709 1.2 + 1.3 Lumbar spine and Pelvis

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Questions and Answers

What should you know at the end of the subjective assessment?

The client's goals and the treatment plan (correct)

The treatment plan and evaluation method

The evaluation method and client's goals

The assessment findings and treatment plan

What should you have at the end of the objective assessment?

Treatment plan, initial treatment, and evaluation method

Client's goals, treatment plan, and evaluation method

Client's goals, assessment findings, and treatment plan

Assessment findings, treatment plan, and evaluation method (correct)

What should you know after each reassessment of a treatment?

Client's goals and next treatment component (correct)

Objective assessment findings and reassessment plan

Effectiveness of treatment and client's goals

Initial treatment and reassessment findings

Which phase comes after research in the clinical decision-making model?

Evaluation Signup and view all the answers

What does the figure below illustrate?

Physiotherapy practice structure and logic Signup and view all the answers

According to Darrah et al. (2006), what do peripheral and spinal musculoskeletal conditions share?

Core principles of assessment and treatment Signup and view all the answers

How is somatic referred pain defined?

Pain felt in a region innervated by nerves different from the actual source of pain Signup and view all the answers

How is somatic referred pain commonly perceived by patients?

Dull and cramp-like Signup and view all the answers

What is the current literature's stance on the concept of sclerotomes?

Not supported Signup and view all the answers

Which nerve roots consistently follow a dermatomal pattern into the lower extremity?

L5 and S1 Signup and view all the answers

What is the most common quality of radicular pain extending past the ankle?

Sharp and localized Signup and view all the answers

What type of characteristics are linked to the types of pain pathways associated with leg pain?

Both nociceptive and neuropathic characteristics Signup and view all the answers

Based on the text, what does radicular pain projected into the big toe most likely originate from?

L5 nerve root Signup and view all the answers

What is the current literature's view on whether L1 and L2 nerve roots cause radicular pain into their respective dermatomes?

'More research is needed' Signup and view all the answers

'An unpleasant sensory and emotional experience associated with actual or potential tissue damage' is a definition provided by which association?

'International Association for the Study of Pain' Signup and view all the answers

'An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage' is a revised definition provided in what year?

'2020' Signup and view all the answers

What is emphasized in the text regarding treatment sessions?

Knowing where to start in the next session Signup and view all the answers

What do clinicians target when treating someone with an ACL rupture?

Person's impairments Signup and view all the answers

Which statement best describes the approach in treating non-specific low back pain?

Addressing patterns of impairments across various elements Signup and view all the answers

What percentage of people with spinal conditions have a specific diagnosis according to the text?

< 10% Signup and view all the answers

What kind of pain is common in the remaining 90% of people with spinal conditions?

Mechanical back or neck pain Signup and view all the answers

In treating someone with an ACL rupture, what kind of impairments are typically targeted?

Motion impairment Signup and view all the answers

What is the main focus when considering treatment for non-specific low back pain?

Targeting impairments based on patterns Signup and view all the answers

How are muscles described in relation to articulations in the text?

Muscles span one or two joints Signup and view all the answers

What does the 5D's in the cervical spine assessment help determine?

Risk of vertebral artery involvement Signup and view all the answers

Which of the following is NOT considered a cauda equina sign in spinal assessment?

Night sweats Signup and view all the answers

What does the term 'malaise' refer to in the context of general health assessment?

Feeling of general discomfort and uneasiness Signup and view all the answers

What type of symptoms are associated with glove and stocking paraesthesia in spinal assessments?

Tingling and numbness in the extremities Signup and view all the answers

What is one of the key elements to be confirmed when reviewing red flags during medical history screening?

Client's goals Signup and view all the answers

'SMART Goal Framework' is used to ensure that goals are:

Client-centered and achievable Signup and view all the answers

What may help make a patient more comfortable in sidelying?

A pillow under their knees Signup and view all the answers

What is better for a patient: standing or walking?

Walking Signup and view all the answers

What behavior is common and not indicative of a red flag regarding night pain?

Pain wakes the patient at night but eases after changing position Signup and view all the answers

What is typically true about back pain in the morning according to the text?

It is worse at the end of the day Signup and view all the answers

What type of onset is not typical for canal stenosis as mentioned in the text?

Sudden onset Signup and view all the answers

What type of history may vary depending on a client's specific situation?

Social history Signup and view all the answers

What section of a client history includes information about their housing situation and family support?

Social/Environmental history Signup and view all the answers

Which factor may suggest certain diagnoses or clinical patterns in individuals with low back or pelvic symptoms?

"Sudden onset" and predisposing factors Signup and view all the answers

What might be advised for individuals who need to stand for long periods according to the text?

Keeping one foot up, adjusting work height, etc. Signup and view all the answers

What is typically true about leg pain by the end of the day according to the text?

It becomes more constant by the end of the day Signup and view all the answers

Why is having a clear structure to history-taking important in physiotherapy practice?

To ensure all necessary information is obtained Signup and view all the answers

What is the purpose of an open-ended question during information gathering in physiotherapy practice?

To efficiently gather important information and make the client feel listened to Signup and view all the answers

Why is asking about the location of a patient's symptoms important in physiotherapy assessment?

To determine potential pain referral patterns Signup and view all the answers

What does a neuroanatomically plausible structure or location help determine in physiotherapy assessment?

The source of the client's symptoms Signup and view all the answers

Which area is NOT typically asked about when reviewing symptom location in physiotherapy assessment?

Shoulders Signup and view all the answers

What is an example of information that can be gathered from an open-ended question during a physiotherapy session?

Insights into the client's goals and expectations Signup and view all the answers

What is the purpose of using body charts in patient assessments?

To indicate where pain is located and describe the type of symptoms experienced Signup and view all the answers

Why is knowledge of potential pain referral patterns crucial in physiotherapy assessment?

To identify whether a given structure could produce symptoms in the described area Signup and view all the answers

What is true about the locations of symptoms shown on a body map?

They can increase or decrease the likelihood of specific conditions Signup and view all the answers

What is an important benefit of having a structure to history-taking in physiotherapy practice?

To provide a framework for obtaining all necessary information Signup and view all the answers

What caution should be taken when asking questions related to symptom behavior?

Be wary of assuming certain activities make the symptoms worse Signup and view all the answers

Why is it important to gather preliminary information before starting a conversation with a client in physiotherapy practice?

To have an idea of what to ask during the conversation with the client Signup and view all the answers

Which factor is typically indicative of people with Non-Specific Low Back Pain (NSLBP) according to the text?

Experiencing increased leg pain after sneezing Signup and view all the answers

Why should questions about symptom location be specific in physiotherapy assessment?

To obtain accurate information on the extent and distribution of symptoms Signup and view all the answers

According to the information provided, what can be a possible cause of increased back and leg pain after sneezing?

A sudden onset of discogenic origin back pain Signup and view all the answers

How do most people with Non-Specific Low Back Pain (NSLBP) feel when sitting according to the text?

Often worse when sitting in flexion Signup and view all the answers

What is a potential easing factor for leg pain after sitting according to the information provided?

'Crook lying' position after sitting for a few minutes Signup and view all the answers

Why is it important to inquire about how a person gets up from sitting according to the text?

'Extension' movements may guide management plans Signup and view all the answers

'Crook lying' and 'crook sitting' positions are mentioned in relation to what type of condition?

'Piriformis syndrome' Signup and view all the answers

Which activity often worsens sitting symptoms for people with Non-Specific Low Back Pain (NSLBP)?

Sitting in a straight chair for extended periods Signup and view all the answers

Study Notes

History Taking

A structured approach to history taking is essential in physiotherapy practice
It ensures all necessary information is obtained, reduces cognitive load, and provides a structure for the client
The assessment starts with preliminary information, including:
- Referral
- Previous investigations
- Client-completed screening form
- Introduction (including who you are, your role, and your expectations of the session)
- Open-ended question (90-second rule) to gather information about the client's concerns and goals

Body Chart

The body chart is a useful tool to document the location and type of symptoms
It helps to identify the source of symptoms and potential pain referral patterns
Components of the body chart include:
- Symptom location (specific and detailed)
- Type of symptoms (e.g., pain, paraesthesia, anaesthesia)
- Spatial continuity (i.e., connections between symptoms)
- Relevant areas (e.g., low back, upper back, neck, abdomen, groin, legs, feet)
- Saddle paraesthesia/anaesthesia (potential cauda equina lesion)

Behaviour of Symptoms

Behaviour of symptoms includes:
- Constant or intermittent symptoms
- Relationship between symptoms
- Open questions to gather more information (e.g., when symptoms are better or worse)
- Functional activities/work/sport
- Coughing/sneezing
- Standing
- Sitting
- Walking
- Lying
- Irritability
- Red flag questions (if necessary)

Clinical Reasoning

Clinical decision-making model involves:
- Theory
- Assessment
- Intervention
- Research and evaluation
The model helps guide physiotherapy practice and ensures a structured approach to treatment

Somatic Referred Pain

Somatic referred pain is defined as pain perceived as arising from a region of the body innervated by nerves or branches of nerves other than those that innervate the actual source of pain
It occurs due to convergence of afferent neurons from different areas of the body onto a common interneuron before being relayed to higher centers
Characteristics of somatic referred pain include:
- Deep, achy, diffuse, and poorly localized
- Dull and cramp-like
- Not necessarily following a segmental pattern into the lower extremity

Radicular Pain

Radicular pain refers to pain that originates from a spinal nerve root
Patterns of radicular pain are not always clear-cut and may not follow a dermatomal pattern
Radicular pain from L5 and S1 nerve roots consistently follows a dermatomal pattern into the lower extremity, while pain from L3, L4, and S2 nerve roots is less consistent

Diagnosis in Spinal Conditions

Less than 10% of people with low back pain have a specific diagnosis such as spinal canal stenosis, spondylolisthesis, or fractures
The remaining 90% have non-specific low back pain or mechanical back pain
Diagnosis is not essential for treatment, as physiotherapists target impairments across the four elements (motion, force, motor control, and energy) in the context of personal and environmental factors### General Health Screening
Special questions include:
- Other relevant medical history and regular medication
- Other relevant surgical history
- Other relevant family medical history
- Other relevant lifestyle: exercise and physical activity
- Other relevant habits: smoking, alcohol, etc
- Night sweats, night pain, weight loss, confusion, fatigue
- Malaise: Feeling of general discomfort, uneasiness, being “out of sorts”

Cervical Spine

5D’s to determine risk of vertebral artery involvement:
- Dizziness
- Dysarthria (speech)
- Dysphagia (swallow)
- Diplopia (vision)
- Drop attacks

Spine

Cord signs:
- Glove and stocking paraesthesia
- Balance problems
- Postural hypotension
Cauda equina signs:
- Bowel or bladder changes (urinary retention, unable to control anal sphincter)

Cognitive Impairment

In older person:
- Depression
- Delirium
- Dementia

Goals

Confirm client goals using the SMART Goal Framework
Ensure goals are client-centered

Obtain information on:
- Housing situation and other members of the household
- Family or friend support
- Employment (demands of work and relationship with employer)
- Hobbies

Red Flags and Yellow Flags

Review screening form for red flag questions
Identify yellow flags (psychosocial factors)

Physical Assessment

Plan for physical assessment:
- What to assess
- How to assess
- Consider limiting assessment due to irritability
- May need to adjust techniques for comfort (e.g., pillow under knees)

Client History

Cover past medical history, including:
- Onset of symptoms
- Mechanism of injury (if applicable)
- Predisposing factors
- Behaviour/progress of symptoms since onset
- Functional status
- Perception of primary symptoms
- Current and previous examinations/tests/treatments

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Description

Learn about the similarities and differences in assessment and treatment principles for individuals with peripheral and spinal musculoskeletal conditions. Explore a clinical decision-making model and elements of collecting cues and information.