Podcast
Questions and Answers
Which classification is primarily concerned with sustained or repetitive loading affecting spinal tissues?
Which classification is primarily concerned with sustained or repetitive loading affecting spinal tissues?
What is NOT a typical sign of derangement syndrome?
What is NOT a typical sign of derangement syndrome?
What symptom specifically indicates involvement of the nerve tissue?
What symptom specifically indicates involvement of the nerve tissue?
In movement systems impairments, which syndrome is characterized by pain in the direction of restricted soft tissue motion?
In movement systems impairments, which syndrome is characterized by pain in the direction of restricted soft tissue motion?
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Which of the following assessments focuses on joint play and capsular involvement?
Which of the following assessments focuses on joint play and capsular involvement?
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What does a positive lumbar compression test indicate when performed in extension?
What does a positive lumbar compression test indicate when performed in extension?
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Which type of tissue can be inferred as involved if a patient experiences pain with palpation and stretching?
Which type of tissue can be inferred as involved if a patient experiences pain with palpation and stretching?
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Which feature is associated with the Dysfunction Syndrome?
Which feature is associated with the Dysfunction Syndrome?
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What is the primary symptom Phil reports that suggests a lumbar classification diagnosis?
What is the primary symptom Phil reports that suggests a lumbar classification diagnosis?
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Which treatment-based classification might be appropriate for Phil based on his symptoms and history?
Which treatment-based classification might be appropriate for Phil based on his symptoms and history?
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Which of the following special tests was positive in Phil's assessment?
Which of the following special tests was positive in Phil's assessment?
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Based on Phil's report of pain that increases with standing and decreases with sitting, which clinical classification principle is best represented?
Based on Phil's report of pain that increases with standing and decreases with sitting, which clinical classification principle is best represented?
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What does the finding of hypomobile central PAs at L4 and L5 suggest in the context of Phil's condition?
What does the finding of hypomobile central PAs at L4 and L5 suggest in the context of Phil's condition?
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Which key aspect of Phil's subjective assessment supports the need for further evaluation of lumbar stability?
Which key aspect of Phil's subjective assessment supports the need for further evaluation of lumbar stability?
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Given the content provided, what is a potential risk factor for Phil's lower back pain based on his demographic?
Given the content provided, what is a potential risk factor for Phil's lower back pain based on his demographic?
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Which of the following is NOT part of the criteria for diagnosing pain control according to treatment-based classification for lumbar conditions?
Which of the following is NOT part of the criteria for diagnosing pain control according to treatment-based classification for lumbar conditions?
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What is the primary focus of the McKenzie Method in patient evaluation?
What is the primary focus of the McKenzie Method in patient evaluation?
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What happens to the symptoms during test movements for a patient with Rotation Syndrome?
What happens to the symptoms during test movements for a patient with Rotation Syndrome?
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How does the Mechanical Diagnosis and Therapy (MDT) approach differ from traditional pathoanatomical diagnosis?
How does the Mechanical Diagnosis and Therapy (MDT) approach differ from traditional pathoanatomical diagnosis?
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Which of the following does NOT form part of the evaluation from a mechanical perspective in MDT?
Which of the following does NOT form part of the evaluation from a mechanical perspective in MDT?
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What is expected to occur when a patient performs repeated movements that centralize their symptoms?
What is expected to occur when a patient performs repeated movements that centralize their symptoms?
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What is indicated by the peripheralization of symptoms during test movements?
What is indicated by the peripheralization of symptoms during test movements?
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Which type of classification system focuses on the patient’s response to movements instead of conventional anatomical labels?
Which type of classification system focuses on the patient’s response to movements instead of conventional anatomical labels?
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During the examination, what is critical for the therapist to formulate a working hypothesis regarding mechanical classification?
During the examination, what is critical for the therapist to formulate a working hypothesis regarding mechanical classification?
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Study Notes
Cervical Treatment-Based Classification
- Whiplash or MVA, symptoms less than 30 days, pain greater than 7/10 or NDI greater than 52, cervical mobilizations and ROM exercises are indicated
- Pain greater than 30 days, pain less than 7/10 or NDI less than 52, pain centralizes, and there are signs of nerve root compression, cervical traction and retraction exercises are indicated
- Symptoms distal to the elbow, cervical traction may be indicated
Lumbar Classification for the Patient
- Patient presents with LBP of 3-year duration
- Pain increases with standing and walking, decreases with sitting.
- Pain is localized to the lower lumbar region, no numbness or tingling.
- Patient’s goal is to be able to walk 5 miles without pain
- Patient had prior treatment for the same pain in high school with questionable success
Examination Findings
- Subjective: Gradual onset of LBP, 3 years ago, localized to lower lumbar, increased with standing and walking, decreased with sitting.
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Objective:
- AROM: Lumbar flexion - 25% with no pain; Lumbar extension - 50% with pain; Repeated lumbar flexion - no pain; Repeated lumbar extension - with pain and increased ROM
- MMT: LE, abdominals, and paraspinals 5/5, no pain
- Palpation: TTP lumbar paraspinal musculature and spinous process of L4 & L5
- Neuro: Unremarkable
- Joint Accessory Motion: Central PAs at L4 and L5 are hypomobile and painful
- Special Tests: + quadrant test to each side, negative lumbar compression, + lumbar distraction, negative passive lumbar extension test, negative active SLR test, negative SIJ special tests
Postural Assessment Findings
- L iliac crest elevated
- R shoulder lower than L
- Forward shoulders
- Mild swayback
Further Examination Findings
- AROM: Forward bending – excessive hamstring length, did not reverse lumbar curve (hypomobile), excessive thoracic flexion; Backward bending – ROM painful, more pain with overpressure; SB within normal limits (WNL); Rotation painful each side
- PROM: Within normal limits (WNL) motion; Mild pain with extension and rotation
- Joint Play: Central PAs – pain with L5; Unilateral lumbar PAs – pain at L4 & L5; Grade 3 throughout
- Palpation: TTP – L4 & 5 SPs
- Special Tests: Lumbar compression – negative in flexion, positive in extension
Pathoanatomic Classification
- Skin: Painful to palpate & stretch
- Ligament & Fascia: Painful to palpate & stretch
- Muscle & Tendon: Painful to palpation, stretch, & resist
- Joint Capsule: Painful to palpate & stretch, painful joint play
- Bursa: Painful to palpate & compress
- Meniscus (knee): + special tests, ROM, & history
- Articular Cartilage: Painful to compress & painful joint play
- Nerve: + neurological testing
- Disc: Painful to compress, painful to shear, decrease pain with distraction
- Bone: Painful with percussion & palpation; imaging
Movement System Impairments
- Lumbar Spine Classification Categories: Flexion syndrome, Extension Syndrome, Rotation Syndrome
Mechanical Diagnosis and Therapy
- Classification Syndromes: Derangement syndrome, Dysfunction syndrome
- Derangement Syndrome: Most frequent, potentially synonymous with discogenic pain. Symptoms include radiating or radicular pain. Repeated movement testing often reveals centralization/peripheralization.
- Dysfunction Syndrome: Contracted, adhered, or adaptively shortened tissues surrounding one or more spinal segments. Pain is produced when restricted surrounding tissues approach the end range of motion. Observed in the same direction as pain production.
Mechanical Diagnosis and Therapy: McKenzie Method
- Developed a classification system based on the individual's symptom and mechanical response to movement and position.
- Exam focuses on repeated movements and sustained positions, monitoring for changes in symptoms and ROM.
- Employs self-intervention procedures and behavior modifications.
- Systematic approach to conservative management of most activity-related spinal disorders.
- Classifies patients based on symptomatic response to movement and position, rather than pathoanatomical diagnoses.
Mechanical Diagnosis and Therapy: Examination
- Patient’s symptomatic and mechanical response to loading guides classification and intervention.
- Comprehensive history includes MOI, symptoms, and functional limitations, formulating an initial working hypothesis.
- Physical exam confirms or refutes the working hypothesis by testing the patient's symptomatic response to loading, and by observing the quality and quantity of movement.
Mechanical Diagnosis and Therapy: Test Movements
- Repeated movements for one rep followed by ten reps.
- Record the effect on the patient’s symptoms during and immediately following movement: produces, abolishes, increases, decreases, no effect, centralizing, peripheralizing.
- Once the patient returns to the neutral position and rests for a few moments, record the effect of movement on symptoms.
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Test movements include:
- Flexion in Standing
- Extension in Standing
Rotation Syndrome
- Rotation in flexion or extension is painful
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