Term
| what are the 4 categories of treatment for LBP |
|
Definition
| manipulation, stabilization, specific exercise, traction |
|
|
Term
| if the problem is hypomobility or misalignment, what treatment should help |
|
Definition
| manipulation: manually move it back into place |
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|
Term
| what are the 5 clinical prediction rules that indicate successful treatment with manipulation |
|
Definition
| 1. no symptoms distal to the knee; 2. onset of symptoms < 16 days; 3. low FABQ-W < 19; hypomobility of lumbar spine; hip IR ROM > 35 for at least 1 hip |
|
|
Term
| what does the number of clinical prediction rules present mean |
|
Definition
| the more clinical prediction rules present, the greater the possibility of success |
|
|
Term
| what does FABQ-W mean/what is it |
|
Definition
| fear avoidance beliefs questionnaire for work; questionnaire asking how work affects back pain |
|
|
Term
| of the 5 clinical prediction rules for manipulation, how many should be present to warrant a manipulation |
|
Definition
|
|
Term
| of the 5 clinical prediction rules for manipulation, how many should be present for manipulation to be necessary |
|
Definition
|
|
Term
| if too much movement is the problem, what is the goal/treatment |
|
Definition
|
|
Term
| what is the physiological method of stabilization |
|
Definition
| strengthening core muscles of the back; retraining core muscles of the back to control spine movement during activity |
|
|
Term
| for the following questions, list the best treatment for the problem |
|
Definition
|
|
Term
| asymmetrical lateral flexion ROM |
|
Definition
| manipulation or specific exercises |
|
|
Term
| diagnosis of lumbar spinal stenosis |
|
Definition
|
|
Term
| unilateral LBP without symptoms into lower extremities |
|
Definition
|
|
Term
|
Definition
|
|
Term
| no movements centralize symptoms |
|
Definition
|
|
Term
| asymmetrical bony landmarks of the pelvis |
|
Definition
|
|
Term
| positive SI dysfnction tests including supine-long sit test, prone knee bend test, standing flexion test |
|
Definition
|
|
Term
| visible lateral deviation |
|
Definition
|
|
Term
| frequent recurrent episodes of LBP with minimal perturbation. "Back hurts every 3 months. I just step down off the curve, and I'm out for a few weeks" |
|
Definition
|
|
Term
| hypermobility of the lumbar spine. "When I push their back, it's easy to move them." |
|
Definition
|
|
Term
| asymmetrical sidebending AROM |
|
Definition
| specific exercise or manipulation |
|
|
Term
| previous history of a lateral-shift deformity with alternating sides: back's all over the place, side to side |
|
Definition
|
|
Term
| frequent prior use of manipulation with dramatic but short-term effects |
|
Definition
|
|
Term
| symptoms of nerve root compression |
|
Definition
| specific exercise or traction |
|
|
Term
| trauma, pregnancy, or use of oral contraceptives |
|
Definition
|
|
Term
| relief with immobilization such as bracing |
|
Definition
|
|
Term
| radiography shows instability |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what are the core muscles to target for stabilization |
|
Definition
| rectus abdominis, transversus abdominis, internal/external obliques, erector spinae, multifidi, quadratus lumborum |
|
|
Term
| what are the 5 clinical prediction rules that indicate successful treatment with stabilization |
|
Definition
| < 40 yo, average SLR > 91 deg, aberrant movements present, + Prone Instability Test, tender to palpation long dorsal SI ligament and pubic symphysis |
|
|
Term
| if someone is postpartum, what are the clinical prediction rules for stabilization |
|
Definition
| posterior pelvic pain, positive active SLR, positive modified trendelenberg |
|
|
Term
| if someone has 3/4 clinical prediction rules for stability, what is their probability of success with treatment |
|
Definition
|
|
Term
|
Definition
|
|
Term
| if someone is hypomobile, is treatment by stabilization likely to be successful |
|
Definition
|
|
Term
| if someone has a negative prone instability test, is treatment by stabilization likely to be successful |
|
Definition
|
|
Term
| if someone has a FABQ-PA >9, is stability treatment likely to be successful |
|
Definition
|
|
Term
|
Definition
| fear avoidance beliefs questionnaire for physical activity |
|
|
Term
| if someone has no aberrant movements, are stabilization exercises likely to be helpful? |
|
Definition
|
|
Term
| what are the 4 failure predictors for stabilization treatment |
|
Definition
| hypomobility, negative prone instability test, FABQ-PA >9, no aberrant movement |
|
|
Term
| how many negative CPRs for stability need to be present to suggest that the patient is likely to fail with stabilization treatment |
|
Definition
|
|
Term
| what is the goal of specific exercise treatment |
|
Definition
| produce lasting centralization of symptoms |
|
|
Term
| how to determine whether something is a good specific exercise |
|
Definition
| if it makes the pain go away, do it! If it hurts, don't do it! |
|
|
Term
|
Definition
| pain moves from an area more distal or lateral to a location more central |
|
|
Term
| what is directional preference |
|
Definition
| decrease or abolish lumbar midline pain. Includes centralization |
|
|
Term
| is directional preference a part of centralization |
|
Definition
|
|
Term
| is centralization a part of directional preference |
|
Definition
|
|
Term
|
Definition
| pain moves from an area more proximal to an area more distal/lateral |
|
|
Term
| what is a status quo movement |
|
Definition
| movements that do not produce centralization or peripheralization |
|
|
Term
| is it ok for an initial increase in central LBP to occur initially with centralization |
|
Definition
|
|
Term
| what is a possible reason why specific exercises in extension provide relief |
|
Definition
| disc is pushed back into place with extension movement |
|
|
Term
| what is a possible reason why specific exercises in flexion provide relief |
|
Definition
| open up space in flexion that restores normal function/motion and decreases compression |
|
|
Term
| what are the 4 clinical prediction rules that indicate successful treatment with specific exercise |
|
Definition
| > 50 yo, symptoms distal to butt, directional preference, response to lateral translation movement |
|
|
Term
| if someone has lumbar spinal stenosis, what will be their directional preference |
|
Definition
|
|
Term
| if someone has disc protrusion, what will be their directional preference |
|
Definition
|
|
Term
| describe the basics of specific exercise treatments |
|
Definition
| repetitive, end-range movements in the direction that centralizes pain. Avoid peripheralization movements. Correct lateral shift deformities. Mobilize to promote centralization movement. |
|
|
Term
| how can traction fix the problem? |
|
Definition
| if nerve root compression is the problem, removing pressure and decompressing trapped spaces should relieve stress/pain |
|
|
Term
| what is the goal of traction treatment |
|
Definition
| to centralize pain enough to progress to another classification |
|
|
Term
| what are the 2 clinical prediction rules that indicate successful treatment with traction |
|
Definition
| signs and symptoms of nerve root compression, no movements centralize symptoms |
|
|
Term
| what are signs and symptoms of nerve root compression |
|
Definition
| positive SLR, diminished reflexes, diminished sensation, diminished strength |
|
|
Term
| what position to use for traction |
|
Definition
| the one that best centralizes symptoms, progressing toward neutral |
|
|
Term
| what intensity to use for traction |
|
Definition
|
|
Term
| when to use static traction |
|
Definition
| long static hold for young patients with disc pathology |
|
|
Term
| when to use intermittent traction |
|
Definition
| short intermittent holds for older patients with stenosis |
|
|
Term
| what is the difference between a mobilization and a manipulation |
|
Definition
| a mobilization is a grade 1-4 low velocity oscillation. A manipulation is a grade 5 high velocity low amplitude thrust. |
|
|
Term
| do manipulation techniques in the low back need to be specific |
|
Definition
| no. the choice of manipulation technique is not as important as the choice of patient for whom spinal manipulation will be successful |
|
|
Term
| does it matter which level you manipulate in the low back |
|
Definition
| no. there is movement at several spinal levels with passive motion |
|
|
Term
| what should be done following spinal manipulatoin |
|
Definition
| simple active ROM exercises. For example, pelvic tilts in supine |
|
|
Term
| what is the purpose of strengthening the deep core stabilizers of the low back |
|
Definition
| to retrain the muscles to control the motion of the spine during movement. |
|
|
Term
| in stabilization, should the deep muscles of the back be trained specifically, or is compensation from other muscles ok |
|
Definition
| the deep muscles of the back should be trained specifically without compensation of surrounding larger muscles |
|
|
Term
| how do deep back muscles contract functionally |
|
Definition
| as a low level, prolonged tonic holding contraction |
|
|
Term
| how should deep back muscles be trained/strengthened |
|
Definition
| as a low level, prolonged tonic holding contraction |
|
|
Term
| how often should deep back muscles be strengthened in order for them to be retrained as a motor skill |
|
Definition
| many times throughout the day |
|
|
Term
| how is it possible to target only the deep core muscles of the back and not have potential for contracting compensatory muscles |
|
Definition
| begin training in positions with decreased external loads to avoid large muscle use activation. Begin in position of quadruped or prone with spine in neutral to teach contraction of deep muscles. Avoid end-range movements. |
|
|
Term
| how is it possible to monitor for use of larger, compensatory muscles when trying to activate deep core muscles |
|
Definition
| observe for movement of the ribcage, shoulders, and pelvis. |
|
|
Term
| should contraction of the deep core muscles affect breathing |
|
Definition
|
|
Term
| is the transverse abdominis a deep core muscle or a larger surrounding muscle |
|
Definition
|
|
Term
| is the lumbar multifidis a deep core muscle or a larger surrounding muscle |
|
Definition
|
|
Term
| is the erector spinae a deep core muscle or a larger surrounding muscle |
|
Definition
| larger surrounding muscle |
|
|
Term
| is the external oblique a deep core muscle or a larger surrounding muscle |
|
Definition
| larger surrounding muscle |
|
|
Term
| is the internal oblique a deep core muscle or a larger surrounding muscle |
|
Definition
| larger surrounding muscle |
|
|
Term
| is the rectus abdominis a deep core muscle or a larger surrounding muscle |
|
Definition
| larger surrounding muscle |
|
|
Term
| is the quadratus lumborum a deep core muscle or a larger surrounding muscle |
|
Definition
| larger surrounding muscle |
|
|
Term
| how to begin core training |
|
Definition
| instruct patient to draw in navel towards spine. Palpate transverse abdominis medial to ASIS. Palpate lumbar multifidus in paraspinal area of lower spine |
|
|
Term
| what is the progression of positions for training the transverse abdominis |
|
Definition
| quadruped (to make activation of rectus difficult) - hooklying - standing - functionl activities - hooklying with marching - hooklying with SLR |
|
|
Term
| how to progress multifidus/erector spinae strengthening if you start with quadruped single arm or leg lfits |
|
Definition
| quadruped opposite arm and leg lifts |
|
|
Term
| how to progress multifidus/erector spinae strengthening if you start with bridgin |
|
Definition
|
|
Term
| how to progress multifidus/erector spinae strengthening if you start with prone extension |
|
Definition
|
|
Term
| what is the progression of positions for training the oblique abdominals if you start with horizontal position with knees as base |
|
Definition
| horizontal position with ankles as base |
|
|
Term
| what are some other oblique strengthening exercises |
|
Definition
| trunk curl-ups with rotation; hanging leg lifts |
|
|
Term
| what is a good exercise for strengthening the quadratus lumborum |
|
Definition
| horizontal support exercises |
|
|
Term
| how to determine intensity and repetition for strengthening/stability exercises |
|
Definition
| listen to the patient. Start with 10 contractions of 10s holds. Progress by increasing hold time, increasing repetitions, and progressing position |
|
|
Term
| what are some specific exercises when flexion is the preferred motion |
|
Definition
| 1. posterior pelvic tilt/flatten back. 2. supine knees to chest: sustained 20-30s and repeated. 3. quadruped rocking to heels |
|
|
Term
| what are additional ways to support improvement with specific exercises |
|
Definition
| manual therapy to increase motion; bodyweight supported treadmill training; address strength/flexibility/conditioning |
|
|
Term
| what are some specific exercises when extension is the preferred motion |
|
Definition
| quadruped rocking forward; prone 30s - prone on elbows 30s - prone push-up x 10 |
|
|
Term
| what are some specific exercises for when latearl shift is the preferred motion |
|
Definition
| prone lateral shift correction - add extension; standing shift correction - progress to extension exercises |
|
|
Term
| what are examples of aberrant movements during lumbar flexion that are part of the CPR for stabilization |
|
Definition
| reversal of lumbopelvic rhythm, painful arc, instability catch, gower's sign |
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