Anatomy
A pt w a herniation lateral to the nerve root would present with a lateral shift towards or away from the side of pain?
Lateral shift away
Correction of excessive pelvic transverse plane motion during gait and quadruped rock back decrease LBP. Other exams in the frontal and sagittal planes were unremarkable. What is the MSI syndrome?
a. extension
b. flexion
c. rotation
d. sidebending
c. rotation
Explain the subcategories of McKenzie and how to treat them.
Postural, dysfunction, derangement
(see chart)
T or F: nerve root pain follows a dermatomal distribution
False
(see image)
How high is the prevalence of serious pathology in patients presenting to healthcare settings with LBP?
Henschke (2007) Prevalence of malignancy ranged from 0.1-3.5% (settings: primary care, emergency care, and secondary referral center)
Downie (2013) Fx and malignancy are most common serious pathos that can present as LBP
Spondylolisthesis is associated with a fracture of what specific structure?
Pars intraarticularis
What 2 non-SIJ exams are performed in Laslett’s cohort?
a. Hodges ADIM and McKenzies exam
b. Maitlands exam and McGills bracing
c. McGills bracing and hip joint assessment
d. McKenzies exam and hip joint assessment
D. McKenzies exam and hip joint assessment
Explain how to name each lumbar spine MSI classification.
Named for the direction that causes pain.
(see chart)
Pt has an erect lordotic posture. Pain does NOT centralize with McKenzie repeated motions. Has 4/5 (+) tests on the Laslett cluster and a (-) ASLR. What is going on and how will you educate/treat this pt?
Excessive force closure
Treatment: relaxation techniques (diaphragmatic breathing), train them how to deactivate their abdominals when necessary
Edu: these patients typically believe that their pelvis is "unstable"
True or False: According to the findings from Downie (2013), given the presence of any one red flag, you should immediately refer your patient for imaging
False
Describe the artho and osteokinematics of sacral nutation
Arthrokinematics: short vertical arm of sacrum glides inferior on short arms of innominate, long horizontal arm of sacrum glides posterior on long arms of innominate
Osteokinematics: sacral base moves ant and inf; sacral apex moves post and sup
A female collegiate lacrosse player’s lumbar motion hinges at L3/4. Abdominal bracing OR hollowing does not change her radiating leg pain while picking balls, and with overhead catches (baseline pain 8/10). What is MOST appropriate treatment if her infra-sternal angle was 100 and the STarT back tool reveals a score of 7/9 (bothersome-ness, fear & anxiety but no depression)?
a. Abdominal curls to develop a 6 pack rectus abdominis
b. Engaging IO w gait and squats
c. Quadruped position while diaphragmatic breathing
d. Quad rockback engaging EO
c. Quadruped position while diaphragmatic breathing
McKenzie exam: Repeated motions testing into flexion consistently produces pain at a consistent end-range. Symptoms do not worsen or change location. Name the syndrome!
Flexion dysfunction
Walk through a pelvic exam. (What do you want to rule out? Order of testing/special tests?)
History
Rule out lumbar spine (repeated motion) and hip (assessment - FABER, ROM)
Laslett cluster
(see image for algorithm)
True or False: According to Henschke (2007), failure to improve after 1 month has high predictive validity when screening for spinal malignancy.
False
Describe the function of the sacrotuberous ligament, sacrospinous ligament, and interosseous ligament.
Sacrotuberous ligament - restricts sacral nutation
Sacrospinous ligament – restricts sacral nutation & lat fxn
Interosseous ligament - acts as AOR for SIJ
A retired HS teacher has experienced increasing frequency of LBP over the past 5 years, often relieved by mms relaxant. The pt reports significant AM stiffness that dissipates after exercising on the stationary bike. Sahrmann lower abdominal level 1. Nagging pain is aggravated by prolonged walking. What else do you want to know?
a. Is there any back ext weakness?
b. Is there only lower ab weakness?
c. Is there lower cross syndrome?
d. Is there upper cross syndrome?
Pt presents with a movement fault of excessive lumbar extension. Identify a possible MSI Source and Cause?
Source: facet
Cause: short iliopsoas, tight paraspinals, weak abs
Upon completing your IE, you find that your patient has a lumbar extension movement fault. What are some interventions we can start with?
Prone progressions
Improve sitting posture: knees higher than hips (more PPT)
Improve abdominal strength/control
Improve hip flexor stiffness
Improve hip ext (to limit L ext)
List the red flags with the highest post-test probability for detection of spinal fracture (Downie 2013).
Older age, prolonged corticosteroid drugs, severe trauma, presence of contusion or abrasion
Which posterior spinal structures are innervated and by what nerve?
PLL - nociceptive fibers form ascending branch of sinuvertebral nerve
Dura mater – recurrent branch of sinuvertebral nerve
Dural sleeve of nerve root – sinuvertebral nerve
Posterior annulus fibrosis - sinuvertebral nerve
A termite inspector (who works by crawling in the crawl space between floors of houses) presents w LBP and movement coordination impairment and MSI rotation syndrome. In hooklying, engaging the multifidus or TA did NOT reduce sx but abdominal bracing in quadruped decreased pain from 4/10 to 1/10. What would be the MOST appropriate early phase exercise?
a. Activate obliques w bent knee fallouts
b. Activate obliques w prone hip rot
c. Engage rectus w bent knee fallouts
d. Engage rectus w prone hip rot
b. Activate obliques w prone hip rotation
Pt presents with unilateral LBP and buttock pain. He recalls a clear onset when he was bending down and to the side to pick up his son 2 weeks ago. Upon exam you find limitations in ROM and pain reproduction with end-range spinal movements. CPAs reveal hypomobility in lower lumbar region. What ICF classification does he fall under?
Explain the steps of a repeated movements examination:
Test FIS and EIS
Test FIL or EIL
Test SGIS
According to Henschke (2007), what red flags raised post-test probability of the presence of spinal malignancy to a significant level when used in isolation?
Hx of cancer, elevated ESR (erythrocyte sedimentation rate > 50 mm/h), low hematocrit (<30%), and clinician judgement