Anatomy
List the muscles that can cause a posterior rotation of the pelvis when the femur is fixed. Include the order that the muscles are most likely to be tight
Hamstrings, glutes (med, min), and external oblique
Describe the MMT grades for a trunk flexion test?
5: hands behind head
4: arms across chest
3+:arms at sides
3: arms at sides but scapula do not clear
Your patient has an upslip of the right inominant. How would you correct? They have a Hx of R ACL repair
Inferior thrust of the right inominant w/ hand placement on the iliac crest
What is the takeaway from the George article, "Fear: A Factor to Consider in Musculoskeletal Rehabilitation"?
Patients w/ lower level pain avoidance have a synchronous relationship between sensory and emotional reaction components.
If a HNP is bulging out of the entrance zone or pedicle what type of pain would it cause?
Radicular
Your patient is presenting w/ LBP and radiating pain down the leg. They present in side-bending to the right. You suspect a left sided HNP, where is the bulge in relation to the nerve root?
The bulge is lateral or superior to the nerve root.
What is referred pain?
pain perceived at a location other than the site of the painful stimulus or source; any innervated structure in the lumbar spine can cause referred pain, including muscles, ligaments, dura mater, facet joints, annulus fibrosis, fascia, and vertebrae
You notice tight hip flexors on your patient. They are 8/10 pain at resting. How would you lengthen them.
PIR in the thomas test position
What does the literature say about comparing DPM program to a strengthening/stabilizing program?(think pain and return to function)
Low quality evidence supports that DPM has better outcomes for intermediate-term function. No difference between intermediate and long term pain.
Your patient has pain at the inferior angle of the right scapula? They are coming to you Direct Access How would to proceed and why?
Refer to their PCP, referred pain from the gallbladder.
List the potential anatomical causes for central stenosis.
Hypertrophy of the ligamentum flavum, deformed uncovertebral processes, apophyseal joints.
!Your patient has a positive FABER (Patrick test). Can you rule in the SI joint? How would you know?
You cannot rule in the SI joint yet because it could still come from the hip. To rule in the SI joint retest w/ the sacral belt!!!!!!!!!!!
List the phasic muscles
Middle trap, lower trap, tib anterior, serratus anterior, peroneals, glutes, abdominals
In regards to core training, does the literature favor a global or local stabilization approach?
There is mixture of evidence for using one over the other, so as of right now either one is appropriate.
Which type of reasoning relies on social communication and building rapport w/ the patient?
Interactive reasoning
Your patient is coming to you post-op repair of a spondylolisthesis. What muscles will be weak?
Multifidi (up to 4 levels above or below), semispinales
Your patient is diagnosed w/ MSI extension syndrome. What are the potential pathoanatomical diagnoses?
A Scotty dog, spondylolysis, and stenosis
What are the parameters for high frequency TENS?
Pulse duration between 50 and 80 microseconds
Pulse frequencies of 100 to 150 pps
Continuous sensory level stimulation
Which method is more effective for abdominal activation? (Hollowing/Bracing)
Bracing activates obliques and rectus abdominis. Hollowing targets more transverse abdominis, pelvic floor.
What are the diagnostic tests you would use for extension sydrome?
Lumbar AROM (Return from flexion, extension)
Hip flexor length test
Supine position/shoulder flexion
Prone hip extension
Quadruped
Your patient is a truck driver. They report having numbness on the lateral thigh. What could be causing the numbness? (structure, nerve, nerve root)
Tight psoas compresses the lateral femoral cutaneous nerve. The lateral femoral cutaneous nerve is derived from roots L2 and L3
Do you use a Gillet test to rule in or out SIJ dysfunction?
Rule in this is a highly specific test
What are the absolute contraindications for joint manipulations?
VBI: 5D’s and 3N’s (includes Drop attacks or blackouts, Dizziness/vertigo, Diplopia, Dysarthira, dysphagia, nystagmus, nausea/vomiting, numbness of one side, ataxia/gait disturbance)
Hearing disturbances
Immediately post partum
Rheumatoid collagen necrosis
Psychogenic disorders
Malignancy of targeted area
Red flags including signs of neoplasm, fracture or systemic disturbance (i.e. long term steroid use)
Unstable upper cervical spine
Lack of practitioner ability
Spondylolisthesis
Gross foraminal encroachment
In the Rabin article, what are the two main criteria for patients who would benefit from a Lumbar Stabilization Exercise program?
1.Patients w/ low back pain and aberrant motions
2. Patients w/ a positive prone instability test
What is the most commonly used questionnaire for the female pelvic floor?
Queensland Female Pelvic Floor Questionnaire