chap 4b- lumbar mobility deficits

What are common signs of Lumbar Mobility Deficits?

Low back pain with or without leg pain that does not travel beyond the knee, limited active lumbar spine mobility, hypomobility with passive lumbar segmental motion testing, and myofascial restrictions with muscle guarding.

What is thrust manipulation?

High velocity, low amplitude therapeutic movements within or at the end range of motion.

What does the 2022 ICF clinical practice guideline recommend for patients with LBP and mobility deficits?

A-level research supports thrust joint manipulation and non-thrust joint mobilization to improve spine and hip mobility and reduce pain and disability.

What is the purpose of passive segmental mobility testing?

To assess passive accessory intervertebral motion (PIVM) and as a mobilization treatment.

What is the validity of manual examination in lumbar mobility deficits?

Patients with passive lumbar hypomobility respond favorably to spinal manipulation; those with hypermobility respond favorably to stabilization exercises.

What factors should be considered in the impairment-based approach for lumbar mobility deficits?

Patient interview, diagnostic classification, patient expectations, screening for red flags, and assessing muscle tone and segmental pain.

What is the role of clinical reasoning in treating lumbar mobility deficits?

To select manipulation techniques based on patient expectations, direction of AROM mobility deficit, and surrounding impairments.

What are absolute contraindications to manipulation and mobilization?

Lack of indications, unstable fractures, bone tumors, infectious diseases, worsening neurological function, and severe non-mechanical pain.

What are relative contraindications to manipulation and mobilization?

Osteoporosis, herniated disc with radiculopathy, signs of spinal instability, pregnancy, and long-term steroid use.

What is the best treatment combination for a patient with right-sided LBP and limited AROM with lumbar right rotation?

Right rotation thrust manipulation in left sidelying position targeted at the L4-L5 spinal segment and hooklying lower trunk rotation exercises.

What is the significance of AROM changes in relation to pain?

Changes in active ROM and pain are predictive of longer-term changes but must be linked to functional impairments.

What is the importance of targeting specific directions in manipulation techniques?

The manipulation technique must target the specific direction of the mobility deficit for effectiveness.

What does the Gillet's marching test assess?

Mobility deficit in the lumbosacral region. look at them marching and see if pt is limited.

What is the Lumbosacral Lift Manipulation used for?

To address right-sided pain/tension with right lumbopelvic rotation mobility deficit.

what are the absolute contraindications to MNP?

Lack of indicationsPoor integrity of ligamentous or bony structures from recent injury or disease process- Unstable fracture- Bone tumors- Infectious disease• Osteomyelitis• Multi-level nerve root pathology• Worsening neurological function• Unremitting, severe, non-mechanical pain• Unremitting night pain• Upper motor neuron lesions• Spinal cord damage

what are the precautions to MNP

Osteoporosis • Herniated disc with radiculopathy • Signs of spinal instability • Pregnancy • Local infection • Inflammatory disease • Active cancer • History of cancer • Long-term steroid use • Systemically unwell • Hypermobility syndromes • Connective tissue disease • A first sudden episode before age 18 or after age 55 • Recent manipulation by another health professional

If a patient with right sided LBP presents with pain and limited AROM with lumbar right rotation, pain provocation with hypomobility at L4L5 PAIVM test, and muscle guarding at the right lower lumbar paraspinal muscles, which of the following would be the best combination of treatments to address these impairments? • A. Left rotation thrust manipulation in right sidelying position targeted at the L45 spinal segment and hooklying lower trunk rotation exercises • B. Right rotation thrust manipulation in left sidelying position targeted at the L45 spinal segment and hooklying lower trunk rotation exercises • C. Lumbosacral lift thrust manipulation and knee to chest exercises in supine • D. Right anterior torsion SIJ manipulation

b

What is the significance of muscle guarding in lumbar mobility deficits?

Muscle guarding indicates underlying issues that may affect mobility and pain levels.

What is the expected outcome of thrust manipulation for lumbar mobility deficits?

Improvement in spine and hip mobility, and reduction in pain and disability.

What is the relationship between segmental mobility and pain provocation?

Determining spinal segment and direction of hypomobility is crucial for effective intervention.

What is the impact of functional mobility deficits on treatment?

Functional mobility deficits must be assessed to tailor effective treatment strategies.

What is the best treatment for low back pain (LBP) with mobility deficits?

Mobilization/manipulation techniques targeting specific mobility deficits, along with exercises to encourage spinal mobility.

why is SI joint more common in females?

Smaller joint surface◼ Flatter and smoother joint surfaces◼ SIJ mechanical disadvantage in female- further from hip and line of gravity- more torque on SIJ due to longer lever arm◼ Hormonal changes◼ Childbirth strains◼ Intercourse strains

What are the diagnostic criteria for a painful sacroiliac joint (SIJ)?

Three of five positive SIJ provocation tests are required, tested against a double SIJ anesthetic and cortisone injection.

List the five SIJ provocation tests.

1. Anterior superior iliac spine (ASIS) distraction, 2. Thigh thrust, 3. Gaenslen's test, 4. ASIS compression, 5. Sacral thrust.

What is the sensitivity and specificity of the thigh thrust test for SIJ pain?

Sensitivity of 0.36 and specificity of 0.50.

What does a positive test cluster of SIJ provocation tests indicate?

A 35% certainty that SIJ is the source of pain.

What does a negative test cluster of SIJ provocation tests indicate?

A 92% certainty to rule out SIJ as the source of LBP.

What is sacroiliac arthralgia?

Pain and sensitivity localized to the SIJ, often with muscle guarding and positive provocation tests.

what is the cause of sacroiliac arthralgia

direct or indirect trauma to jt

What are the common treatment approaches for sacroiliac arthralgia?

Rest, support, soft tissue techniques, and treatment of surrounding dysfunctions.

What is the significance of Laslett's diagnostic criteria?

It helps differentiate SIJ-related conditions as a cause of LBP.

When is the SIJ most likely NOT the source of a patient's low back pain?

A: When only one SIJ provocation test is positive (a cluster is required to implicate the SIJ)

Q: What does one positive SIJ provocation test indicate?

A: SIJ is unlikely the primary pain source

what is the cause of SIJ-related pain with movement coordination impairments

Cause • Repetitive minor trauma • Childbirth strains • History of trauma • Hypermobility • Loss of motor control

what are the s/s of SIJ related pain w/ mov coordination

Dull ache on assuming a fixed posture often radiates to posterior thigh • Periodic joint displacement or subluxation • Hypermobile with motion assessment • Positive provocation testing • Positive Active SLR test

what is the treatment for SIJ-related pain with movement coordination impairments

SI belt• Anti-inflammatory and anti-sensitivity treatment• Treat surrounding joint dysfunctions and mmimbalances• Fusion/sclerosis

What is the role of manual transport of loads in SIJ pain prevalence in women?

Women may experience more SIJ pain due to the mechanics of manual transport and the associated strains.

What is the impact of hormonal changes on SIJ-related pain in females?

Hormonal changes can contribute to increased laxity and strain on the SIJ.

Q: What does the Active Straight Leg Raise (ASLR) test assess in patients with suspected SIJ-related pain?

A: It differentiates posterior pelvic/SIJ pain due to pelvic instability caused by insufficient anterior (transversus abdominis) or posterior (multifidus) muscular support

Q: A positive ASLR test suggests what impairment?

A: Impaired load transfer and pelvic instability (TrA and/or multifidus dysfunction)

what should you see with pelvic compression belts

immediate effects even if it is good or bad

What is the significance of Cook et al.'s study on early changes in pain intensity?

It explores whether within-session changes predict long-term improvements in patients receiving manual therapy.

What is the expected outcome of thrust manipulation versus non-thrust manipulation?

The study compares the effectiveness of both techniques in treating LBP.

What are the common symptoms of sacroiliac joint-related pain?

Localized pain, sensitivity, and muscle guarding in the lumbar/thoracic region.

What is the significance of the study by Dreyfuss et al. regarding SIJ pain diagnosis?

It evaluates the value of medical history and physical examination in diagnosing SIJ pain.

What are the implications of a positive likelihood ratio in SIJ testing?

It indicates a higher probability that the SIJ is the source of pain.

What is the role of the American Physical Therapy Association in LBP management?

They provide clinical practice guidelines linked to the international classification of functioning and health.

What is the main focus of the 2021 revision of interventions for LBP management?

To update clinical practice guidelines for managing acute and chronic low back pain.

What is the purpose of the sacroiliac joint provocation tests?

To assess the presence of SIJ-related pain and dysfunction.

What factors contribute to the mechanical disadvantage of the SIJ in females?

The joint's distance from the hip and line of gravity, leading to more torque.

What is the expected outcome of using thrust manipulation in LBP treatment?

To achieve short-term improvement in patients with low back pain.

What does the term 'mobility deficits' refer to in the context of LBP?

Limitations in the range of motion or movement capabilities in the spine.

What is the significance of having only one positive SIJ provocation test?

It suggests that the SIJ is most likely not the source of the patient's pain.

What is the role of the pelvis in load transference?

The pelvis transfers loads from the trunk to the lower extremities and vice versa.

What evidence supports the use of pelvic compression belts?

Moderate evidence suggests they decrease laxity of the SIJ, alter lumbopelvic kinematics, and reduce pain.

What was the finding of Beales et al. regarding pelvic compression belts?

Application of pelvic compression belts resulted in varied EMG activity in trunk muscles among patients with chronic pelvic girdle pain.

What is dynamic stabilization in the context of pelvic instability?

An exercise program targeting the multifidus and transversus abdominis muscles to enhance pelvic stability.

what is the cause of SIJ-related pain with mobility deficits?

hypermobile jt overrides articular prominence, trauma to jt and surrounding tissues, and muscle holding

What are the signs and symptoms of SIJ-related pain with mobility deficits?

Raised or lowered iliac crest, restricted lumbopelvic motion, and positive provocation tests.

What is the recommended treatment for SIJ-related pain with mobility deficits?

Manipulation of lumbosacral and SIJ structures, addressing motor control issues, and treating impairments of the hip and lumbar spine.

What is the most likely diagnosis for a patient with right-sided lumbosacral pain after a fall and positive SIJ tests?

C. SIJ-related pain with mobility deficits.

If a 25 year old female patient presents with a 4 week history of right sided lumbosacral area pain that is started after she slipped on the ice and landed on her right ischial tuberosity, and demonstrates a positive Gillet's marching test, mobility deficit with SIJ gapping, and pain provocation with the thigh thrust and ASIS compression/distraction tests, which of the following is the most likely diagnosis? • A. SIJ-related pain with movement coordination impairments • B. SIJ-related pain/arthralgia • C. SIJ-related pain with mobility deficits • D. LBP with mobility deficits

c

What is the relationship between SIJ conditions and gender?

Painful SIJ conditions are more common in women during their childbearing years or with direct trauma to the pelvis.

What is the importance of assessing SIJ for low back pain?

The SIJ is a potential source of low back pain and must be assessed for pain provocation and mobility deficits.

What does the term 'myalgia' refer to in the context of SIJ-related pain?

Muscle pain that may contribute to conditions like left patellofemoral knee pain.

What is the significance of monitoring patient response to pelvic compression belts?

Not all patients with pelvic girdle pain will respond the same; close monitoring is essential.

What are the implications of hypermobility in SIJ-related pain?

Hypermobility can lead to joint instability and pain, often requiring targeted stabilization exercises.

What is the role of manual therapy in treating SIJ conditions?

Manual therapy is used to address impairments in the lumbopelvic region and hips.

What are the key components of a plan of care for SIJ-related pain?

Joint mobilization, soft tissue mobilization, ROM exercises, and strengthening exercises for core and lower extremities.

What is the purpose of the Lower Extremity Functional Scale (LEFS)?

To assess functional limitations in patients with lower extremity conditions.

What does a positive Gillet's marching test indicate?

It suggests potential dysfunction or pain in the SIJ.

What is the significance of the ASLR test in pelvic pain assessment?

It helps identify stability issues in the pelvis related to muscle function.

What are the common treatment goals for patients with SIJ-related pain?

To restore mobility, reduce pain, and improve functional stability.