MISC of course
the back's red flags
all the spondys
referring and radiating
extra special tests
more miscellaneous because i can't think of other categories
classifications of LBP
more random things (of course)
get centralized
Exercise!
100

how can you test for centralization/peripheralization

repeated movements

sustained postures

traction (manual or mechanical)

100
abdominal aortic aneurysm - what is it and what are the risk factors

widening/bulging of the abdominal aorta

risk factors: >60 years old, men > women, history of cardiovascular disease, history of smoking

signs and symptoms: LBP, abdominal pain, pulsatile mass near umbilicus (ie belly button pulse)

death may occur quickly with rupture

100

what is spondylosis

spinal degeneration of vertebrae and disks, often involving arthritis

100

how do you know when leg pain is more likely radicular?

when accompanied by signs of conduction loss (myotomal weakness, dermatomal sensation change, hyporeflexia) and stretch intolerance (+SLR, +slump, +Elys) AND
radicular symptoms are below the knee (95% SENS)

100

what is this special test used for and what is a positive test

used for lumbar spine instability

positive test would be pain or 'heaviness' in the low back (symptoms should reside when legs are set back down)

84% SENS, 90% SPEC

100

why do we perform muscle endurance testing of the trunk

LBP may be more common in individuals with low lumbar endurance

strong correlation between trunk muscle endurance and back "health"

100

what would be typical in a pt with severe acute LBP

high level of pain (>7/10), irritability, and disability

may have no directional preference (ie movement in all directions is painful)

may have hypomobility but too irritable to manip/mob to increase movement (you can still do it for pain modulation tho)

may have hypermobility, but too irritable for intense exercise

100

what type of mattress should someone with LBP use

medium-firm mattress promotes comfort, sleep quality, and spinal alignment

BUT

depends on the pt, recommend trial in putting board under mattress to firm it up or trying softer bed/couch and seeing how that fares

100

what are the exercises you can use for someone who centralizes with extension

prone: props or press ups

standing: back bends

quadruped: camel or forward rocking into press up

additionally, you can do manual therapy to increase the extension or the pt can use a strap/pillowcase/fingers to create a fulcrum on their back

100

what is stability

controlled stiffness/rigidity

it is also a result of coordinated, properly sequenced muscle activity that controls vertebral movement while maintaining adequate spine stiffness

200

what is symptom onset like for LBP typically

onset is idiopathic with most LBP

there are likely contributory lifestyle factors such as sedentary behavior

200

what is cauda equina syndrome 

due to compression of multiple lumbosacral nerve roots below conus medularis

sources of compression can include large central disc herniation, tumor, and spondylolisthesis

pts not treated in 48 hours of symptom onset have significantly poorer outcomes, including chronic incontinence

200

what is the pars interarticularis

bone bridge between inferior and superior articular surfaces of a single vertebra

200

what is the purpose of the SLR test

used to ID L-spine disc pathology or nerve root irritation

tenses lumbosacral nerve roots (primarily L4-S2), sciatic nerve, and branches

200

what is this special test used for and how do you perform it

this is used for SIJ instability

pt supine, performs 6 inch SLR; if painful, stabilize pelvis and have pt repeat SLR

positive test = decreased pain with stabilization

87% SENS; 94% SPEC

200

what do you do with pts who do not improve at all despite treatment for 2-4 weeks

additional examination!:

is there something important you overlooked

is there a disconnect between pts goals the PT's POC

is the pt continuing to micro-traumatize injured tissue

is there an underlying systemic pathology

200

what treatments should you prioritize in pts with chronic LBP

exercise including: trunk muscle strengthening and endurance, multimodal exercise interventions, specific trunk muscle activation exercise, aerobic exercise, aquatic exercise, general exercise

manual therapy: joint mobs and manips, soft tissue mobs, dry needling maybe, neural mobilization

pain neuroscience education

psychosocial intervention

200

how is LBP like the common cold

both are ubiquitous - part of the human experience

there are steps a person can take to reduce their risk, but some individuals are more susceptible than others

both tend to resolve over time (regardless of treatment)

there are multiple symptom remedies available

some individuals over react

200

what exercises can you do for someone who centralizes with flexion

supine knees to chest

posterior pelvic tilt

quadruped rocking (childs pose)

sidelying knee to chest

sitting flexion

(also adding lumbar rotation may improve symptoms further by increasing IV foramen diameter)

200

what are the spine stabilizing components

passive: vertebrae, IVDs, ligaments

active: neuromuscular control

300

what is stenosis and what are the clinical findings associated with it

narrowing that can occur in the central neural canal (central stenosis) or lateral foramen (lateral foraminal stenosis)

clinical findings:

>48 years old

bilateral symptoms

leg pain>back pain

pain with walking/standing

pain relief with sitting

300
signs and symptoms of cauda equina syndrome

history of LBP (94% SENS)

rapid onset of symptoms within 24 hours (90% SENS)

urinary retention (90% SENS)

sacral sensation loss aka saddle anesthesia (85% SENS)

loss of sphincter tone (80% SENS)

fecal incontinence

gait disturbance

300

what is spondylolysis

unilateral or bilateral fracture in the pars interarticularis

90% occur at L5

can be caused by:

overuse/traumatic: occurs in younger individuals, common with forceful flexion/extension, rotation to immature skeleton OR

degeneration: occurs in older individuals as a progression from spondylosis

300

at what degree range will concordant radiating symptoms likely occur when doing a SLR test

when hip is flexed between 30 and 70 degrees (with knee extended)

SENS 91%: thus negative SLR strongly rules out a L-spine disc herniation

300

what are the special tests used for SI joint pain/instability

pelvic instability test (aka active SLR test)

thigh thrust test (used to distinguish between pelvic girdle pain and LBP)

Gaenslen's test

SIJ compression test

SIJ distraction test

(maybe sacral thrust and maybe FABER)


300

when classifying someone into chronic LBP without generalized pain, what is the treatment approach generally

moderate to high intensity exercise

300

when should you do neural mobilization techniques and what are the two techniques often used

when radiating symptoms are non-irritable

you can do nerve sliding and nerve tensioning

300

what type of training is just 1 set of exercises normally good enough for

strength training for chronic LBP

300

what to do if someone has a lateral shift

address this before doing flexion/extension for centralization

can either do manual or have pt lean against the wall

when doing manual, pressure on, then release pressure by about 50%

go slowly and be patient

300

what are the mechanisms by which spinal stability is achieved

muscular compression/constraint

intra-abdominal pressure: decrease abdominal cavity volume leads to increased abdominal pressure; this can increase trunk stiffness by about 40%

400

what are some important SRMs for LBP

Oswestry Disability Index (ODI)

Roland-Morris Disability Questionnaire (RMDQ)

STarT Back Screening Tool (SBST)

400

what is myelopathy

spinal cord compression that is due to degenerative stenosis , degenerative or traumatic spondylolisthesis, posterior IVD herniation, tumor

symptoms tend to be more neurologic over pain and include sticky gait, balance difficulties, non-dermatomal sensory loss, urinary dysfunction, UMN signs (hyperreflexia, primitive reflexes like Babinski and clonus; LE weakness)

usually occurs after age 50

not very common in the lumbar spine

400

what is spondylolisthesis

forward slippage of superior vertebra on inferior vertebra

occurs only with bilateral spondylolysis 


400

what strongly rules in a L-spine disc herniation

positive crossed SLR

400
how to determine if the pain is coming from the SIJ

practitioner must focus on the history, location of pain, and SIJ provocative maneuvers

if pt exhibits > or equal to 3 provocative maneuvers, then the SIJ may be considered as a possible source of pain

400

when classifying someone into chronic LBP with generalized pain, what is the treatment approach generally

progressive, low-intensity, submaximal fitness and endurance activities along with pain management and health promotion strategies

400

what is the purpose of treatment with subacute back pain

shift from "making the pt better" to preventing chronicity and recurrence

address strength/endurance/flexibility impairments

address functional limitations

400

what is one concern about the McKenzie method

it might increase risk of kinesiophobia

pts may become over fearful of flexing or extending

400

what is centralization strongly associated with in terms of pathoanatomical findings

centralization is strongly associated with discogenic pain and predictive of intact annulus

centralization is also predictive of high non-operative success

400

what is abdominal hollowing 

pull abs in towards your spine as you exhale

has been shown to be ineffective for stabilizing spine after sudden perturbation

500

when might a leg length difference be relevant to a pts LBP

if:
LBP increases while weightbearing AND
LBP decreases while non-weightbearing

500

colon cancer what do you know about it

3rd most common cancer

usually occurs after age 50

red flags include blood in stool, pain unchanged by position or movement, pain >1 month, unexplained rapid weight loss, history of colon cancer in immediate family, smoker (?)

500

signs and symptoms of degenerative spondylolisthesis 

tend to have focal LBP

pain may improve with lying down since this stabilizes the spine

walking may intensity pain due to lumbar spine movement

(slippage of vertebrae can cause spinal nerve root, nerve root compression (radiculopathy) or central cord compression (myelopathy)

500

where do disc herniations most commonly occur

at L4-L5 and L5-S1

500

what special test can be used to test for piriformis syndrome and how is it performed

FAIR test

pt sidelying with involved LE on top; position pts hip in 90 flexion, adduction, and IR

stabilize pelvis and press down on lateral knee to increase IR and adduction

positive = concordant pain in middle of piriformis or pain shooting down posterior thigh and leg (Frieburg sign)

88% SENS, 83% SPEC

500

what is recommended in the treatment of pts with acute LBP

reassure them

advise to return to normal activities (find out what exercises/movements they are most likely to do)

discourage bed rest

use NSAIDs and weak opioids for short periods

consider manipulation

maybe try lumbosacral corset transiently

try superficial heat for pain relief, improving muscular strength and flexibility

try TENS

refer to specialist if no improvement within 4 weeks

no mention of exercise

500

what patients are most appropriate for manipulation

mechanical LBP

mobility limitations

EROM pain

agreeable to manipulation

no/low fear avoidance beliefs

no/low irritability

no radicular or myelopathic symptoms

no contraindications

500

is sitting back for your back

it has been shown that sitting for 1-7 hours per day for 5 days is associated with immediate increases in LBP in people with and without a history of LBP

prolonged sitting time and prolonged driving time are significant risk factors of LBP among adults BUT

important for clinicians not to perpetuate worry that sitting down for more than 30 minutes in one position is dangerous or should always be avoided

500

for pts that centralize with flexion, how can you help increase walking tolerance

stretch hip flexors to increase hip extension

use overhead unloading system/alterG/pool

500

what is abdominal bracing

tense your entire trunk, without drawing in or pushing out

has been shown to provide greater stability than hollowing with minimal increases in spine compression

actively stabilizes the trunk and decreases L-spine displacement after perturbation

600

what is piriformis syndrome and what are the signs and symptoms

pain from inflamed or irritated piriformis muscle; may compress sciatic nerve and cause radiating pain

usually due to trauma, overuse, or anatomic anomalies

S&S: deep gluteal pain and TTP that may radiate down posterior thigh; + FAIR test

600

signs and symptoms of ureter infection, blockage, or injury

posterior pain typically located near costovertebral angle

may radiate into lower abdomen, upper thigh, groin, and genital region

can be excruciating

may have fever, malaise, etc with infection

600

what is retrolisthesis

backward slippage of superior vertebra on inferior vertebra

occurs after bilateral spondylolysis

usually at L5-S1 or L4-L5

less common

600

what are the lower leg dermatomes and myotomes

600

what does radicular pain that does not centralize suggest

poor prognosis with non-surgical treatment

consider lumbar traction, and if they don't respond to this, consider PCP referral

600

what are the 2 typical pt profiles for those with radiating symptoms that centralize

pts who centralize with extension or lateral flexion tend to be 30-50 years old and often have sxs of IVD pathology

pts who centralize with flexion tend to be >50 years old and often have degenerative or stenotic spinal conditions

600

for exercises for chronic LBP, what are the positive outcomes likely from

non-specific effects related to movement/activity like pain gating, release of endogenous opiates, or psychosocial factors such as decreased movement-related fear, increased confidence, etc
600

should you do traction for pts with radicular symptoms?

research has shown that traction has little or no impact on pain intensity, functional status, global improvement, and return to work among people with LBP but you should base your reasoning on current evidence

600

what does manipulation do

neurophysiologic mechanisms: decrease pain via "gate control", reflexive alteration of muscle activity; serotonin release

somewhat treatment expectations and placebo

600

what is important to remember about exercises for specific muscles for LBP

no one muscle is though to contribute more than 30% to lumbar spine stability, any muscle that increases spinal stiffness contributes to spine stability THUS

we should focus on training motor patterns that involve the contribution of many lumbar spine stabilizers because focusing on a single muscle, or only a few, appears to be a misdirected clinical effort if the goal is to ensure a stable spine

700

what value of newtons puts the spine at risk of spine injury

>3300 N increases risk of spine injury

700

what exercises have the highest EMG for glute med and glute max

glute med: sidelying hip abduction

glute max: single limb squat and single limb deadlift

700

what are good exercises for glute max (which has been proven to be weak and fatigable with chronic LBP)

single leg squat

single leg deadlift

supine leg supine bridging

single leg extension in quadruped

700

what two trunk flexor exercises provide high levels of oblique activity while producing low levels of spine compression

abdominal curls with torso rotation

hanging SLR to 90 degrees hip flexion

700

compare muscle activation and shear forces in sit ups with knees bent vs knees straight

psoas activity higher during hip-flexed sit up vs extended position

rectus abdominis torque same in both positions

compression and shear higher during hip flexed sit up

700

what is the cost of exercise

compressive and shear stress

700

overall, what do you do for someone with LBP

base POC on exam findings and current best available evidence

be encouraging, optimistic, and positive

educate
refrain from stoking fear

strike a careful balance between providing palliative interventions and promoting physical activity

carefully guide recovery with an emphasis on preventing recurrence and chronicity


700

benefits of exercise for LBP

decreased pain

increased self-efficacy

increased function

improved quality of life

reduced likelihood of long term disability

M
e
n
u