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These curvatures found in the spine are known as kyphotic, or rather as “primary curves”
What are the Thoracic and Sacrococcygeal curvatures
The difference between referred pain and radiating pain is what?
Referred: Pain perceived at a location other than the site of the painful stimulus or source
Radiating: pain resulting from impingement or inflammation of the nerve root. Pain is burning, electric, or lancinating “like a vein”
The four Movement Coordination Deficits in relation to MSI can be described as…
Posture and alignment
Muscle force/length
Physical Activity
Faulty Movement Patterns
What muscles are tight/lengthened in extension syndrome?
Tight: Lumbar paraspinals, hip flexors
Lengthened: Abdominals
What are the normal attributes of bracing for abdominal recruitment?
Umbilicus does not move, lateral walls fill in (cylinder), Neutral pelvis/lumbar (back flat on table if in supine for example)
This structure transmits tension and bending forces from the posterior elements to the vertebral body
What is the pedicle
What are the McKenzie Classifications and describe each one
Postural: Pain at end range with SUSTAINED postures ONLY (time-dependent)
Dysfunction: Pain at end range with restriction of motion; central location
Derangement: More constant in nature, can be central or referred
Upon repeated movement testing, the pt’s outcomes are no better, no worse, and have had no effect. What do you do and how does this affect your treatment?
Keep going until either green or red light has been achieved. If green light is achieved then those motions become our treatment, whereas if red light is achieved then we must change our treatment approach.
What are the abnormal attributes of abdominal recruitment?
Rectus dominant (umbilicus “winks”), Posterior/Anterior tilt, ribs elevate/hollow, sides hollow, and lumbar extends
What muscles are tight/lengthened in flexion syndrome?
Tight: Abdominals, hip extensors
Lengthened: lumbar paraspinals
An increase of the lumbosacral angle will have what implications?
An increase of the lumbosacral angle will increase lordosis and anterior shear of L5 on S1. The compressive forces will also move towards the pars interarticularis, possible causing a stress fracture.
When observing a T2 MRI, which structures will be bright white? What is this better for looking at?
What is water and inflammation (pathology)
The three aspects of Improved Patient Outcomes are…
Individual Clinical Experience
Best Available Clinical Evidence
Patient’s Values and Expectations
What are the tests to confirm excessive extension within Movement Coordination Impairments?
Return from bending excessive lumbar extension, backward bending excessive lumbar extension, supine excessive lumbar extension, bilateral shoulder flexion excessive lumbar extension, prone hip extension excessive lumbar extension
What are the tests to confirm excessive flexion within Movement Coordination Impairments?
Abdominal bracing (Sahrmann), forward bend, seated excessive flexion, seated knee extension excessive lumbar flexion, unilateral hip flexion excessive lumbar flexion, and of course quadruped (rockback)
The posterior layer of the thoracolumbar fascia arises from the spinous and transverse processes to connect to what other structures?
What are the sacrum, PSIS, iliac crest, latissimus dorsi, and gluteus maximus
Reduced Forced Closure - what is it? Example of how this may happen.
Peripheral pain drive associated with excessive strain to sensitized SIJ/surrounding tissue secondary to ligamentous laxity
Commonly seen post-partum
Educational Messaging on LBP, what will you tell your pt?
The prognosis on LBP is good - most get better!
Modalities and OTC meds are good for short term but not long term recovery
Tissue injury does not always equal pain, pain does not mean damage, and pain can persist even with no tissue injury.
What conditions correspond to the following statements? I feel that my back pain is terrible and it’s never going to get any better? In general, I have not enjoyed all the things I used to enjoy.
What is catastrophizing and depression, respectively
What are the tests to confirm excessive rotation within Movement Coordination Impairments?
Gait, side bending, lumbar rotation, bent knee fall out, sidelying hip ABD/external rotation (clam shell), prone hip extension (looking for rotation)
Describe the following motions in detail: Nutation and Counternutation
Nutation = Sacrum glides inferior and posterior on innominate. Coccyx moves AWAY from the IT
Counternutation = sacrum glides anterior and superior on innominate. Coccyx moves CLOSER to the IT
Laslett Cluster - what are the 5 tests? Which test has the greatest Sn/Sp? What are the clinically significant results?
1. Distraction, Thigh Thrust, Gaenslen's (2x), Compression, and Sacral Thrust
2. Distraction = Sp and Thigh Thrust = Sn
3. 2/4 or 3/6 positive tests (3/6 is .3 better)
What are the three things we look for when observing respiration?
What are bucket handle, pump handle, and more abdomen than chest excursion
The key components of motivational interviewing are what?
Asking open ended questions
Providing affirmation to your pt
Reflection - understanding what the pt is thinking and feeling then saying it back to demonstrate active listening
Summary - a longer reflection of more than one client statement
These three questions help Physical Therapists determine the irritability of the pt...
How many activities aggravate it?
Does it affect your sleep at night?
When aggravated how long does it take to go back to baseline?