Term
| What are the steps for LLTT? |
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Definition
| Knee ext, Hip flex, Ankle DF, Hip IR, Hip add, Neck flex |
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Term
| What do you add to LLTT for tibial nerve bias? |
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Definition
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Term
| What do you add to LTT for Common Peroneal Nerve bias? |
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Definition
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Term
| What are the steps for femoral nerve tension test? |
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Definition
| Prone, Knee flex, Hip abd, Neck flex, Hip ext if needed |
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Term
| What are the steps for saphenous nerve tension test? |
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Definition
| Prone, Knee ext, Hip abd, Hip ER, Hip ext, Ankle DF, Ankle ev |
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Term
| How long do you hold a nerve stretch? |
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Definition
| As tolerated, aiming to reach 20 seconds. |
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Term
| What are we trying to achieve with manual therapy? (mobs/manips) |
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Definition
1. Relief of joint stiffness
2. Stabilization of hypermobile joints
3. Normal soft tissue tone
4. Normal joint function
5. Elimination of pain |
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Term
| What is most likely the main cause of local and referred pain? |
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Definition
| The muscles surrounding a stiff joint. (pg I2) |
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Term
| General absolute contraindications to Grade 2 or 3 mobilizations (7) |
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Definition
1. Bone disease
2. Active inflammatory and infective arthritis
3. Ununited fractures or dislocations
4. Joint instability
5. Ankylosed joint
6. Malignancy
7. Acute Rheumatoid episode |
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Term
| Regional absolute contraindications to grade 2 or 3 mobilizations |
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Definition
1. Upper cervical RA or OA
2. Vertebral artery syndrome
3. Traumatized transverse or cruciate ligament
4. Cranio-vertebra. Instability
5. Upper cervical lesion when dizziness is reported
6. Bi-level cervical root signs
7. Disc Prolaps with n. root impingement
8. Cauda Equina syndrome
9. Tri-level lumbar root signs
10. Suspected or diagnosed spinal or aortic aneurism
11. Recent surgical sites |
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Term
| Regional absolute contraindications to grade 2 or 3 mobilizations (11) |
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Definition
1. Upper cervical RA or OA
2. Vertebral artery syndrome
3. Traumatized transverse or cruciate ligament
4. Cranio-vertebra. Instability
5. Upper cervical lesion when dizziness is reported
6. Bi-level cervical root signs
7. Disc Prolaps with n. root impingement
8. Cauda Equina syndrome
9. Tri-level lumbar root signs
10. Suspected or diagnosed spinal or aortic aneurism
11. Recent surgical sites |
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Term
| Relative contraindications to grade 2 or 3 mobilizations (14) |
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Definition
1. osteoporosis
2. osteoarthritis
3. subacute or chronic rheumatoid arthritis
4. neurological signs
5. acute signs or symptoms
6. disc herniations
7. hypermobilibty
8. fever of unknown cause
9. pt unable to relax
10. cervical trauma
11. pregnancy
12. prolonged steroid use
13. dizziness
14. spondylolisthesis |
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Term
| What is the main stabilizer between the vertebrae? |
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Definition
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Term
| What is the orientation of cervical spine facets in relation to the saggital plane? |
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Definition
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Term
| What is the orientation of thoracic spine facets in relation to the saggital plane? |
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Definition
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Term
| What is the orientation of lumbar spine facets in relation to the saggital plane? |
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Definition
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Term
| What is the orientation of cervical spine facets in relation to the frontal plane? |
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Definition
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Term
| What is the orientation of thoracic spine facets in relation to the frontal plane? |
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Definition
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Term
| What is the orientation of lumbar spine facets in relation to the frontal plane? |
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Definition
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Term
| What force does the nucleus palposis resist? |
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Definition
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Term
| What force does the annulus fibrosis resist? |
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Definition
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Term
| What happens to forces within the disc when the nucleus palposis degenerates? |
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Definition
| The annulis fibrosis becomes responsible for resisting compression, which it’s not built for --> pain. |
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Term
| How do you measure forward trunk flexion? |
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Definition
| Place tape on S1 and T12 or C7 bony landmarks. Have them bend until pelvis starts to move. |
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Term
| How do you measure trunk rotation with a tape? |
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Definition
| Place tape on sternomanubrial ridge, and S1. |
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Term
| How do you measure trunk side flexion with a tape? |
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Definition
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Term
| What is optimum stimulation for regeneration of the disc? |
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Definition
| Compression and decompression for the cartilage, and rotation for the collage (modified tension along the lines of stress). |
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Term
| How does fluid exchange occur within the vertebral disc? |
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Definition
| As you rotate, the natural bulge that is around the disc compresses in on the nucleus palposis. This squeezes the fluid out of the nucleus palposis because of the increased intradiscal pressure. When you return to neutral, fresh fluid gets sucked back in. So rotation promotes nutrition exchange. |
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Term
| When you side flex to the right, on which side do the facets close? |
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Definition
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Term
| When you rotate to the right, on which side do the facets close? |
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Definition
| Left. They gap open on the right. |
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Term
| Where does the most shear force occur on the disc? |
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Definition
| Posterolaterally – which is also where the most disc herniations occur, because this is the weakest point. |
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Term
| How does pathology affect the axis of rotation? |
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Definition
| It changes the axis of rotation which can affect proprioception, and can affect muscle, causing it to spasm/guard. |
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Term
| From T3 to L5, when the vertebral segments are not closed packed, if you side bend to the right, which direction does the spine rotate? |
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Definition
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Term
| From T3 to L5 when the vertebral segments are closed packed, fully flexed or extended, if you side bend to the right, which direction does the spine rotate? |
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Definition
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Term
| In which direction does the C Spine rotate if it is side bent to the right? |
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Definition
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Term
| If the disc is protruding, extension exercises may help reduce symptoms. But they also may worsen the problem. How? |
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Definition
| It can help by pushing the disc back in. It could hurt by pinching the nucleus palposis off into 2 pieces, which instigates increased symptoms. And once it’s out, it can’t go back in. |
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Term
| What vertebral ligament is very highly innervated and can be compressed by a protruding disc leading to high levels of local pain? |
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Definition
| The posterior longitudinal ligament |
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Term
| What portion of the annulus fibrosis is innervated and can become painful? |
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Definition
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Term
| At what angle of leg elevation does the sciatic nerve begin to get stretched? |
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Definition
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Term
| At what point of leg elevation does further elevation lead to NO further sciatic stretch? |
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Definition
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Term
| Below what level is no sciatic stretch being applied? |
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Definition
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Term
| Describe the well leg test and how it works. |
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Definition
| When the uninvolved leg is elevated in SLR, symptoms present in the involved side. This is indicative of a disc herniation directly under the nerve, so when the well leg is raised, it pulls the spinal cord laterally during the stretch, causing increased compression of the nerve on the involved side |
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Term
| Why is it difficult to pinpoint which segment is problematic with nerve root irritation? |
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Definition
| There are innervation overlaps between and across segments. So irritation of an L3 pattern don’t necessarily correspond to an L3 disc problem. It could be higher, or lower. |
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Term
| How can palpating closely along the sides of the vertebral spinous processes aid you in finding the problematic segment creating nerve root symptoms? |
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Definition
| The multfidi are segmentally innervated. |
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Term
| How can you decrease pain at segmental level L3, if the patient does not tolerate pressure directly above this vertebrae? |
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Definition
| You can provide grade 1 oscillations at L1,2,4, or 5 to decrease pain, because of the shared innervations – oscillating these areas will also trigger a gating effect on the affected nerve area. It will, however, take longer. |
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