Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
O Spine
notes
| Term | Definition |
|---|---|
| flexion | good for extremely painful problems, acute problems, prolapsed disks, stenosis, spondylolisthesis |
| extension | good for bulging disc, flat lordosis, pain decreases with, leg pain centralizes with |
| straight leg raising | in supine bring straight leg into 90 degrees at hip. positive test if pain in sciatic distribution. dorsiflexion of ankle creates increased tension on nerve. bilateral test also down. indicates HNP. do on leg that has pn |
| instruction in proper posture including, sleeping, sitting, standing | acute/protected phase |
| log rolling | acute/protected phase |
| postures for pn relief (prone, prone on elbows/or sidelying flexion) | acute/protected phase |
| positional traction | acute/protected phase |
| cervical pillow or lumbar roll | acute/protected phase |
| AROM painfree range | acute/protected phase |
| knee rocking | acute/protected phase |
| chin tucks/axial ext | acute/protected phase |
| body mechanics | acute/protected phase |
| frequent position change | acute/protected phase |
| TrA-drawing in | acute/protected phase |
| manual mechanical traction | acute/protected phase |
| pelvic tilting/Williams flexion | acute/protected phase |
| neutral spine | acute/protected phase |
| bracing | acute/protected phase |
| standing ext | acute/protected phase |
| gentle isometrics/mm setting | acute/protected phase |
| multifidus activation/supine | acute/protected phase |
| diaphragmatic breathing | acute/protected phase |
| LE strength (mini-squatting, wall sits) | subacute/controlled motion |
| abdominal bracing | subacute/controlled motion |
| controlled stabilization (bridging, cat/cow, birddogs) | subacute/controlled motion |
| hamstring stretching | subacute/controlled motion |
| balance in standing- 1 leg | subacute/controlled motion |
| walking | subacute/controlled motion |
| press-ups | subacute/controlled motion |
| multifidus activation all positions (supine, quadruped, std) | subacute/controlled motion |
| teach body mechanics/back school | chronic/min protection & return to function phase |
| ergonomic assessment | chronic/min protection & return to function phase |
| stretching all tight spinal structures | chronic/min protection & return to function phase |
| strengthening Er Spinae (supermans, prone over Swiss ball) | chronic/min protection & return to function phase |
| endurance activity-biking, swimming | chronic/min protection & return to function phase |
| dynamic stabilization- Swiss ball) | chronic/min protection & return to function phase |
| Roman Chair | chronic/min protection & return to function phase |
| abdominal strengthening | chronic/min protection & return to function phase |
| hip flexor stretching | chronic/min protection & return to function phase |
| limb loading with multifidis/TrA activation | chronic/min protection & return to function phase |
| can try McKenzie press ups (see how pt tolerates) | acute/protected phase |
| ALL- anterior longitudinal ligament | limits ext |
| PLL- posterior longitudinal ligament | limits flex |
| ISL- interspinous ligament | limits flex- span only 1 vertebral section- can be easily palpated |
| ligamentum flavum | yellow ligament- very strong stabilizer- connects lamina |
| SSL-supraspinous ligament | limits flexion |
| ITL- intertransverse ligament | between TPs-limits lateral bending |
| intervertebral foramina | nerves exit-located btw each vertebral segment in the post pillar (ant boundary:intervertebral disc/post boundary: facet jt/superior & inferior boundaries: pedicles of the superior & inferior vertebrae of the spinal segment)-size is affected by spinal mot |
| flexion will help... | open facet jt & intervertebral foramina |
| extension will help... | if disc is protruding |
| nucleus pulposus when you're young... | is like jelly/part water |
| nucleus pulposus when you're older, 30's 40's 50's... | gets drier & harder w/age, more like playdoh |
| splenius capitis & cervicis | neck ext/rotation |
| SCM | neck flex/rotation (we never ex.-always strong-usually tight so we stretch) |
| scalenes | neck flex/lateral flexion (we never ex.-always strong-usually tight so we stretch) |
| erector spinae | (spinalis, longissimus, iliocostalis)- extension (to exercise, either put pt in prone or bend & then std like a bent over dead lift) |
| active control in the lumbar spine... | abdominal mm, transverse abdominis stabilization activity, erector, multifidus stabilization activity |
| passive control in the lumbar spine... | thoracolumbar (lumbodorsal) fascia, lumbar & abdominal aponeurosis, ligaments |
| multifidus | deep mm in spine, important stabilizer, spans only a single segment, pts w/ LBP have a delay in recruitment, atrophies quickly if sedentary |
| motions of the spine... | 6 degrees... flex/ext, side bending, rotation |
| postural pain signs | resolves when pt moves, gets worse longer they stay in posture, pain in areas of stress, pain usually relieved w/activity, negative x-rays, CT scans, adaptive shortening & lengthening, adaptive wkness |
| PT goals for postural pn | decrease pn & mm guarding, restore normal flexibility, restore normal mm strength & balance, retrain body awareness & posture, teach body mechanics |
| rx for postural pn | modalities, therapeutic ex, posture edu |
| sprain | occurs in jt |
| strain | occurs in mm |
| spine mm strain caused by | overstretching, overloading or overuse (poor postural habits included), inflammatory process due to micro-tears of mm tissues, often occurs w/jt sprain as a result of trauma, no clinically proven way to see strain, tests come up negative, have to palpate |
| spine mm strain S&S | pn w/contracture or elongation of injured tissues, tenderness to injured area, edema in injured area, posture/body mechanics may be a contributor, neuro, x-rays and scans are normal |
| spine mm strain rx | modalities, therapeutic ex, posture edu |
| spine joint sprain | traumatic or chronic over stretching of capsule & ligaments & subsequent inflammatory response. rx is same as for mm strain |
| spine facet jt impingement | a mechanical dysfunction where synovium folds or capsular "menisci" get stuck in jt & cause a locking (bend fwd & can't return) rx w/traction or manipulation in addition to rx for inflammation & strain |
| DJD/OA/spurring/spondylosis | chronic degeneration & inflammation that commonly results in narrowing of IV foramen (stenosis) |
| spine jt sprain is caused by | long term compression from postural syndrome, hypermobility (rx w/stabilization ex, bracing), prolonged stiffness due to poor jt nutrition (rx w/flexibility) exercises, normal aging, overuse |
| spine sprain signs | AM stiffness & pn (or after any prolonged posture), relieved w/mild activity, worsens w/strenuous activity, xrays & other tests reveal abnormal spurring on vertebral segments, possible radicular symptoms due to nerve comp, generally occurs w/DJD, DDD |
| DJD- degenerative joint disease | jt degenerates |
| DDD-degenerative disc disease | disc degenerates-loses water, gets thinner & flakey- like old worn out tire |
| whiplash | most common in MVA, won't show up unless lig completely torn, hyperflex/hyperext trauma to the cervical area w/tearing/ microtearing of ligaments and mm |
| DJD/OA/DDD of spine | mostly over 40 crowd, spurring, spondylosis, significant loss of disc fluid/narrowing, may result in radiculopathy |
| rx of sprains | flex ex, flexibility/stabilization ex, modalities, walking program often helpful for jt nutrition, anti-inflammatory meds. general rule-if it hurts, don't do it. |
| disc lesions | from repeated trauma, mostly younger pts |
| bulge/protrusion | annular fibers weak: allows disc to bubble, early prolapse, will show up on MRI, pn, numbness, wk, radiates down leg or arm |
| prolapse | annular breakdown but still intact: disc protrudes out of normal area |
| extruded | annulus is broken & part of nucleus is out of annulus (nothing can put that back in) |
| sequestered or fragmented | part of nucleus is broken off and floats in spinal canal, almost always requires sx, depends on where nucleus migrates after getting snipped off |
| degeneration | the annulus wears thru out, loses water and becomes thin such that facet jts now touch, and IV foramen narrows |
| etiology of disc problems | prolonged poor postures and/or body mechanics, history of activity that increases disc pressure, possible hypermobility as cause, then can become hypomobile in time |
| disc lesions are most commonly | L4-5 or L5-S1/ C5-6 or C6-7- most mobile areas |
| disc lesions goals/rx | address pn w/modalities, posture/maintain mobility & strength/decrease disc pressure-tx, positioning, no fwd bend, ab strengthening or isometrics in acute or subacute/improve body mechanics & posture/address any LE probs/mk pt as Ind as possible/sx |
| sacralization/lumbarization | congenital defect, often assymtomatic |
| lumbarization | sacral vertebra 1 does not fuse-results in extra movement available and 6 lumbar vertebra |
| sacralization | one or both sides of 5th lumbar vertebra fuses w/ sacrum. result is asymmetrical mvmt. no disc present. result is less mvmt |
| spina bifida occulta (often assymtomatic) | absence of full closure of bony elements of spine, may or may not result in neurological defect, commonest congenital deformity of spine |
| spondylolysis | refers to bilateral fx thru the pars interarticularis |
| spondylolisthesis | refers to displacement of the vertebral body as result of fx |
| spondylolysis/spondylolisthesis | occurs in lumbar spine, can be congenital or acquired, usally occurs w/ increased lordosis, back pn increases w/ bkwd bending, pn may or may not occur & may or may not be significant, can lead to OA, nerve root compression, may need sx |
| rx for spondylolisthesis | extension is contraindicated but strengthening of the extensors is not (can bridge or do small superman), back brace may be helpful, abdominal strengthening |
| compression fx (also called crush fx) | happens in hip & spine the most, may occur spontaneously w/OA & more common in throacic spine, may occur w/trauma |
| S&S of compression fx | usually does not cause harm to spinal cord & does not require fixation. local pn over site of fx-maybe edema if acute |
| rx of compression fx | modalities, ex to improve posture (ext), bracing (TLSO) |
| ankylosing spondylitis | uncommon (horrible), begins at SI w/synovium & lig becoming inflamed, thick & ultimately calcified. finally results in total spinal fusion |
| pagets dx (osteitis deformans) | accelerated resorption & regeneration of bone tissue in long bones & spine. begins age 40-60. |
| pagets dx (osteitis deformans) S&S | pn, thickening/deformities of cranium, spinal & LE deformities |
| TOS- thoracic outlet syndrome | compression on the neurovascular bundle that runs thru the throacic outlet & carries the brachial plexus, subclavian artery & subclavian vein |
| TOS S&S | pn in the shd and/or UE, tingling, numbness, coldness in the arm or hand, loss of biceps jerk, triceps jerk, positive Adson's test |
| TOS common areas of compression include | ant & middle scalene, 1st rib, clavicle, pec minor |
| TOS causes | tight scalenes, cervical rib (a congenital anomaly), trauma, postural changes, clavicular fx |
| idiopathic non-structural scoliosis | curve reverses w/fwd bending, always mm imbalances in strength or length that need to be addressed |
| TOS rx | exercise(pec stretching), posture education |
| myelogram | dye introduced into canal (usually btw L4 & L5) so that disc can be visualized on xray (not that common anymore, risk of headache & infection) |
| MRI | can't do w/metal (Beth says excellent test tho) |
| discogram | dye injected into disc & xrayed (older procedure, rare now) |
| bone scan | rules out CA or fx (common) |
| epidural injection | cortisone & an anesthetic injected into outer dural sac for pn relief |
| laminectomy | lamina removed & extruded disc material removed |
| foramenotomy | for stenosis-increase size of IV foramen |
| fusion | for severe instability after several laminectomies or fx. graft taken from iliac crest & braced for 4-6 wks |
| flexion is good for ... | extremely painful probs, acute probs, prolapsed discs, stenosis, spondylolisthesis |
| extension is good for... | bulging disc, flat lordosis, pn decreases with ext, leg pn centralizes with ext |
| best -> worst position for bulging disc | ext in prone, ext in std, sitting w/lumbar (better in PM) |
| best -> worst position for DDD, DJD | supine, flex w/o compression (sidelying, supine flex), flex w/sitting, standing (better in AM) |
| extension approach | pn usually caused by disc lesion or flexed postures/bending, lifting. pn increases w/flex. pn decreases w/ext. rx w/ext/McKenzie type protocol |
| flexion approach | pain caused by DDD, DJD, spurring, stenosis. pn relieved w/flex. rx w/unweighted flex & flex posture positions |
| hypermobility approach | pn caused by lack of good neuromuscular control, wk ligaments. activity in increases symptoms, relieved by rest. treat w/ Kinesthetic Awareness Ex. treat w/Core Stabilization Ex |
| hypomobility approach | caused by lack of mobility and stiffness. rx w/stretching/joint mob which relieves pn quickly (we can fix them fast) |
| cervical exercises | axial ext (cervical retraction), scalene mm stretch, inhibitive distraction, manual traction/traction, mm energy to increase ROM, isometrics |
| lumbar spine exercises | drawing-in maneuver (abdominal hollowing ex) for TrA, ab bracing, post pelvic tilt, multifidus activation & training, ext, Williams flex, stabilization training |
| functional activities: basic ex techniques | wt bearing ex- modified bridging ex, push-ups w/trunk stabilization, wall slides, partial lunges, partial squats & steps |
| compression test | apply compression thru lumbar or cervical, pt in sitting. pn/radicular signs are positive test: indicates disc pathology |
| distraction test | done in sitting. examiner applies distraction & if pn relieved, positive test. indicates disc pathology |
| Adsons test | in sitting, palpate radial pulse. rotate head toward test shd. ask pt to take breath & hold. examiner takes arm into ER & ext. decreased pulse indicates compression at TO. also look for reproduction of symptoms (looking for TOS) |
Created by:
jessigirrl4
Popular Physical Therapy sets