definitions
Pain leads to redistribution between muscles (neuroplasticity), which changes mechanical behavior, which causes further central sensitization.
(pain will reoccur)
Recidivism
Which arthrokinematic dysfunction occurs in non-neutral (flexion or extension) where SB and rotation are to the same side?
Occurs at 1 level at a time, seen best in NWB, presenting with an FRS or ERS
type 2 dysfunction
tx with L/S gapping, positional distraction, mobs and manips, and METs
The common eval system/ terminology/ classification system/ treatment system for LBP.
doesn't exist lol
patho-anatomical
Most common in L4/L5 or L5/S1
starts with pain, then sensation loss, then motor loss. worse with sitting, bending, lifting (flexion) and better with standing, walking (extension).
presents with flattened back, antalgic stance, and a lateral shift. Shortened LE mm and weak abs/ back extensors. Abnl response in dermatomes, myotomes, and DTRs.
Lumbar radiculopathy
tx with repeated motions (usually extension), lateral shift correction, mm strengthening, improved postures, aerobic conditioning, and neural mobilization
Do not recommend imaging at this point
LBP classification systems
pathoanotomical, osteopathic, mvt system impairment approach, mechanical dx and tx (MDT), tx based, ICF based
which arthrokinematic dysfunction occurs in neutral, where SB and rotation are opposite each other?
often at 3+ levels and a compensation for hip issue, radiculopathy, LLD, etc
caused by SI/IS dysfxn, LLD, OA dysfunction, rib dysfunction, myofascial restriction, or another type of dysfunction superior or inferior to it
type 1 dysfunction, often scoliosis
tx with L/S gapping, positional distraction, and schroth
Spinal degeneration
Somatic dysfunction in the musculoskeletal system, treated via METs. Further classified as an FRS, ERS, or sacral torsion.
osteopathic
Pt < 40yo w h/o repeated motion, prolonged postures, MVA/fall, and a feeling of "catching" in spine
worse with prolonged posture and vigorous activity, better with support, rest, self manip, and aberrant motion
presents with hinging and angulations, juttering mvmt, increased ROM in affected spinal segment, spring testing reactive with increased mvmt. weak TA, IO, multifidus and short LE mm. may see a hypertrophic band
lumbar instability
tx with strengthening stabilizers and from nwb to wb to functional, improve FNP, improve biomechanics, perform abdominal drawing in progressions
What is it called when a disc degenerates and two levels fuse together via ossification of the anterior longitudinal ligament
DISH (diffuse idiopathic sclerotic hyperostosis)
Fryette's CONCEPTS of spinal motion
1: neutral/ type 1 = SB one way, rotate to opposite side
2: non-neutral/ type 2 = SB to one side, rotate to same side
3: motion introduced in one plane will decrease it in other planes
Causes of mechanical low back pain
muscle strain, HNP, OA, spinal stenosis, spondylolisthesis, scoliosis, etc
Irritation of myofascial, periarticular, or articular tissue. Treated via repeated mvmt and prolonged postures. Named for direction of alignment/ stress/ motion that causes symptoms. Goal is to decrease motion at the dysfunctional level by improving motion at the surrounding levels.
movement systems impairment
What is the difference between spondylolysis vs spondylolisthesis?
spondylolysis (stress fx in pars interarticularis, L5/S1, h/o hyperext w rot and loading, pain w rot and ext, better w flexion)
spondylolisthesis (degenerative, deterioration of facet joints and disc, canal narrowing and enlargement of arthritic facets cause nerve root compression)
spondylolisthesis (isthmic, must be bilateral and displaced, UMN signs when in spinal canal but more common in vertebral foramen w LMN signs)
BOTH spondylolisthesis types: hyperlordotic, present with a palpable step/ hypertrophic band/ angulation/ juttering
BOTH: tx with mm strengthening/endurance, surgery if necessary
Pain refers TO the lumbar spine from which joints?
SI joint and hip joint
What are the results of the FABQ that require further intervention?
Physical activity section > 14
Work items > 20 concern, > 22 and not working = risk of chronicity, > 29 and working = current chronicity
What is the difference between foraminal and canal spinal stenosis?
foraminal: narrowing at nerve roots, symptoms in a dermatome and unilateral
canal: narrowing at spinal cord, symptoms in multiple dermatomes and bilateral
McKenzie, patient controls forces on their own as much as possible without PT force input
mechanical diagnosis and treatment
caused by metabolic or pathological issues, 50 yo or older, h/o corticosteroid use or substance abuse
CPR: prolonged corticosteroid use, trauma, >70yo, female (3 of these is a knockout)
local pain that does not radiate, worse with weight bearing, better with sitting (especially reclining). presents with increased kyphosis, decreased and painful extension, and weak mm
Compression fracture (instability)
tx by improving posture and biomechanics and strengthening mm to improve stability and functional mobility
When do we use directional preference?
for radiating and referring symptoms (radiculopathies)
acute and subacute LBP w mobility deficits
acute, sub, and chronic LBP w mvmt coordination impairments
acute LBP with referred LE pain
acute, sub, and chronic LBP w radiating pain
acute or sub LBP w related cognitive or affective tendencies
chronic LBP w related generalized pain
ICF based classification system subsets
which outcome measure is this:
higher score = higher dysfunction
sections include pain intensity, personal care, lifting, walking, sitting, standing, sleeping, social life, traveling, and employment/homemaking
The oswestry scale
treatment based classification
flexed posture, h/o hypomobility or hypermobility, weak mm
differential dx: vascular claudication and neurogenic claudication
spinal stenosis
tx: flexion based exercise to open spinal canal and foramen, stretching, strengthening, aerobic fitness, PNE