Lumbar Spine
Pt. has DP multisegmental flexion pattern. Which of the following should be assessed next? a) hamstring mobility b) UE pattern 1 & 2 c) hip flexion mobility d) lumbar flexion mobility e) all of the above
a) hamstring mobility b) hip flexion mobility d) lumbar flexion mobility
Distal pain originating from the spine abolishes in a distal to proximal direction. May increase local low back pain. a) centralization b) peripheralization
a) centralization
Lasting change in the location of the symptoms - a) centralization b) direction specific exercise c) directional preference
a) centralization
Right lumbar rotation: a) closes on the left, opens on the right b) closes on the right, opens on the left
a) closes on the LEFT, opens on the RIGHT
During lumbar _________, the nucleus pulposus is displaced posteriorly and the posterior annulus fibrosis is stretched. a) flexion b) extension c) side-bending d) rotation
a) flexion
During lumbar __________, there is an 80% increase in disc pressure posteriorly as the anterior vertebrae become compressed. a) flexion b) extension c) side-bending d) rotation
a) flexion
When testing the pelvic floor to see if those are the muscles causing asymmetry in SI dysfunction, the PT compresses - a) the greater trochanters of the femurs b) the lateral iliac crests c) lateral compression towards the spine d) all of the above
a) greater trochanters
______________ is an umbrella term that refers to anything in the lumbar spine that could be putting pressure on a nerve, causing radiating symptoms down the leg.
Space Occupying Lesion
RELATIVE Contraindications of Lumbar Traction
- acute sprain/strain - pregnancy (cervical) - osteoporosis - hiatal hernia - claustrophobia or altered mental - respiratory or cardiac insufficiency - rheumatoid arthritis - Down's syndrome
Lumbar Red Flags: Sinister Conditions
- fracture - sacral stress fracture - acute spondylolisthesis - aneurysm - vascular claudication - kidney stone - cancer - infection - cauda equina - ankylosing spondylitis - central sensitization disorder - genital pathology - gastrointestinal pathology
Describe the appropriate position for the FABER Test.
- patient in supine - cross leg over opposite knee - stabilize opposite pelvis so it doesn't come up - let leg go into flexion, abduction, and external rotation - note end-feel and ROM
Describe the positioning of the Modified Thomas Test.
- pt sits on very edge of table and lays down supine - PT passively brings BOTH legs up into flexion until they see the sacrum start to tilt - PT holds one leg up in flexion while slowly lowering the other down into hip extension
ABSOLUTE Contraindications to Lumbar Traction
- tumor or infection of spine or nervous system - vascular compromise - any condition where movement is contraindicated (spondylolisthesis, fracture, ligament rupture) - pregnancy
Which of the following is NOT one of the diagnoses of lumbar spine that you might see on an intake form? a) herniated disc b) facet arthritis c) SI joint lesion d) spondylolisthesis e) degenerative disc disease
All of the above are possible diagnoses
Which of the following is not one of the LBP specific approaches that are proven to be effective? a) repeated movements b) movement system/muscle imbalance c) motor control training d) manipulative therapy
ALL are proven to be effective treatments of LBP
T or F: A positive Crossed Straight Leg Raise indicates poor prognosis and the PT needs to refer patient to primary care physician for some imaging.
True
T or F: A positive Sign of the Buttock test indicates a red flag non-musculoskeletal pathology.
True
T or F: Acute LBP patients are classified into 1 of 4 categories based on key historic, demographic, and physical exam variabless.
True
T or F: Evidence suggests that 25-33% of acute LBP patients recover in 1 month, while less than 60% recover in 3 months.
True
T or F: Over the course of 12 months 60-85% of patients will experience at least one recurrent episode of LBP due to improper rehabilitation.
True
T or F: The Supine Long Sit Test has poor psychometric properties and thus poor clinical utility.
True
T or F: There is conflicting evidence on whether patients with low back pain benefit from traction, but there is moderate evidence to suggest that clinicians should NOT use traction.
True
T or F: We need to test hip rotation in a seated AND prone position.
True
T or F: We see pretty immediate, gross improvements of LBP with treatment but then recurrence about 73% of times.
True
T or F: Centralization ensures a poor prognosis.
FALSE
T or F: Disability reduction of LBP is directly related to the type of manipulation performed.
FALSE
T or F: The majority of patients with acute LBP spontaneously recover in 4-6 weeks.
False
T or F: We see pretty immediate, gross improvements of LBP with treatment that last up to 8 weeks.
False
T or F: Since 1990, disability because of LBP has decreased by 54%.
False - it has INCREASED
T or F: If the SI is symptomatic, it is usually due to increased lumbar lordosis and weak hip flexors.
False - usually due to rotated pelvis
Mechanical Effects of Lumbar Traction:
MOST benefit individuals with - 1) radicular symptoms - bilateral or unilateral 2) (+) straight leg raise test 3) (+) crossed straight leg raise test 4) (+) passive straight leg raise test
Describe the Sign of the Buttock test.
Passively raise the patient's leg to the point of limitation and then bend/flex the knee.
Describe the Quadrant Test.
Patient actively moves into extension, side-bending, and rotation to the ipsilateral side and holds the position for 3-5 seconds.
What is the MOST IMPORTANT THING to remember BEFORE performing the Repeated Movement Testing for someone in the Direction Specific Category?
SET A BASELINE!!!!!!!!! 1) Pain rating 2) Location of symptoms
T or F: Flynn created a Clinical Predictive Rule that proved that lumbar manipulations improve non-radicular low back pain ~50% in over 2 days.
TRUE
What are side glides named for?
The side of the lower shoulder, not the hips ex: left shoulder is lower, right shoulder is higher = LEFT side glide
What is Fortin's Sign?
When the patient points to their SI joint as the place of their pain
How many degrees of hip extension do we want to see in the Modified Thomas Test? a) 0 b) 25 c) 30 d) 50
a) 0
For Degenerative Disc Disease (DDD), use ________ mode for lumbar mechanical traction. a) 30:10 - intermittent b) 30:10 - sustained c) 60:20 - intermittent d) 60:20 - sustained
a) 30:10 - intermittent
With Seated Hip External Rotation, how many degrees of motion do we want to see? a) 45 b) 25 c) 30 d) 50
a) 40-45 degrees
Which individual would benefit MOST from lumbar traction? a) 57-year-old man with degenerative disc disease with (+) passive straight leg raise test and crossed straight leg raise test b) 62-year-old woman with osteoporosis and stenosis with peripheralizing symptoms c) 47-year-old man post-lumbar fusion with non-radicular LBP d) 52-year-old woman with a herniated L4/L5 disk and hypomobility with symptoms that run down to her feet with flexion
a) 57-yr-old man with DDD with (+) passive straight leg raise test and crossed straight leg raise test
Patient Y is a 75-year-old man who presents to the clinic with an extremely kyphotic thoracic spine and forward head posture. He complains of low back pain that is much worse when he is standing or walking around the house but that sitting down to rest makes him feel much better. What diagnosis would you give this patient? a) Direction Specific - Flexion Responder b) SI dysfunction - Mobilization/Manipulation c) Direction Specific - Extension Responder d) Direction Specific - Lateral Shift Responder
a) Direction Specific - Flexion Responder
Which of the following are the most helpful of the Test Item Cluster for SI dysfunction? Select all that apply. a) Distraction b) Thigh Thrust c) Compression d) Sacral Thrust e) Gaenslen
a) Distraction b) Thigh Thrust - if both are positive, you only need to perform one additional test to rule in/out SI
Patients in the stability category should progress to which of the following during treatment? a) Pattern work - quadruped birddogs, half kneeling chops & lifts, deadlifts b) Inner core work - breathing, TA draw-ins, multifidus work c) Outer core work - crunches, planks, Russian twists d) Any of the above could work for treatment
a) Pattern work - quadruped birddogs, half kneeling chops & lifts, deadlifts, etc...
Patient Z presents to the clinic with her hips shifted to the right in a visible frontal plane deviation. What would be the next thing to do after fixing the lateral shift? a) Prescribe prone press-ups and left side-glides into a wall b) General lumbosacral manipulation c) Manually translate the pelvis to the left d) Repeated Movement Testing
a) Prescribe prone press-ups and left side-glides into a wall
Patient X has low back pain symptoms distal to their buttocks that moves up to their low back when bending backward and walking but moves further down the leg during sitting and touching their toes. What would be an appropriate treatment progression for their diagnosis? a) Prone lying, extension exercises, Mobilization with Movement, then motor control once centralized b) Mobilization with Movement, followed by motor control work to get centralized, then prone lying and extension exercises c) Single knee to chest and prone rocking, seated lumbar flexion mobilization with movement, inner core motor control, unloaded treadmill walking program and home exercise program d) Mobilization with movement, inner core motor control work until centralized, then progress to single knee to chest and prone rocking, followed by unloaded treadmill walking programs
a) Prone lying & extension exercises --> mobilization w/ movement --> motor control (bird dogs, rolling, bridges)
Which of the following are good tests to rule OUT a space occupying lesion? Select all that apply. a) SLUMP test b) Passive Straight Leg Raise Test c) Crossed Straight Leg Raise Test d) Active Straight Leg Raise Test e) All of the above
a) SLUMP test b) Passive Straight Leg Raise Test
Which stage of disc herniation: Nucleus remains within the annulus and only a slight bulge can be seen. a) Stage 1 - Protrusion b) Stage 2 - Prolapse c) Stage 3 - Extrusion d) Stage 4 - Sequestration
a) Stage 1 - Protrusion
Patient W is a 16-year-old female gymnast. She reports bouts of low back pain that shoots down her left leg during her routine when she does backflips but says the pain returns to her low back when she bends forward as if to touch her toes. Which of the following would be appropriate for educating this patient? a) Tell patient to not sleep on her stomach b) Tell patient to try walking a mile every day c) Tell patient to try biking on her off days d) All of the above
a) Tell patient to not sleep on her stomach c) Tell patient to try biking on her off days
Lower Cross Syndrome: Weak glutes/hamstrings = weak __________ a) abdominals b) glutes & hamstrings c) hip flexors d) lateral rotators
a) abdominals
Lumbar Mechanical Traction in prone is the BEST used for - a) herniated disc b) rheumatoid arthritis c) degenerative disc disease d) spondylosis
a) herniated disc c) degenerative disc disease
Which of the following are two of the most commonly pathoanatomical problems seen in the lumbar spine? a) herniated disc b) facet arthritis c) SI joint lesion d) spondylolisthesis e) degenerative disc disease
a) herniated disc e) degenerative disc disease
If neither the rectus femoris or IT band/TFL seemed to be limiting a patient's hip extension during the Modified Thomas Test, then we by default assume it is _____________ muscle limiting the ROM. a) iliopsoas b) IT band/TFL c) rectus femoris
a) iliopsoas
Which muscle has the following referral pattern: Anterior thigh pain and unilateral low back pain a) iliopsoas b) glute medius c) multifidus d) glute min
a) iliopsoas
Left lumbar side-bend: a) inferior facets on right side slide anterosuperior, inferior facets on left side slide posterosuperior b) facets on right side close and facets on left side open c) inferior facets on right side slide posteroinferior, inferior facets on left side slide anterosuperior d) facets on right side open and facets on left side close
a) inferior facets on right side slide anterosuperior, inferior facets on left side slide posterosuperior d) facets on right side OPEN and facets on left side CLOSE
Which of the following are treatment considerations for SI dysfunction? a) innominate rotational correction b) hip flexor resisted strengthening c) inner core motor control d) general lumbosacral manipulation e) sidelying neutral gapping manipulation
a) innominate rotational correction c) inner core motor control d) general lumbosacral manipulation
Patient X presents with pain in their lower back. They point to the PSIS region and complain of pain particularly in their groin and buttocks. They have a (+) Supine Long-Sit Test and 3/5 positives on a test item cluster. Which lumbar spine category would they fall under? a) manipulation/mobilization & sacroiliac dysfunction b) direction-specific exercise c) stabilization d) traction
a) manipulation/mobilization & sacroiliac dysfunction
Which of the following is NOT true about the Active Straight Leg Raise Test of the SI joint dysfunction testing? a) pain is a positive finding b) it is not part of any CPRs or Test Item Clusters - but helps to guide interventions c) helps determine which inner core muscles to train first d) positive finding is when the patient reports one leg is "heavier" or "harder" to lift off the table than the other e) all of these are true
a) pain is a positive finding - only (+) finding = "heavier" leg
Which of the following are ways to rule IN or OUT of the Manipulation/Mobilization category? Select all that apply. a) positive Clinical Predictive Rule for manipulation b) demonstrates an "opening pattern" c) classified as an "SI joint dysfunction" d) demonstrates a "closing pattern" e) all of the above
a) positive CPR for manipulation c) classified as an SI joint dysfunction d) demonstrates a "closing pattern"
Which of the following is NOT part of the local exam process? a) red flag screening b) passive physiological movements c) passive accessory movements d) palpation
a) red flag screening
Pars interarticularis fracture - a) spondylolysis b) spondylolisthesis c) spondylosis
a) spondylolysis
Patient X had 3/5 positives on the lumbar manipulation CPR. What is their likelihood ratio? a) 1.52 b) 2.61 c) 24.38 d) infinite
b) 2.61
What is the MINIMUM amount of sets and reps you can allow during the Repeated Movement Testing before you move on to a different position? a) 4 sets of 20 b) 3 sets of 10 c) 5 sets of 15 d) 2 sets of 25
b) 3 sets of 10 - MINIMUM
During the prone on elbow lumbar extension/rotation test (opposite of t-spine test), how many degrees of motion do we want to see? a) 25 b) 30 c) 50 d) 75
b) 30 degrees - active and passive
What are the 3 sub-classifications of the Direction Specific lumbar spine category? a) Stenosis b) Extension responder c) Herniated disc d) Flexion responder e) Lateral shift
b) Extension responder d) Flexion responder e) Lateral shift
The Quadrant Test is a good rule IN test for which of the following? a) SI joint dysfunction b) Facet joint impingement c) Opening pattern of pain d) All of the above
b) Facet Joint Impingement (aka Closing Pattern pain)
To see if the __________ is the muscle limiting hip extension ROM during the Modified Thomas Test, we take the leg out LATERALLY with the knee still bent as we let the leg down into hip extension. If the patient can do this while maintaining 90 degrees of knee flexion and 0 degrees hip extension, then it was a ___________ muscle limitation. a) iliopsoas b) IT band/TFL c) rectus femoris
b) IT band/TFL
Patients in the stability category should be prescribed which of the following during Day 1 of treatment? a) Pattern work - quadruped birddogs, half kneeling chops & lifts, deadlifts b) Inner core work - breathing, TA draw-ins, multifidus work c) Outer core work - crunches, planks, Russian twists d) Any of the above could work for treatment
b) Inner core work - breathing, TA draw-ins, multifidus reflexive training
The FABER Test is a special test for which of the following? Select all that apply. a) lumbar extension mobility b) S.I. joint dysfunction c) hip extension mobility d) sacral motion mobility
b) SI joint dysfunction c) hip extension mobility
Which of the following are important neural related clearing tests to perform for someone you think might fall into the Direction Specific Exercise category? Select any that apply. a) Distraction b) SLUMP Test c) Compression d) Straight Leg Raise Test
b) SLUMP Test d) Straight Leg Raise Test
Which stage of disc herniation: Nucleus has reached the edge of the disc but the annulus is still in-tact. a) Stage 1 - Protrusion b) Stage 2 - Prolapse c) Stage 3 - Extrusion d) Stage 4 - Sequestration
b) Stage 2 - Prolapse
Which of the following is NOT true about Repeated Movement Testing? a) Is somewhat robust so only do with the people who have symptoms of the Direction Specific Exercise category b) Start with the pain-free motion FIRST c) Keep doing flexion/extension exercises until the pain goes away d) Frontal plane motions like side-bending likely won't occur on Day 1
b) Start with the pain-free motion FIRST - start with the PAINFUL movement first
What is NOT one of the 5 predictive factors of lumbar spine stenosis? a) Age >48 b) Unilateral symptoms c) Leg pain more than back pain d) Pain during walking/standing e) Pain relief with sitting
b) Unilateral symptoms - usually bilateral
Which of the following are ways to rule IN or OUT of the Stabilization category? Select all that apply. a) positive Clinical Predictive Rule for traction b) age <40 yrs c) repeated movements do not centralize symptoms d) signs and symptoms of nerve root compression e) SLR >90 f) Aberrant movements g) (+) prone instability test
b) age <40 e) SLR >90 degrees f) aberrant movements g) (+) prone instability test
If patient has an Oswestry score of greater than or equal to 25... a) do not perform manipulations b) classify patient into 1 of 4 LBP categories c) perform traction only d) fill out pain avoidance questionnaire
b) classify patient into 1 of 4 LBP categories
Left lumbar rotation: a) closes on the left, opens on the right b) closes on the right, opens on the left
b) closes on the RIGHT, opens on the LEFT
Patient X presents with pain in their lower back. The pain is intermittent and sometimes feels like a burning and other times a numbness in their right leg. They say sitting around all day really hurts their back and produces numbness in their leg, but when they get up and walk around, their pain is much better. Which lumbar spine category would they fall under? a) manipulation/mobilization & sacroiliac dysfunction b) direction-specific exercise c) stabilization d) traction
b) direction-specific exercise - extension responder
During lumbar ___________, the size of the vertebral canal and IVF are decreased as loading is concentrated in the area of the pars intraarticularis. Nuclear pressure is reduced by 35%. a) flexion b) extension c) side-bending d) rotation
b) extension
During lumbar ____________, the nucleus pulposus is displaced anteriorly and the anterior annulus fibrosis is stretched. a) flexion b) extension c) side-bending d) rotation
b) extension
Lumbar Mechanical Traction in prone is the BEST choice if you want lumbar - a) flexion b) extension c) side-bending d) rotation
b) extension
Right lumbar side-bend: a) inferior facets on right side slide anterosuperior, inferior facets on left side slide posterosuperior b) facets on right side close and facets on left side open c) inferior facets on right side slide posteroinferior, inferior facets on left side slide anterosuperior d) facets on right side open and facets on left side close
b) facets on right side CLOSE and facets on left side OPEN c) inferior facets on right side slide posteroinferior, inferior facets on left side slide anterosuperior
Which of the following are the passing criteria for the Modified Thomas Test? a) no pain b) femur lies flush on the table c) knee at 90 degrees flexion d) no lateral deviation e) all of the above
b) femur lies flush on table c) knee at 90 degrees flexin d) no lateral deviation
Which muscle has the following referral pattern: lower back/sacrum near the PSIS a) iliopsoas b) glute medius c) multifidus d) glute min
b) glute medius
The Double Knees-to-Chest regional examination test assesses - a) lumbar flexion b) hip flexion c) lumbar extension d) sacral tilt
b) hip flexion
Closing pattern - extension and side-bending increases pain on the ___________ side a) contralateral b) ipsilateral c) both
b) ipsilateral
During the regional examination of pt's Prone Rock Test, the PT notes they have a nice kyphotic thoracic curve but a flat lumbar spine curve. What does this mean? a) hip flexion mobility issue b) lumbar spine mobility issue c) hyperkyphotic t-spine d) hyperkyphotic lumbar spine
b) lumbar spine mobility issue
What is a positive Crossed Straight Leg Raise Test? a) symptoms in leg improve b) pain in the opposite leg c) reproduction of back/leg pain <45 degrees d) reproduction of back/leg pain
b) pain in the opposite leg
Proximal symptoms originating from the spine are produced in a proximal to distal direction - a) centralization b) peripheralization
b) peripheralization
A right posteriorly rotated innominate would need a Muscle Energy Technique that activates the ________ hip flexors and __________ hip extensors. a) left; left b) right; left c) right; right d) left; right
b) right hip flexors, left hip extensors
Which of the following ligaments greatly limits the mobility in the SI joint? Select all that apply. a) facet capsulary ligament b) sacrospinous ligament c) interspinous ligament d) sacrotuberous ligament
b) sacrospinous ligament d) sacrotuberous ligament
Anterior slippage of vertebral body - a) spondylolysis b) spondylolisthesis c) spondylosis
b) spondylolisthesis
Which of the following is NOT one of the three manual therapy techniques to help positive CPR lumbar manipulation criteria? a) non-thrust PA mobilization b) supine pistol grip c) general lumbosacral manipulation d) sidelying neutral gapping manipulation
b) supine pistol grip
When testing the transverse abdominis to see if that is the muscle causing asymmetry in SI dysfunction, the PT compresses - a) the greater trochanters of the femurs b) the lateral iliac crests c) lateral compression towards the spine d) all of the above
b) the lateral iliac crests
Patient X had 4/5 positives on the lumbar manipulation CPR. What is their likelihood ratio? a) 1.52 b) 2.61 c) 24.38 d) infinite
c) 24.38
With Seated Hip Internal Rotation, how many degrees of motion do we want to see? a) 60-70 b) 20-25 c) 30-45 d) 50-70
c) 30-45 degrees <30 = problem
How much improvement do you expect to see 2-4 days after a patient has had a lumbar manipulation? a) 35% b) 28% c) 50% d) 99%
c) 50% - if not, repeat the manipulation
During the regional examination of pt's Passive Straight Leg Raise, the PT notes they can only get to 65 degrees. What is normal ROM? a) 65 b) 45 c) 80 d) 90
c) 80 degrees for PSLR
Which of the following is not one of the historical factors to look for with someone in the SI dysfunction category? a) unilateral PSIS pain - Fortin's Sign b) groin pain c) ASIS pain d) buttocks pain
c) ASIS pain
Patients in the stability category should progress ultimately to which of the following? a) Pattern work - quadruped birddogs, half kneeling chops & lifts, deadlifts b) Outer core work - crunches, planks, Russian twists c) Adding load - kettelbell swings, resisted single leg deadlift, Turkish get-up
c) Adding load - Kettlebell swings, resisted single leg deadlift, Turkish get-up
Which of the following are good tests to rule IN a space occupying lesion? Select all that apply. a) SLUMP test b) Passive Straight Leg Raise Test c) Crossed Straight Leg Raise Test d) Active Straight Leg Raise Test e) All of the above
c) Crossed Straight Leg Raise Test
Patient X has low back pain symptoms distal to their buttocks that moves up to their low back when bending backward and walking but moves further down the leg during sitting and touching their toes. What diagnosis would you give this patient? a) Direction Specific - Flexion Responder b) SI dysfunction - Mobilization/Manipulation c) Direction Specific - Extension Responder d) Direction Specific - Lateral Shift Responder
c) Direction Specific - Extension Responder
Lasting improvements in symptoms and mechanics though not ALWAYS a change in location of the pain - a) centralization b) direction specific exercise c) directional preference
c) Directional preference
Which grades of spondylolisthesis will likely produce neurological symptoms and will need surgery? Select all that apply. a) Grade 1 - <25% slippage b) Grade 2 - 25-50% slippage c) Grade 3 - 50-75% slippage d) Grade 4 - >75% slippage
c) Grade 3 d) Grade 4
Patient Z presents to the clinic with her hips shifted to the right in a visible frontal plane deviation. What is the #1 priority for her treatment today? a) Prescribe prone press-ups and left side-glides into a wall b) General lumbosacral manipulation c) Manually translate the pelvis to the left d) Repeated Movement Testing
c) Manually translate the pelvis to the left
Prone hip mobility and Brettzle would be great exercises for which of the following patients? a) Patient X - extension responder b) Patient Y - lateral shift responder c) Patient Z - flexion responder d) None of the above
c) Patient Z - flexion responder
Which patient would benefit MOST from the Saarman posterior pelvic tilt progressions? a) Patient X - extension responder b) Patient Y - stabilization category c) Patient Z - flexion responder d) Patient W - traction category
c) Patient Z - flexion responder
What is a positive Prone Instability Test? a) Increase in symptoms when feet lift off ground b) Increase in symptoms when PA glide is applied c) Segment is no longer painful when lift feet off ground d) Complete elimination of symptoms
c) Segment is no longer painful when lift feet off ground during PA glide OR d) Complete elimination of symptoms
Patient Y is a 75-year-old man who presents to the clinic with an extremely kyphotic thoracic spine and forward head posture. He complains of low back pain that is much worse when he is standing or walking around the house but that sitting down to rest makes him feel much better. What interventions would you give this patient? a) Prone lying, extension exercises, Mobilization with Movement, then motor control once centralized b) Mobilization with Movement, followed by motor control work to get centralized, then prone lying and extension exercises c) Single knee to chest and prone rocking, seated lumbar flexion mobilization with movement, inner core motor control, unloaded treadmill walking program and home exercise program d) Mobilization with movement, inner core motor control work until centralized, then progress to single knee to chest and prone rocking, followed by unloaded treadmill walking programs
c) Single knee-to-chest & prone rocking --> seated lumbar flexion mobilization with movement --> inner core work --> unloaded treadmill walking program & home exercise program
Which stage of disc herniation: Annulus ruptures and nucleus pulposus starts to push out but everything else is still in-tact. a) Stage 1 - Protrusion b) Stage 2 - Prolapse c) Stage 3 - Extrusion d) Stage 4 - Sequestration
c) Stage 3 - Extrustion
Which test is described below: Patient stands on one leg and goes into lumbar extension. Looking for pain in the lumbar region. Palpating for a step-off deformity is better - one spinous process is palpated more anterior than the others below. a) Pars Interarticularis Fracture Test b) Repeated Movement Testing c) Stork Test d) Slump Test
c) Stork Test
Which of the following are important post-manipulation instructions? Select all that apply. a) Avoid asymmetrical movements and patterns b) Rest and drink lots of fluids in order to recover c) Stretching and motor control exercises - TrA draw in, hands & knees rocking, prone press-ups d) Stay active!! Exercise in ways that are pain-free e) Meaningful individualized program which includes fitness integration
c) Stretching and motor control exercises - TrA draw in, hands & knees rocking, prone press-ups d) Stay active!! Exercise in ways that are pain-free e) Meaningful individualized program which includes fitness integration
Which of the following are proven MOST effective at ruling in/out of the stability category? a) age <40 yrs b) SLR >90 c) Aberrant movements d) (+) prone instability test
c) aberrant movements d) prone instability test
What is considered a positive Supine Long Sit Test? a) no asymmetry when lying down but asymmetry of malleoli when sitting b) posteriorly rotated innominate shifts anteriorly c) asymmetry when laying supine but malleoli level out when sitting up d) all of the above are considered positives
c) asymmetry when laying supine but malleoli level out when sitting up
Which of the following are ways to rule IN or OUT of the Direction Specific Exercise category? Select all that apply. a) positive Clinical Predictive Rule for manipulation b) demonstrates a "closing pattern" c) centralization phenomena d) perform repeated movement testing e) all of the above
c) centralization phenomena d) perform repeated movement testing
In lumbar rotation, the facets close on the __________ side and open on the ___________ side. a) ipsilateral; contralateral b) contralateral; contralateral c) contralateral; ipsilateral d) ipsilateral; ipsilateral
c) close on contralateral, open on ipsilateral
Which of the following is NOT considered an aberrant movement? a) painful arc b) instability catch c) dystonic spasm d) Gower's sign
c) dystonic spasm
What is the goal of repeated movement testing? To find a direction that - a) peripheralize symptoms b) provoke pain c) increases ROM d) centralizes symptoms e) decreases pain
c) increases ROM d) centralizes symptoms e) decreases pain
Which is NOT an indication for use of lumbar traction? a) herniated disc b) DDD c) joint hypermobility d) facet impingement e) muscle spasm
c) joint hypermobility - hypomobility
When testing the multifidus to see if that is the muscle causing asymmetry in SI dysfunction, the PT compresses - a) the greater trochanters of the femurs b) the lateral iliac crests c) lateral compression towards the spine d) all of the above
c) lateral compression towards the spine
Which of the following is a positive FABER Test? a) symptoms in leg improve b) hypomobile lumbar segment c) leg is greater than 2 fists from table d) reproduction of back/leg pain
c) leg is greater than 2 fists away from the table
Which muscle has the following referral pattern: Anterior abdominal pain a) iliopsoas b) glute medius c) multifidus d) glute min
c) multifidus
Which of the following is NOT considered a lumbar spine red flag that should follow up with primary care referral? a) inability to reproduce pain during examination b) data isn't adding up c) pain goes away with medication d) bilateral pain encompassing several dermatomes
c) pain goes away with medication
Which is the most reliable way to rule in an SI joint issue? a) palpation b) palpation + movement c) provocative testing to induce pain in SI d) limited testing to avoid inducing pain in SI e) nothing is reliable to rule in SI joint issues - which is why its controversial
c) provocative testing that provokes pain in the SI
To see if the __________ is the muscle limiting hip extension ROM during the Modified Thomas Test, we extend the knee as we let the leg down into hip extension. If the patient can do this with no lateral deviation and 0 degrees hip extension, then it was a ___________ muscle limitation. a) iliopsoas b) IT band/TFL c) rectus femoris
c) rectus femoris
Which of the following are ways to rule IN or OUT of the Traction category? Select all that apply. a) positive Clinical Predictive Rule for traction b) demonstrates an "opening pattern" c) repeated movements do not centralize symptoms d) signs and symptoms of nerve root compression e) hypermobility in hip ROM
c) repeated movements do not centralize symptoms d) signs and symptoms of nerve root compression
What is a positive Passive Straight Leg Raise test? a) symptoms in leg improve b) pain in the opposite leg c) reproduction of back/leg pain <45 degrees d) reproduction of back/leg pain
c) reproduction of back/leg pain <45 degrees
What is a positive sign of the Quadrant Test? a) symptoms improve b) increased lumbar flexion c) reproduction of symptoms d) no change in symptoms
c) reproduction of symptoms
A left anteriorly rotated innominate would need a Muscle Energy Technique that activates the ________ hip flexors and __________ hip extensors. a) left; left b) right; left c) right; right d) left; right
c) right hip flexors, left hip extensors
Degenerative changes - a) spondylolysis b) spondylolisthesis c) spondylosis
c) spondylosis
Lower Cross Syndrome: Tight Back Extensors = Tight ____________ a) abdominals b) glutes & hamstrings c) hip flexors d) lateral rotators
c) tight back extensors = tight hip flexors
During the Prone Instability Test, the patient lifts their feet a few inches off the ground, engaging the _______ muscles. If the pain in their back goes away after this, obviously there is a _____________ issue.
core; core stability
During the regional examination of pt's Double Knees-to-Chest, the PT notes they can only get to 95 degrees before their sacrum lifts up. What is normal ROM? a) 90 b) 180 c) 100 d) 120
d) 120 degrees
How long should you wait to follow up with a patient after a manipulation to re-assess disability? a) 1-2 weeks b) 3-4 days c) 1-2 days d) 2-4 days
d) 2-4 days
How many positive items do you need to have to rule IN an SI joint issue? a) 2/5 b) 5/5 c) 4/5 d) 3/5
d) 3/5 have to be positive
For Herniated Nucleus Pulposis (HNP), use ________ mode for lumbar mechanical traction. a) 30:10 - intermittent b) 30:10 - sustained c) 60:20 - intermittent d) 60:20 - sustained
d) 60:20 - sustained
During the regional examination of pt's Active Straight Leg Raise, the PT notes they can only get to 45 degrees. What is normal ROM? a) 65 b) 45 c) 55 d) 70
d) 70 degrees for ASLR
Which of the following is NOT part of the Clinical Predictive Rule for a Lumbar Manipulation? a) no pain past the knee b) less than 16 days duration; acute pain c) one hypomobile lumbar segment d) > 20 degrees of hip internal rotation e) FABQ <19
d) >20 degrees IR - should be >35 degrees of hip IR
Patient X has low back pain symptoms distal to their buttocks that moves up to their low back when bending backward and walking but moves further down the leg during sitting and touching their toes. What would be appropriate treatments? a) Prone lying & extension exercises every hour b) Educate patient to avoid sleeping in a fetal position, don't sit for >20 min at a time, & use towel roll if driving/sitting c) Progress to quadruped bird dogs, bridging, extension-based rolling, and improving hip extension ROM d) All of the above e) None of the above
d) All of the above
Which of the following would be appropriate treatment techniques for a patient with a right lateral shift? a) Prescribe prone press-ups and side-glides into a wall towards the left b) Manually translate the pelvis to the left c) Educate pt. to avoid asymmetrical movements d) All of the above e) None of the above
d) All of the above
Patient Z came in with bouts of low back pain that sometimes shoots down his leg into his foot. Patient had a (+) passive straight leg raise and (+) crossed straight leg raise. After classifying him into the Direction Specific Exercise category, you perform a thorough Repeated Movement Testing that leads to NO centralization. Which of the following should you do next? a) Send them to their primary care physician right away b) Classify them into the stabilization category c) Continue the Repeated Movement Testing until symptoms centralize d) Classify them into the traction category
d) Classify them into the traction category
__________ stability is dependent upon the functional relationship of the joints above and below the lumbar spine. a) Lumbar b) Thoracic c) Cervicothoracic d) Core
d) Core
Patient Z presents to the clinic with her hips shifted to the right in a visible frontal plane deviation. What would be her diagnosis? a) Mobilization/Manipulation b) Direction Specific - Right Lateral Shift Responder c) Traction d) Direction Specific - Left Lateral Shift Responder e) Stabilization
d) Direction Specific - Left Lateral Shift Responder
____________ is SO IMPORTANT for treating low back pain!!! a) Thoracic rotation mobility b) Sacral tilt mobility c) Hip flexion mobility d) Hip extension mobility
d) Hip Extension Mobility
Which of the following movements are unloaded? a) Toe touch b) Backward bend in standing c) Side glide in standing d) Knee-to-chest rocking e) Prone press-up
d) Knee-to-chest rocking e) Prone press-up
What is the MOST important thing to remember when performing the General Lumbosacral Manipulation? a) stand opposite side to be manipulated b) side bend away/rotate towards you c) provide high velocity, low amplitude thrust through the pelvis d) maintain the side bend
d) MAINTAIN THE SIDE BEND !!!!
Which stage of disc herniation: Annulus ruptures and fragments becomes lodged in epidural space. a) Stage 1 - Protrusion b) Stage 2 - Prolapse c) Stage 3 - Extrusion d) Stage 4 - Sequestration
d) Stage 4 - Sequestration
For a rotated innominate - a) muscle energy technique should be used b) discourage patient from asymmetrical movement patterns c) prescribe lots of hip and core stability exercises d) all of the above e) none of the above
d) all of the above
Which of the following could qualify as a space-occupying lesion? a) herniated disk b) bone spur c) tumor d) all the above e) none of the above
d) all the above
Which muscle has the following referral pattern: Pain down the posterior leg that looks a lot like sciatica. a) iliopsoas b) glute medius c) multifidus d) glute min
d) glute min
Patient X had 5/5 positives on the lumbar manipulation CPR. What is their likelihood ratio? a) 1.52 b) 2.61 c) 24.38 d) infinite
d) infinite
A left posteriorly rotated innominate would need a Muscle Energy Technique that activates the ________ hip flexors and __________ hip extensors. a) left; left b) right; left c) right; right d) left; right
d) left hip flexors, right hip extensors
A right anteriorly rotated innominate would need a Muscle Energy Technique that activates the ________ hip flexors and __________ hip extensors. a) left; left b) right; left c) right; right d) left; right
d) left hip flexors, right hip extensors
The ___________ is similar to PNF pattern work in which, instead of using stretching, we are using the patient's own muscles to facilitate or inhibit tone in order to get everything back in alignment. a) general lumbosacral manipulation b) PA glides c) anterior and posterior pelvic tilting d) muscle energy technique
d) muscle energy technique
What is a positive test of the Sign of the Buttock? a) symptoms in leg improve b) increased hip flexion c) reproduction of back/leg pain <45 degrees d) no change in hip flexion with knee straight or flexed
d) no change in hip flexion with knee straight or flexed - (-) test: increased hip flexion
Which of the following is NOT one of the demographic and physical exam variables used to categorize LBP patients? a) pain intensity b) fear-avoidance level c) duration of symptoms d) pain below the hips e) movement characteristics f) response to repeated movements
d) pain below the hips - should be knees
Which muscle has the following referral pattern: Around the greater trochanters, often confused with trochanteric bursitis. a) glute med b) multifidus c) erector spinae d) quadratus lumborum
d) quadratus lumborum
Which of the following is NOT one of the treatment-based classification categories for acute LBP? a) Stabilization b) Traction c) Manipulation/mobilization d) Repeated exercise e) Direction specific exercise
d) repeated exercise
What is a positive Slump Test? a) symptoms in leg improve b) pain in the opposite leg c) reproduction of back/leg pain <45 degrees d) reproduction of back/leg pain
d) reproduction of back/leg pain
Which ligament is more vulnerable to sacral flexion? a) facet capsulary ligament b) sacrospinous ligament c) interspinous ligament d) sacrotuberous ligament
d) sacrotuberous ligament
If a patient is negative on the CPR but demonstrate a clear closing pattern of pain - limitation with extension and pain with ipsilateral side-bending - then consider which technique? a) non-thrust PA mobilization b) supine pistol grip c) general lumbosacral manipulation d) sidelying neutral gapping manipulation
d) side-lying neutral gapping manipulation
Which of the following is NOT true about lumbar manipulations? a) a neurophysiological response occurs b) disability reduction is not related to the specific type of manipulation c) afferent input into the system interacts with either excitatory or inhibitory interneurons, which helps reduce tone and tension and allows joints to glide better d) the thrust allows us to put joints and structures back into their proper place
d) the thrust allows us to put the joints and structures back into their proper place
Which of the following is the least helpful in the SI joint dysfunction Test Item Cluster? a) Distraction b) Thigh Thrust c) Compression d) Sacral Thrust e) Gaenslen
e) Gaenslen
What is the MOST important thing to remember when performing the Side-Lying Neutral Gapping Manipulation? a) effected side is up b) flex the hip to lock from the bottom and rotate the trunk to lock from the top c) palpate the interspinous space btw 2 vertebrae d) perform high velocity, low amplitude thrust e) log roll
e) LOG ROLL
Patient W is a 16-year-old female gymnast. She reports bouts of low back pain that shoots down her left leg during her routine when she does backflips but says the pain returns to her low back when she bends forward as if to touch her toes. What diagnosis would you give this patient? a) Highly stenotic lumbar spine b) Mobilization/Manipulation c) Direction Specific - Extension Responder d) Needs further eval to tell e) None of the above
e) None of the above - Direction Specific - Flexion Responder
Which of the following is a reason why SI dysfunction is very controversial in orthopedic medicine? a) prevalence of joint issues b) the type of joint c) movement of the joint d) accuracy of imaging and clinical exam (palpation) e) all of the above f) none of the above
e) all of the above
In ________, your discs are losing height, causing bone-on-bone rubbing which can create bone spurs. a) herniated disc b) facet arthritis c) SI joint lesion d) spondylolisthesis e) degenerative disc disease
e) degenerative disc disease
Which of the following is not part of the LBP Traditional Approach? a) definition by duration b) rule out "red flags" c) use of NSAIDs d) continue current level of activity e) discontinue current activity
e) discontinue current activity
Keeping the knees together during the Double Knees-to-Chest assessment takes out the _____________ in order to isolate hip flexors to see if those are limiting hip flexion ROM.
hamstrings