If herniation is lateral to the nerve root, will bending towards the affected side or away from the affected side relieve the pain?
leaning away will relieve (contralateral)
If herniation is medial to the nerve root, will leaning away or leaning towards the affected side cause more pain?
leaning away will cause more pain
What kind of herniation syndrome if loading strategies decrease, abolish, or centralize symptoms? (DH)
derangement - reducible
What kind of herniation syndrome if no loading strategies decrease, abolish, or centralize the symptoms? (DH)
derangement - irreducible
What kind of herniation syndrome if pain only at end ranges?
dysfunction (adherent nerve root)
What kind of herniation syndrome if pain only on static loading with physical examination showing normal
postural
What kind of mckenzie herniation classifications are symptomatic? What kind are symptomatic and mechanical? What does this mean?
symptomatic - postural symptomatic and mechanical - derangement and dysfunction symptomatic if pain, mechanical if difference in movement
Which herniation syndrome will patient pursue centralization of symptoms and avoid peripheralization of symptoms?
derangement
What syndrome if LIMITED ROM and pain at end range?
dysfunction (ANR)
Postural syndrome only has pain at when? What is an example?
static loading, example = slouched posture lengthening posterior tissues
What is McKenzie's prone progression for herniation?
prone, prone on elbow, prone on hand
Methods for maintenance of positions for healing annular fibers in treating HNPs?
use lumbar roll to maintain correction and proper posture
What kind of movements to avoid in treating HNPs?
rotation, flexion
What is the process for intervening with herniation?
establish diagnosis
determine irritability
determine outcome to measure to re-assess
What are the three components of movement?
mobility/flexibility, power/endurance, motor control
What kind of things should the patient demonstrate prior to doing LBP stabilization exercises in terms of positive tests, mobility and motions at segments, age, prior episodes, and SLR?
positive prone instability, aberrant motions, hypermobile segments, younger than 40, 3 or more prior episodes with increasing frequency, and over 91 SLR bilaterally
Clinical guideline summary for LBP says what required to do mechanical nerve root tension (flossing)?
difficulty flexing in standing, positive neural tension signs
If neuro signs, leg symptoms, and no centralization during objective exam, what kind of intervention? (AKA nonreducible derangement)
traction (mechanical or manual)
Name this wadells sign: disproportionate pain to light touch, not correlating with anatomic structures
superficial or nonanatomic tenderness to palpation
Name this waddells sign: Axial compression of the head or rotational simulation maneuver elicits "pain" despite no actual provocation
simulation sign
name this waddels sign: when a test that was painful originally when performed is not painful anymore when they are in a distracted state
distraction sign
What score on Wadell's means no organic reason for pain? What are the five signs?
3/5 or higher
superficial/non anatomic tenderness to palpation
simulation sign
distraction sign
regional sensory/motor disturbance
overreaction
Score on Oswestry index that is normal?
0-20%
In lower crossed syndrome, match hip and trunk muscles? Which are facilitated/inhibited?
hip flexors with back extensors (facilitated) hip extensors with trunk flexors (inhibited)
Pain in the thoracic spine is often ____ related
posture (excessive kyphosis)
Is trunk extensor weakness or trunk extensor endurance a bigger issue in thoracic back pain?
endurance
Subacute low back pain with mobility deficits seen at what part of range in spinal motions?
mid to end range
Spinal instabilities with acute low back pain with movement coordination impairments seen at what part of range?
initial to mid range
Thoracic pain is higher in females or males?
females
Acute, subacute, or chronic: symptoms produced with mid-range motions that worsen with end range movements
subacute
Trunk coordination, strengthening, and endurance exercises used in acute, subacute, or chronic?
subacute and chronic
Most common part of spine affected by metastases from other cancers?
T-spine
What are the facilitated muscles in upper crossed syndrome?
SCM/pectorals + upper trap/levator scapula
What are the inhibited muscles in upper crossed syndrome?
deep cervical flexors + lower trap/serratus anterior
according to clinical guidelines Activities/exercise to promote centralization is recommended as intervention if pt meets what 2 criteria?
Peripheralization/Centralization during objective exam preference for one posture
What kind of interventions for reducing pain and disability in older patients with chronic low back pain with radiating pain? (4)
flexion combined with manual therapy, strengthening, nerve mobs, walking
most common area for abdominal aortic aneurysm?
below renal artery
Symptoms of herpes zoster?
pain and itching in cranial or spinal dermatome before a unilateral maculopapular rash
Most common vertebral dermatome for shingles
T5-6
What are the "typical" ribs
ribs 3-9
What are the "atypical" ribs and where do they attach?
1,2,10,11,12 all attach to their respective vertebrae
What are the true, false, and floating ribs?
true - 1-7 false - 8-10 floating - 11-12
Most flexion allowed in what part of the t-spine?
lower
Dowager's hump associated with
osteoporosis or long term corticosteroid use
What is the Gibbus deformity? What is it associated with as for a cause?
sharp posterior angulation of spine, associated with infection, fracture, or bony anamoly
T/F: there is reduced motion at the thoracic spine compared to the L-spine/C-spine due to the facet orientation
false - less motion but NOT due to the facet orientation
____ disorders such as _____ can refer to the thoracic spine
renal; pyelonephritis (kidney infection), nephrolithiasis (kidney stones)
Typical and atypical thoracic vertebrae?
typical T2-10 atypical T1,T11,12
T/F: during forward flexion, nonstructural scoliosis does not appear whereas structural scoliosis appears
true
Ribs on side of convexity and concavity in scoliosis would do what?
convexity - spread apart concavity - come together
What is T4 syndrome? What does it manifest as?
hypomobility of a segment (normally T4) leading to sympathetic reaction; can manifest as glove like numbness/paresthesias in arms/hands
What techniques can resolve T4 symptoms?
manual therapy
local tenderness of bony points, positive slump test, positive upper limb tension tests, depression or prominence of one or more spinous processes, and local thickening and stiffness of one segment
T4 syndrome
5 criteria for spinal manipulation according to CPR
Duration of current LBP under 16 days
no symptoms distal to knee
FABQ under 19 points
at least one hypomobile segment in LS
1 or both hips at least 35 IR
What is Scheuermann's disease?
hyperkyphosis in adolescents (13-16), an osteochondrosis of the spine
In Scheuermann's disease, what happens at the vertebral bodies, end plates, IV space, and ALL?
vertebral bodies wedge anteriorly end plates have Schmorl's nodes, IV space narrowed ALL thickened
Compensatory increase in lumbar lordosis in adolescents associated with what disease?
Scheuermann's
In Scheuermann's, if kyphosis under ____ then exercise intervention only. What kind of interventions?
under 60 degrees
intervene with muscle stretching hip flexors, pecs, and hamstrings extension exercise
What degree for bracing + exercise or surgery in Scheuermann's?
bracing + exercise if over 60 degrees surgery only over 80 degrees
Genetic marker for ankylosing spondylitis
carry HLA-B27
Age and sex of ankylosing spondylitis typically? What ethnicity?
adult 20-30 years old, males 2-3 times more likely northern european most common
Back pain worsens with what motions in Scheuermann's? Where is this pain usually located?
extension and rotation - apex of the kyphosis
Radiographic changes in ankylosing spondylitis (2)
intervertebral ossification like bamboo spine, sacroiliitis which leads to SI ankylosis
Symptoms of ankylosing spondylitis (5)
back pain and stiffness, fever, IBD, uveitis, peripheral joint involvement
History questions about ankylosing spondylitis? What would 4 or more positive answers tell you?
morning stiffness, reduction in discomfort with exercise, onset of back pain before 40, gradual onset, pain over 3 months 4 or more tells you high probability of AS
BASDAI, BASFI, and BASMI all for what (bath forms)
ankylosing spondylitis
Tragus to wall measurement used to detect what? What score of 15 or 30 tell you?
change in AS posture under 15 is mild, over 30 severe
Components of the BASMI (5)
cervical rotation, tragus to wall, lumbar side flexion, modified schobers, intermalleolar index
treatment goals for AS (3)
symptom relief, posture correction, delaying the inevitable
Education pieces for AS? (3)
daily exercise crucial, joint protection, posture
Best approach for exercise in AS (3)
multimodal approach with aerobics, strengthening, pulmonary
things to avoid with AS movements
high impact, abrupt movements, FLEXION
sex, ethnicity, body type, nutritional risk factors for osteoporosis?
female, northern european or asian, ectomorph skinnier builds, and lack of calcium and Vit D in diet
Diagnosis of osteoporosis done with
bone densitometry (dexa scan)
What makes up bone strength
bone mineral density and bone quality
Regions of the body with high cancellous bone (most affected by osteoporosis)
spine, hip, distal forearm, proximal humerus, pelvis
T-scores for osteopenia, osteoporosis, and severe osteoporosis
ostopenia: T score between -1.0 and -2.5 SD osteoporosis: over -2.5 T score severe osteoporosis: over -2.5 T score with one or more fraactures
Exercise focused on what components in osteoporosis
increasing bone and muscle strength and balance
What exercises indicated for osteoporosis with no fractures
resistance, aerobics, tai chi
What kind of strengthening exercise may indirectly reduce fall risk and fracture in osteoporosis
spinal extensors strengthening
impact exercise does a better job increasing BMD in pre or post menopausal women
pre
85-90% of adult bone mass acquired by what age in males and females
18 females, 20 males
Vertebroplasty versus kyphoplasty? (thoracic vertebral fracture)
vertebroplasty - cement injection in v-body that doesn't restore shape kyphoplasty - balloon injection to help restore shape/height of fx. bone
Due to the compensatory lumbar lordosis that is present in Schuermann's disease, there is an increased risk of what other pathology?
spondylolisthesis due to increased shear (from increased lordosis/sacrohorizontal angle)
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