ICF
What are the six LBP ICF classifications?
LBP with mobility deficits, movement coordination impairments, referred pain, radiating pain, related cognitive or affective tendencies, and related generalized pain
How do you determine the direction of the patient’s treatment exercises?
Repeated movements testing; whichever movement centralizes/decreases/abolishes pain
What is the difference between source and cause?
Source is the pathoanatomical structure that is symptomatic and cause is the mechanical factor (movement) that results in symptoms
What does SINSS stand for?
Severity, irritability, nature, stage and stability
Describe diagnostic, narrative, and interactive reasoning.
Diagnostic → basically 724, forming the PT Dx
Narrative → the pt’s story, subjective Hx
Interactive → building block for trust, small talk
What is a common cause of LBP with mobility deficits?
Unguarded/awkward movement or position
What are the 3 syndromes?
Derangement, dysfunction, and posture
Name 3 factors that are associated with motor coordination deficits.
Posture, alignment, muscle length, muscle strength, faulty movement patterns, hobbies/occupation
What is the STarT Back Screening Tool used for?
Identifying psychosocial risk factors
What are the CPI areas that Manny said an entry-level DPT needs to meet?
Professional practice - safety, professional practice - professional behavior, professional practice - accountability, professional practice - communication, and patient management - clinical reasoning
How can you differentiate between referred and radiating pain in the subjective history?
Ask if the patient could trace the pain with a line. If they can = radiating, if they can’t = referred
Often below the knee with radiating
Numbness tingling → radiating not referred
How do you progress force during treatment?
AROM → patient generated overpressure → therapist generated overpressure → therapist mobilization → therapist manipulation
Describe the path of instantaneous center of rotation.
The most optimal point for the joint and for the muscles to work, the constant axis of rotation/motion. It can be used as an index of functional status of the movement system.
Describe the 3 pain mechanisms and give an example of each.
Nociceptive → activation of nociceptors, mechanical, (ankle sprain, OA)
Nociplastic → disturbance in central pain processing (nonspecific LBP, fibromyalgia)
Neuropathic → lesion of the somatosensory system (diabetic neuropathy, carpal tunnel syndrome)
Your patient tells you that the orthopedist told them that they have a “pinched nerve” and it’s making your patient really nervous. Pretend Ben is your patient and re-word the diagnosis in patient-friendly language.
Mechanical responder, irritated, etc.
A patient presents with low back, buttock, thigh, and leg pain. Pain is worsened with flexion and sitting. Patient has reduced lumbar lordosis and limited lumbar extension. Pain is centralized with repeated movements. Which ICF classification would this patient fall into?
LBP with referred pain
Which syndrome presents with no deformity and a fixed pain pattern?
Dysfunction
A patient has LBP when putting her hair into a high ponytail while sitting at her vanity. You ask her to show you how she does her hair and you notice excessive lumbar extension. How can you perform a corrected/secondary test to confirm that lumbar extension is the faulty movement?
Have the patient do her hair while sitting in a chair, but put focus on posterior pelvic tilt/keeping the low back pressed against the chair. If the pain goes away then the test is positive.
Describe the 2 levels of triage involved in treatment-based care of LBP.
Triage by first-contact health provider to determine the appropriate medical management (medical, rehab, self-care)
Triage by rehab provider to determine the appropriate rehab approach (symptom modulation, movement control, functional optimization)
Name 3 phasic muscles.
Peroneals, anterior tibialis, glutes, abdominals, serratus anterior, mid/lower trap, DNF
A patient presents with LBP and referred LE pain at rest (3/10). Patient rates pain as a 6/10 with mid-range extension and 3/10 at end-range extension. Patient tolerates the Sorenson Test for 5 seconds. CPAs show hypermobility at L1-L3 and hypomobility at T11-T12. Which ICF classification would this patient fall into?
LBP with movement coordination impairments
What are the updated McKenzie classifications for derangement syndrome and which is the least favorable?
Central/symmetrical, unilateral/asymmetrical to knee and unilateral/asymmetrical below knee
What are the 3 components of treatment according to MSI?
Contributing factors/impairments, proper movement and education on prevention
A patient presents with LBP (Best 5/10 worst 9/10 current 7/10) 1 week s/p MVA. Patient reportst that the pain is now “achy and annoying” at rest, and is aggravated by movement in any direction. Patient says there isn’t anything that makes the pain better and they aren’t sleeping through the night so they’ve been taking medication to fall asleep. Patient notes that the pain “hasn’t really changed since the accident” and has never had back pain before. What is the SINSS?
S → moderate
I → max
N → nociceptive
S → acute
S → staying the same
Name 5 tonic muscles.
Gastrocnemius, ADDs, hamstrings, hip flexors, piriformis, erector spinae, QL, pecs, upper trap, levator scap, SCM, scalenes, suboccipitals