Ortho 3 & 5 - Clinical Reasoning During Follow up Visits / Lumbar Classification

what are the steps of hypodeductive reasoning?

generate explanations, collect data, tests and measures, revise findings to strengthen or weaken hypothesis

confirmation bias

the tendency to search for information that supports your preexisting beliefs while dismissing contradictory evidence

premature closure

accepting a diagnosis too early, before its fully verified

anchoring

cognitive bias where you rely too much o the very first piece of information you see or hear when making a decision

structural diagnosis

disease/pathology centered diagnosis that identifies specific tissues at fault

functional diagnosis

diagnosis based upon the patients signs and symptoms and there by dictates treatment (PR, movement based diagnosis)

T/F: research suggests that treatments applied based on diagnosis syndromes/classifications to be superior to treatment based on tissue diagnosis

True

what is a classifcation system

symptoms and impairments related to body function are grouped into defined clusters

syndrome

collection of signs and symptoms, implies that a specific tissue diagnosis is not known. treatments typically match to specific syndromes

Clinical Prediction Rules

are used to describe the likelihood, presence or absence of a condition, assist in determining patient prognosis, and help the classification of patients for treatment

ICF classifications

create evidence base practice guidelines for management of pt’s w musculoskeletal impairments

CPG stands for

clinical practice guideline

CPG: Low back pain w related cognitive and affective tendencies

generalized pain

CPG: Low back pain with mobility deficits

Lumbar Degenerative Joint Disease/Facet Syndrome

CPG: Acute Low back pain and related (referred) lower extremity pain

lumbar disc disorder with LE referred pain

CPG: Low back pain with movement coordination impairments

lumabr instabilities

CPG: Acute low back pain with radiating pain

sciatica

CPG: Chronic low back pain with radiating pain

Spinal Stenosis

treatment based classification system

uses information from physical exam and patient self report of pain and disability to classify patients

extension syndrome

pt response positive to extension (centralization), and negatively to flexion (peripheralize)

flexion syndrome

pt has directional preference to flexion

lateralshift/asymmetric extension syndrome

directional preference with lateral translation movements of pelvis

What are the 5 indications that someone meets the CPR for lumbar region manipulation

<16 days since onset, Hypomobility PIVM/PAIVM, No pain below knee, FABQW <19, Hip IR >35

oswestry score

measures functional disability from low back pain

if a patient has 4 or more of the manipulation factors there is a ___ % success they will have a decrease in pain

95

TBC indications for stabilization

age under 40, SLR >91 degrees, + prone instability test, hypermobility with spring test, aberrant motions with flexion/extension (catching, looks guarded)

Gauers Sign

using hands to come up from standing flexion

TBC classification for traction

no directional preference on repeated movement exam, signs of nerve root compression, lateral shift that does not correct or centralize with repeated movement, symptoms relieved/decreased/centralize with manual/mechanical traction

derangement syndrome (McKenzie)

pt demonstrates directional preference in response to loading strategies and is typically associated with movement loss

Dysfunction syndrome

clinical presentation where symptoms are produced consistently and only at a limited end-range of movement. Indicates tissue issue

postural syndrome

clinical presentation where symptoms are produced only from prolonged static loading (sitting, slouching, for long periods of time)

movement impairment syndrome (MIS)

syndromes/classifications are descriptive of either the alignment, stress or movement direction that stimulates the pt’s pain

MIS treatment philosophy

retrain movement patterns through prescriptive exercise to lengthen shortened tissues and strengthen lengthened weakened tissues

Centrally mediated pain disorder

a chronic condition where the brain and spinal cord misinterpret or amplify pain signals due to a malfunction in the central nervous system

patient has centrally mediated pain disorder, what are some issues that might pop up in a history/eval?

yellow flag risk form score >55, elevated Start Back Screen, elevated OSPRO Score, increased FABQ

Pain Mechanism Classificaction System

classification based on data from Yellow Flag Screening Questionnaire and mechanical examination

peripheral mechanisms of pain

pain signals driven by the body from irritated tissues or a nerve.

central mechanisms of pain

refers to how the nervous system is processing pain.

nocioceptive inflammatory is a _____ mechanism of pain

peripheral

nocipceptive ishcemic is a ______ mechanism of pain

peripheral

central sensitization is a ______ mechanism of pain

central

afffective-emotional-referral is a ______ mechanism of pain

central

central sensitization

nervous system is amplifying pain and sensory systems, making the body hyper reactive to touch, light, sound, etc