on stabilization Osteoporosis and falls can cause |
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What is a Jefferson fracture? How manifest? |
Fracture of dens, can be life-threatening Pain in the back of the mouth These patients will have a halo. |
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Symptoms of Spondylolisthesis |
Bilateral LE symptoms Worse with extension/overhead Relief with flexion May have just back pain if grade one or two |
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Clinical predication rules for low back |
Manipulation/mobilization Stabilization Exercise in directional preference Traction |
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Five criteria for spinal manipulation |
Recent onset (less than 16 days) Low FABQ ( <19) fear avoidance belief questionnaire No symptoms below knee Lumbar hypomobility Good hip IR ( >35) |
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Treatment protocol for spinal manipulation |
Two visits manipulation Three visits lumbar/core stabilization |
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Five L's of lifting Engaging core prevents what? |
Load, lungs, lever, legs, lordosis Valsalva |
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Global and segmental lumbar muscles attach where? What does each do? |
Global muscles have no direct spinal insertion (abdominals, erector spinae, QL). Primary movers
Segmental have segmental spinal attachment (transverse abdominus, multifidus) primary stabilizers |
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How to engage transversus abdominis and multifidus |
Abdominal hollowing maneuver
Quadruped/prone exercises |
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When do you use McKenzie extension progression |
With acute disc 16-55y/o Symptoms worse with flexion/in morning Compression fractures of vertebral bodies |
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When do you use flexion protocol? |
Over 60 Y/O DDD or stenosis Symptoms worse with standing or walking Spondylolisthesis |
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What is it that causes radicular nerve pain down the leg? |
Nerve root bathed in swelling or chemical soup |
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What does a positive straight leg raise test indicate? When does it usually show up? |
Nerve root issue, back pain Shows up 24 to 48 hours after back injury |
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When is traction indicated |
Stenosis DDD If directional centralization exercises are unsuccessful Stubborn protrusions or herniations You need hydration into the disc |
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What are the spine surgeries and what do they do? |
Laminectomy or laminotomy: create space for nerve roots
Disc decompressing (discectomy): Paul little piece of disc out, minimally invasive
Fusion: screw to bones together, or auto fusion/bone graft
Disc replacement |
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Do people start walking right after spine surgery? A.D.? How to get out of bed? |
Usually Possibly an AD Logroll |
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First three days after surgery limit what? No to what motions? |
Limit sitting to no more than an hour at a time
No bending, lifting, twisting |
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When does strengthening begin after spinal surgery? What exercises begin early in recovery phase? |
After initial wound healing is complete and pain decreased
Gentle active extension and pelvic tilts |
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What is the thoracic outlet syndrome? |
Entrapment or compression from elevated 1st rib, compressed subclavian artery, brachial plexus. ( could be scar tissue too) |
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How to treat TOS? |
Mobilize thoracic spine and first rib Stretch into scalenes all ways, pecs too Improve nuero re education Posture re-ed Sleeping position |
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How heavy is the head? Who is mostly affected by neck pain? |
8-12 lbs Women |
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What is whiplash? Symptoms When is it worse? |
Mechanism of injury to neck, no injury itself Extensors overstretch, anterior neck compressed Neck ache, sore throat, tinnitus, headache Worse if symptoms start right away |
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Another name for neck sprain What exactly happens? What else can cause them? |
Torticollus Facet lock Disc bulge/ herniation, muscles or ligaments |
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How to treat cervical injuries |
Centralize and stabilize Chin tucks Possibly traction Scapular and posterior cervical stabilization exercises Patient education on posture, sitting, muscular endurance |
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What for the first 14 days after whiplash? Then what next? |
Modalities Gentle ROM, Chin tucks, scapular stabilization Gentle cervical isometrics Educated they will be OK |
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For general spine management what do you do in the acute phase? Sub acute phase? |
Stabilization and functional movements that does not set symptoms off
Subacute: begin limiting modalities and get them exercising. Stretching and mobilization, RPEs Cardiopulmonary conditioning, relaxation exercises, postural management and functional activities |
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What type of exercises would you do for chronic spinal pain |
Functional activities |
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What type of exercises would you do for chronic spinal pain |
Functional activities |
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Management for nonweightbearing bias |
Traction, harness, Pool. Progress to weight-bearing as tolerated |
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Conditions for extension bias Use with? |
Disc lesion Traction and postural training |
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Feiss line test Girth figure 8 Thompson test Homan's sign Tinel's test |
Flat foot test Swelling of ankle Calf squeeze for Achilles Blood clot Nerve test |
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Tests for low back pain(2) Tests for TOS ULTT stands for? Vertebral artery test |
Slump and prone instability Adson and Roos Upper limb neural tension test Looks for occlusion |
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ACL tests(2)
Meniscus tests(3)
Hamstring tightness? Hip flexor tightness? |
Anterior drawer Lachmans
Mcmurrays Bounce home Apleys
Phelps or 90/90 Thomas test |
