Lumbopelvic – Flashcards
Unlock all answers in this set
Unlock answersquestion
What are 4 components that may contribute to why LBP pts don't get better
answer
-core -multifidi -transversus -muscles that control specific segmental motion that regulates the shearing
question
Threats to quality care for LBP
answer
-overuse of ineffective treatments -under-use of effective treatments -misuse of potentially effective treatments
question
How can you correct overuse of ineffective treatments?
answer
decrease use which will improve quality of care
question
How can you correct under-use of effective treatments?
answer
increase use which will improve quality of care
question
How can you correct misuse of potentially effective treatments?
answer
improved decision making will improve quality of care
question
Example of a treatment not often used for LBP that shows to be effective?
answer
high velocity manipulation
question
STM/heat/US and LBP treatment effectiveness
answer
-not much evidence -should only use in conjunction with other treatments, to get tissue pliable, to calm system prior to exercise
question
3 best treatments for LBP
answer
-mob/manipulation -direction specific exercise -stabilization approach
question
Medical model of disease
answer
-pain is a reflex response to a physical stimulus -every symptom has an underlying stimulus -in order to alleviate symptoms, need to alleviate underlying stimulus
question
Implications of LBP and imaging
answer
imaging may reveal a pathology that is not the direct cause of LBP that the pt presents with
question
1st level of treatment-based classification
answer
is the pt appropriate for physical therapy management?
question
2nd level of treatment based classification
answer
what is the level of acuity? staging of pt
question
3rd level of treatment based classification
answer
what treatment should be used?
question
3 options for the 1st level of classification
answer
-appropriate for PT (symptoms of mechanical origin) -requires consultation (med/psych) -requires referral (med/surg, psych)
question
What happens if there are red flags on initial exam when classifying pt?
answer
referral/consult with medical specialist
question
What happens if there are yellow flags on initial exam when classifying pt?
answer
fear avoidance? psych consult?
question
How is acuteness determined?
answer
by the nature of the presenting symptoms and the goals for treatment
question
Stage 1 second level classification characteristics (6)
answer
-acute -Oswestry >30 -unable to sit >30 min -unable to stand >15 min -unable to walk >1/4 mi
question
Stage 2 second level classification characteristics (5)
answer
-subacute -Oswestry ~ 15-30 -able to sit, stand, walk -unable to perform complex task -no stage 1 findings
question
Stage 3 second level classification characteristics (3)
answer
-Oswestry <15 -able to perform complex tasks -unable to perform demanding tasks
question
Treatment goals for stage 1 second level classification
answer
-control pain -improve ability to perform basic mechanical functions -reduce disability
question
Treatment goals for stage 2 second level classification
answer
-focus on impairment correction -further reduce disability -improve ability to perform complex functional tasks
question
Treatment goals for stage 3 second level classification
answer
-restore higher level of function -improve ability to perform demanding activities
question
Treatment for pt in stage 1 second level classifcation
answer
-mobilization -specific exercise -immobilization -traction
question
Progression for pt in stage 1 to stage 2 second level classification
answer
-aerobic activity -eliminate impairments -trunk strengthening -general strengthening
question
Manipulation classification characteristics
answer
-no symptoms below knee -onset 35
question
Treatment for manipulation classification
answer
-manipulation -exercise
question
Specific exercise classification characteristics
answer
-centralization phenomenon with movement exam -postural preference
question
Specific exercise classification treatment
answer
-activities to promote centralization -ex. worse with sitting, better with extension => sit less, perform repeated extensions
question
Stabilization classification characteristics
answer
-prone instability test -aberrant motions -hypermobility -age 91 -usually will be a young highly flexible pt
question
Treatment for stabilization classification
answer
-stabilization ex. -turn on core muscles -decreased abnormal shearing in back -decrease pressure on pain producing structures
question
Traction classification characteristics
answer
-neurological signs -leg symptoms -peripheralization with movement exam -crossed SLR
question
Treatment for traction classification
answer
mechanical/auto traction to relieve neurological pressure
question
What do you need to know in PMH for history of interventions?
answer
-have you had PT or other treatment before? -what did they do in PT/other treatment? -have they had injections?
question
What to know about HPI
answer
-MOI -date of onset -has it happened before? -does it relate to time of day? -any correlation with eating? -meds
question
Do you see a pt who is also seeing a chiropractor simultaneously?
answer
No - too much overlay; chances of hurting pt increase
question
Visceral screen
answer
-urogenital -OBGYN -other viscera
question
What are you screening for asking for change in b&b?
answer
cauda equina syndrome
question
If the pt has a history that has restricted motion in joint opening or closing pattern, what do you suspect?
answer
facet syndrome
question
If the pt has a history that has symptoms centralizing or peripheralizing with movement, how do you test and what do you suspect?
answer
-repeated motions testing -discogenic pain
question
How will discogenic pain present with repeated motions testing?
answer
better in extension; worse in flexion
question
If the pt has a history of pain in LEs that increases by extension and decreases by flexion, as well as increases in weight bearing positions, what do you suspect?
answer
spinal stenosis (unilateral = lateral; bilateral = central)
question
If the pt has a history of sudden locking, catching, giving way during motion, or aberrant motions, what do you suspect?
answer
lumbar instability
question
If the pt has a history of pain increased by stretching or muscular contraction with a history of trauma associated with it, what do you suspect?
answer
sprain/strain
question
Cancer red flags
answer
-male > 50 yo -unexplained weight loss -prior history of cancer -poor response to conservative care -night pain that takes a long time to decrease upon waking
question
Cauda equina syndrome red flags
answer
-L4-S1 dermatome and saddle region -progressive LE weakness (DF, PF, toe ext) -urinary/fecal incontinence, retention, sensory deficits
question
Osteomyelitis red flags
answer
-immunosuppression -drug use -recent infection -increased body temp
question
Fracture red flags
answer
-history of trauma -prolonged steroid use -> 70 yo
question
Yellow flag
answer
-patients false beliefs about pain or injury, self efficacy, appropriate strategies -emotional distress -FABQ
question
Blue flag
answer
-injured workers -low job satisfaction -conflicts with employer -conflicts with other workers -these may change how pt reacts to their pain
question
Black flag
answer
-social issues -financial issues -incentive not to get better?
question
0-20% on Oswestry
answer
minimal disability
question
20-40% on Oswestry
answer
moderate disability
question
40-60% on Oswestry
answer
severe disability
question
60-80% on Oswestry
answer
crippled
question
80-100% on Oswestry
answer
bed bound or exaggeration
question
Minimal detectable change for Oswestry
answer
6 points
question
When do you give a FABQ?
answer
to see if pt can fit in manipulation category
question
When do you administer Roland-Morris disability questionnaire?
answer
in patients with LBP ONLY
question
Score > 30 on McGill pain questionnaire
answer
symptom exaggeration
question
Where is the location of stress found in spondylolisthesis, spondylolysis?
answer
pars articularis
question
Why don't facet joints check AP shearing well?
answer
located in the sagittal plane mostly
question
Are the IV foramen open or closed in flexion?
answer
open
question
What happens to the annulus during flexion?
answer
pinches in the front, becomes taut in the back
question
What happens to the nucleus pulposus during flexion?
answer
squishes posteriorly
question
What happens to the spinal cord during flexion?
answer
elongates, increases dural tension
question
Interspinous ligaments during flexion
answer
taut
question
PLL in flexion
answer
taut; helps annulus keep disc in place
question
Facet joints in flexion
answer
glide up and forward
question
Facet joints when rotating R
answer
facet joints on R will separate and gap
question
Type II lumbar SB/ROT and how the spine begins
answer
with a flexed lumbar spine, ipsilateral
question
Type I lumbar SB/ROT and how the spine begins
answer
with a neutral or extended spine, contralateral
question
How is the sacrum during R rotation?
answer
L side anterior, R side posterior
question
Right on right torsion of ROA
answer
L side deep/stuck forward
question
Where is right on right torsion of ROA more dysfunctional?
answer
lumbar flexion - sacrum moves backward and it becomes more asymmetrical
question
Where is right on right torsion of ROA less dysfunctional?
answer
lumbar extension - sacrum moves forward and becomes more symmetrical
question
Left on right torsion of ROA
answer
L side shallow/stuck backward
question
Where is left on right torsion of ROA more dysfunctional?
answer
lumbar extension - sacrum moves forward, asymmetrical
question
Where is left on right torsion of ROA less dysfunctional?
answer
lumbar flexion - sacrum moves backward, symmetrical
question
Observation component of LBP exam
answer
-distress? -preferred posture -body type -posture assessment -sitting disposition -palpation for position -gait exam
question
Grade 1 vertical compression test
answer
buckles with initial compression to bone pressure
question
Grades 2-5 vertical compression test
answer
increase pressure by same increments
question
Least specific to most specific assessment of lumbar mobility
answer
-AROM -PROM -PPIVM -PAIVM
question
Capsular pattern of LS
answer
FB and SB contralateral; ROT ipsilateral
question
Myosfascial pattern of LS
answer
FB and SB contralateral, more so than rotation
question
What are you looking for with PSIS FB test?
answer
innominate hypomobility; tests mobility of the iliosacral joint
question
What are you looking for with Marcher's, Gillet test?
answer
mobility of IS joint; ability of innominate to drop down and out when leg is lifted (if hypomobile, will stay still or go up)
question
+ Flare test
answer
moves < 2.5 mm medial or lateral translation; reproduction of symptoms
question
What does the leg swing assess?
answer
-innominate in the sagittal plane -hip flex/EXT -sacral FLEX/ext -L5 flex/EXT
question
+ Slump sacral base test
answer
change in rotation/asymmetry or end feel *check thumb depth and spring *can also be done for innominate at PSIS
question
If in extension, the L sacral base is shallow with hard end feel on the L and in flexion L sacral base is level with a soft end feel, what is the problem?
answer
left stuck on ROA
question
If in extension, the L PSIS stops first with HEF and the R crest continues into anterior rotation, what is the problem?
answer
L innominate stuck posteriorly
question
What is important to keep in mind about the sit/slump test for sacral base and innominate?
answer
-blockage can be at the hip -may need to raise table or slide to the edge if they have decreased hip flexion ROM -changes should occur in other positions as well (prone-->prone on elbow) -need to compare to other findings
question
What is a significant leg length change in the supine to long sit test?
answer
at least 2.54 cm change
question
If you have a right anterior rotation issue, what are your findings in supine?
answer
right leg longer
question
If you have a right anterior rotation issue, what are your findings in long sit?
answer
right leg shorter
question
If you have a right posterior rotation issue, what are your findings in supine?
answer
right leg shorter
question
If you have a right posterior rotation issue, what are your findings in long sit?
answer
right leg longer
question
If you have left anterior rotation issue, what are your findings in supine?
answer
left leg longer
question
If you have left anterior rotation issue, what are your findings in long sit?
answer
left leg shorter
question
If you have left posterior rotation issue, what are your findings in supine?
answer
left leg shorter
question
If you have left posterior rotation issue, what are your findings in long sit?
answer
left leg longer
question
What are lumbopelvic special tests based on?
answer
-static positional faults -movement deficits -symptom reproduction
question
What type of test has the better interrater reliability for the SI joint?
answer
provocation tests
question
What type of examination should you be doing for SI joint?
answer
-provocation testing -cluster testing
question
What does a positive SI joint symptom reproduction test tell you?
answer
SI joint is the pain producing structure for your low back pain
question
How do you identify stiffness dominant behavior?
answer
On a PA, identify R1 and R2
question
How do you identify symptom dominant behavior?
answer
on a PA, if P1 and P2 comes before hitting R2; P1 is where they first notice pain and P2 is where they won't let you go any further
question
Intervention protocol for symptom dominant behavior
answer
tissue health modalities; grade 1,2 mobs; no end range stretches
question
What is the more reliable indicator for a problem when doing PAIVM testing?
answer
pain
question
Neurological component to LBP exam
answer
-DTR -sensation -muscle test -nerve tension -gait -balance
question
Indicator of neurological weakness
answer
-tested at end range -repeated testing has quick fatigability
question
What can you test if unable to test great toe for neurological issues?
answer
hip abduction
question
What if knee flexion and knee extension are weak?
answer
suspect musculoskeletal
question
What if multiple myotomes are weak together in a group or near each other?
answer
space occupying lesion; cauda equina
question
What does a positive crossed SLR test indicate?
answer
large herniated disc - poor prognosis
question
Sciatic nerve bias position
answer
-hip flex -hip add -hip IR -knee ext -ankle DF
question
Tibial nerve bias position
answer
-hip flex -hip add -hip IR -knee ext -ankle DF -foot eversion
question
What is SLR a test for?
answer
disc herniation
question
Sural nerve bias position
answer
-hip flex -hip add -hip IR -knee ext -ankle DF -foot inversion
question
Common peroneal nerve bias position
answer
-hip flex -hip add -hip IR -knee ext -ankle PF -foot inversion
question
What does Brudzinski-Kernig sign assess?
answer
meningeal irritation, dural irritation, nerve root involvement positive in meningitis
question
What can give you a "positive" prone knee bend test?
answer
-tight quads -limitations in lumbar ext -limitations in SIJ -limitations in APT -femoral nerve issue
question
Lateral femoral cutaneous nerve issue
answer
-distinct bordered area of sensation loss -entrapment = myalgia paresthetica
question
Lateral femoral cutaneous nerve bias position
answer
prone hip ext adduction knee flex
question
Saphenous nerve bias position
answer
prone -hip ext -abd -ER -knee ext -ankle DF -eversion
question
Components of slump test
answer
-trunk flex -cervical flex -knee ext -ankle DF
question
+ Quadrant sign
answer
closes down foramen to increase radicular symptoms
question
What does the bike test assess for?
answer
neurogenic vs. intermittent claudication
question
+ Bike test
answer
onset of LE symptoms that decreases when pt slumps = neurogenic claudication
question
What if there is no change in symptoms when doing the bike test?
answer
vascular issue
question
Superficial tenderness Waddell sign
answer
tender to light touch over a broad area
question
Non-anatomic tenderness Waddell sign
answer
deep tenderness over broad area
question
Simulation components of Waddell sign
answer
-axial loading -rotation (hips with trunk)
question
Distraction component of Waddell
answer
SLR findings not consistent with slump findings
question
Regional component of Waddell (weakness and sensory)
answer
multiple spinal levels involved without a diabetes dx
question
Overreaction component of Waddell
answer
overt upon observation during the exam
question
5 categories of Waddell
answer
-tenderness -simulation -distraction -regional -overreaction
question
What is a positive Waddell finding?
answer
>= 3/5 criteria positive
question
When do you give sustained pressure during mobilization?
answer
-stretching -addressing connective tissue
question
Benefits of doing oscillations during mobilization?
answer
-provides neurophysiological effect -pt may tolerate this better than sustained pressure
question
Perform joint mob, pt gets worse, what do you do?
answer
-hold and monitor -decrease 1 variable and repeat and re-examine
question
Perform joint mob, pt gets slightly better, what do you do?
answer
repeat, re-examine
question
Perform joint mob, pt gets much better, what do you do?
answer
hold and monitor
question
Perform joint mob, no change, what do you do?
answer
-increase 1 variable -repeat -re examine
question
What do you want to eliminate when performing joint mobs?
answer
extension - won't be able to feel anything
question
Where do you block during side bending with finger block mob?
answer
edge of superior SP
question
Mechanical pain syndrome
answer
symptoms reproduced through movement or position and, therefore, deemed to be a condition that is amenable to PT intervention
question
Centralization phenomenon
answer
symptoms migrate from a more distal to a more proximal location *indicator of favorable prognosis
question
In what syndrome does centralization happen?
answer
derangement syndrome
question
What does centralization occur in response to?
answer
loading strategies - repeated movements or postures
question
What is leg pain at intake a significant predictor of?
answer
chronic pain and disability
question
Competent disc
answer
annular wall of disc is intact, indicating the ability to reduce the disc and centralize symptoms; otherwise it is an incompetent disc
question
Directional preference
answer
direction of movement which causes symptoms to centralize or improve
question
What is important about directional preference in the initial stages of care?
answer
it is the primary focus of intervention
question
Lateral shift aka sciatic scoliosis
answer
displacement of the upper body relative to the lower body in the frontal plane
question
What is lateral shift defined by?
answer
the side to which the upper body is displaced relative to the lower body
question
MDT syndromes
answer
-postural -dysfunction -derangement
question
Postural syndrome characteristics (4)
answer
-normal structures under abnormal stress -pain from prolonged poor postures -reduction of symptoms with correction of posture -no loss of motion
question
Dysfunction syndrome (4)
answer
-adaptive shortening of soft tissue; restricted movements -partial loss of motion -end range pain without peripheralization; local pain (unless nerve root is adhered) -pain reduced when stress is released
question
How do you want to move in dysfunction syndrome?
answer
towards pain - stretch it!
question
How is dysfunction syndrome named?
answer
direction in which symptoms are reproduced
question
Derangement syndrome (4)
answer
-alteration in contents of the disc -peripheralization of symptoms with specific motions -loss of motion, spinal deformity -variable symptoms (sometimes it hurts sometimes it doesn't)
question
How do you want to move in derangement syndrome?
answer
away from pain
question
Example of dysfunction syndrome
answer
arm in a cast for 8 weeks
question
Example of derangement syndrome
answer
-disc -bony derangement -locking knee with meniscus
question
Age range for derangement
answer
20-55
question
Pain rating/frequency for derangement
answer
sometimes yes, sometimes no for intermittent and constant
question
Local or referred pain for pain location of derangement?
answer
sometimes yes sometimes no for both
question
Acute, subacute, or chronic for derangement?
answer
all 3
question
Gradual onset or sudden onset for derangement?
answer
either
question
Motor/sensory deficits, abnormal reflexes, dural signs for derangement?
answer
can be all of them, but not necessarily
question
Range of motion loss for derangement?
answer
yes - obstructed
question
Changes in pain location with repeated movements for derangement?
answer
yes
question
Pain during movement with repeated movements for derangement?
answer
yes
question
End range pain with repeated movements for derangement?
answer
yes
question
Age range for dysfunction
answer
over 30
question
Intermittent or constant pain for dysfunction?
answer
intermittent
question
Local or referred pain for dysfunction?
answer
both
question
Acute, subacute, or chronic for dysfunction?
answer
chronic
question
Gradual or sudden onset for dysfunction?
answer
gradual
question
Motor/sensory deficits, abnormal reflexes, or dural signs for dysfunction?
answer
dural signs
question
ROM loss for dysfunction?
answer
yes - restricted
question
Changes in pain location for dysfunction with repeated movements?
answer
no
question
Pain during movement for dysfunction with repeated movements?
answer
no
question
End range pain with repeated movements for dysfunction?
answer
yes
question
Age range for postural
answer
under 30
question
Intermittent or constant pain for postural?
answer
intermittent
question
Local or referred pain for postural?
answer
local
question
Acute, subacute, or chronic for postural?
answer
acute
question
Gradual or sudden onset for postural?
answer
gradual
question
Motor/sensory deficits, abnormal reflexes, or dural signs for postural?
answer
none
question
ROM loss for postural?
answer
no
question
Changes in pain location with repeated movements for postural?
answer
no
question
Pain during repeated movement for postural?
answer
no
question
End range pain with repeated movement for postural?
answer
yes
question
What is important when testing repeated motions?
answer
-need to set a baseline -need location and intensity of symptoms
question
What positions do you do repeated movement testing?
answer
-standing -lying down
question
Progression of forces for MDT intervention
answer
-patient generated -patient generated with overpressure -therapist generated
question
Extension progression to provoke symptoms (8)
answer
-prone lying over pillows -prone lying -POE -extension in lying -extension in lying w overpressure -therapist PA mob -therapist manip -extension in standing
question
Flexion progression to provoke symptoms (4)
answer
-flexion in lying -flexion in sitting (gradually straighten legs out) -flexion in step standing (good for adherent nerve root) -flexion in standing
question
Lateral progression to provoke symptoms (7)
answer
-prone lying with hips offset -extension in lying w hips offset -extension in lying w hips offset and overpressure -rotation mob in ext -rotation manip in ext -side glide in standing -rotation mob in flexion
question
Spinal instability
answer
based on spinal pathology associated with excessive movement at the intervertebral or segmental level - abnormal shearing forces
question
Segmental instability
answer
failure of passive restraints that function to limit segmental motion
question
What can abnormally large intervertebral motions cause?
answer
-compression and/or stretching of inflamed neural elements -abnormal deformations of ligaments, joint capsules, annular fibers, end plates *have high density of nocioceptors!
question
Function of passive subsystem/spinal column
answer
enough soft tissues/ligamentous structures to hold spine together in alignment and prevent excessive movement
question
Function of active subsystem/spinal muscles
answer
stabilizing muscles that can turn on and control and create a force against abnormal shearing in a way that protects the spine
question
Function of control subsystem/neural
answer
sensitivity and firing capability from a neurological perspective to control everything to protect the spine
question
Components of Panjabi model
answer
-control subsystem -active subsystem -passive subsystem
question
Clinical instability
answer
-significant decrease in the capacity of the stabilizing system of the spine to maintain the IV neutral zones within physiological limits which results in pain and disability -dysfunction in one or more of the stabilizing subsystems leading to an increase in size of the neutral zone
question
Neutral zone
answer
part of range of physiological IV motion, measured from neutral position, within which spinal motion is produced with a minimal internal resistance
question
Elastic zone
answer
after the neutral zone, where tissues begin to stretch and cause resistance to motion (R1)
question
Hypermobility instability
answer
larger area where shifting/shearing occur before resistance is given
question
Goal if spine is hypermobile
answer
increase stiffness for spine to protect itself from unstable movement
question
Things that can affect passive subsystem
answer
-traumatic injury -lax ligaments -degenerative disc
question
Things that can affect active subsystem
answer
disuse - not exercising or using muscles, so they become weak
question
Things that can affect control subsystem
answer
-unable to recruit segmental mm so larger mm take over and cause strain -abnormal firing pattern resulting in inhibition (can be caused by pain) -altered motor programs that prevent accessing inner mm
question
Flow sheet for a dysfunctional spine
answer
injury/degeneration/disease --> decrease passive and active stability --> decrease neural control --> guarding --> accelerated degeneration/abnormal mm loading/muscle fatigue --> chronic dysfunction/pain
question
Indicators for neural control subsystem issues
answer
-changes in mm onset timing -changes in patterns of mm recruitment determined by EMG -changes in mm activation and spinal stiffness determined by biomechanical modeling -changes in kinematic patterns of spinal movement determined by visual observation or instrumented motion analysis
question
Examination predictors for success for pts with spinal instability
answer
- 91 deg
question
Examination predictors for some improvement for pts with spinal instability
answer
- + prone instability test -aberrant movement -hypermobility with lumbar spring test -FABQ physical activity subscale <9
question
Examination predictors for no improvement for pts with spinal instability
answer
- - prone instability test -no aberrant movement -no hypermobility with lumbar spring test -FABQ physical activity subscale > 9
question
What 3 components provide compressive force and increased stability to spine?
answer
-thoracolumbar fascia -transversus -multifidus
question
Transversus abdominis function
answer
attachment to lateral raphe of thoracolumbar fascia allows it to apply compressive force to fascia
question
Multifidus function
answer
exerts a pushing force on thoracolumbar fascia and produces a hydraulic amplifier mechanism
question
The cylinder, with top and bottom, components of spinal stabilizers
answer
-diaphragm -transversus + thoracolumbar fascia + multifidus -pelvic floor
question
What happens to other parts of the cylinder if one component of the horizontal portion is having an issue?
answer
loss of pelvic floor control
question
(+) passive lumbar extension test
answer
pain or feeling of instability
question
What does active SLR test test?
answer
pelvic instability
question
(+) active SLR test
answer
symptom reproduction with active SLR; symptom reduction with active SLR + directed force through ilia
question
In LPM, what is the diagonal direction determined by?
answer
what foot is forward
question
Where do you apply pressure for flexion LPM?
answer
coracoid
question
Where do you apply pressure for extension LPM?
answer
upper scapula area
question
What do proprioceptors need to do in LPM?
answer
detect abnormal shearing force and respond to protect before reaching an abnormal position
question
Grade 0 LPM
answer
no/poor initiation
question
Grade 1 LPM
answer
lumbar shears with initial compression to bone pressure
question
Grades 2-5 LPM
answer
increase pressure by same increments
question
Muscle recruitment phase of TA drawing in
answer
deep stabilizers only
question
Force output phase of TA drawing in
answer
6 mmHg - 8 mmHg
question
Endurance phase of TA drawing in
answer
10 sec x 10 reps
question
Position phase of TA drawing in
answer
prone, supine, sit, stand
question
Contraction phase of TA drawing in
answer
isometric to isotonic
question
Extremity activity phase of TA drawing in
answer
UE, LE, superficial movers
question
Function phase of TA drawing in
answer
critical ADL
question
Formal skill training for the TA
answer
drawing in the abdomen with concurrent multifidus contraction
question
Integration into dynamic function for the TA
answer
deep muscle provide support while superficial muscles perform movement
question
Incorporation of skill into heavy tasks for the TA
answer
deep muscles stabilize while focus is on restoring superficial muscle function
question
Type of exercise to isolate LMS
answer
local segmental control
question
Type of exercise to train LMS control
answer
closed chain segmental control
question
Train LMS functionally
answer
open chain segmental control
question
Components to assess stability
answer
-upper ab MMT -lower ab MMT -trunk extensor MMT -TADIM -multifidus test -aberrant movement? yes or no -prone instability test -SLR -active SLR
question
Diagnoses that are flexion biased
answer
-MDT flexion dysfunction -MDT anterior derangement -TBC flexion syndrome -central stenosis -lateral stenosis -spondylolisthesis/lysis -paravertebral myofascial pain syndrome -facet joint spondylosis -opening/tension syndrome with low reactivity -closing/compression syndrome with high reactivity -degenerative disc disease without HNP
question
Progression for flexion-biased regimen
answer
unloaded --> partially loaded --> loaded --> lateral component
question
Diagnoses that are extension biased
answer
-MDT postural syndrome -MDT extension dysfunction syndrome -MDT posterior derangement syndrome -TBC extension syndrome -bulging or HNP -closing/compression syndrome with low reactivity -opening/tension syndrome with high reactivity
question
Progression for extension biased regimen
answer
unloaded --> partially loaded --> loaded --> lateral component
question
Examples of unloaded flexion biased exercises
answer
-PPT -SKTC -DKTC
question
Examples of partially loaded flexion biased exercises
answer
-cat stretch -prayer stretch -seated PPT -seated flexion
question
Examples of loaded flexion biased exercises
answer
-standing PPT -standing flexion
question
Examples of lateral component of flexion biased exercises
answer
-LTR -prayer stretch 3 ways -seated flexion with SB -standing flexion with SB -side glide in stand -SL stretch with bolster -million dollar roll
question
Examples of unloaded extension biased exercises
answer
-prone lying -APT (rarely) -POE -PPU
question
Examples of partially loaded extension biased exercises
answer
-cow -seated APT -seated extension
question
Examples of loaded extension biased exercises
answer
-standing APT -standing extension
question
Examples of lateral component of extension biased exercises
answer
-LTR -prone lying with hips offset -POE with hips offset -PPU with hips offset -side glide in stand -SL stretch with bolster -million dollar roll
question
What does the fascial system do?
answer
-ensheathes and permeates all tissues and structures -supplies mechanical supportive framework that holds and integrates body together and gives it form -provides for the space and lubrication between bodily structures -creates pathways for nerves, blood, lymphatic vessels
question
What do fascial cross links do?
answer
immobilize what used to be a functional joint - limits extensibility
question
How do soft tissue restrictions occur?
answer
-cross linking -scar tissue -dehydration of ground substance -lymphatic stasis -neuro changes (mechanoreceptors) throughout system -cellular electrochemical changes (cellular function, membrane permeability) -pain (at injured site, referral patterns)
question
What do golgi mechanoreceptors respond to?
answer
-GTO muscle contraction -other golgi receptors - strong stretch
question
Possible techniques to affect golgi mechanoreceptor
answer
-active contraction -STM with active movement or dynamic stretching
question
Know results of stimulation of golgi mechanoreceptor
answer
tonus decrease
question
What do Pacini mechanoreceptors respond to?
answer
-rapid pressure changes -vibration -fast stimulation
question
Possible techniques to affect Pacini mechanoreceptors
answer
-HVLA -oscillatory mob
question
Known results of stimulation to Pacini mechanoreceptors
answer
increased sense of kinesthesia
question
What do Ruffini mechanoreceptors respond to?
answer
-sustained pressure -tangential forces (lateral stretch)
question
Possible techniques to affect Ruffini mechanoreceptors
answer
-trigger point release -deep fascial mobilization
question
Known results of stimulation for Ruffini mechanoreceptors
answer
inhibition of sympathetic activity and increased local proprioception attention
question
What do interstitial mechanoreceptors respond to?
answer
-rapid and sustained pressures -even split between high and low mech. threshold units
question
Possible techniques to affect interstitial mechanoreceptors
answer
-low level group = gentle massage -high level group = deep fascial work, HVLA
question
Known results of stimulation of interstitial mechanoreceptors
answer
-vasodilation -increase in plasma extravasation
