LBP + SIJ Dysfunction

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Questions and Answers

What are the clinical features of rotator cuff tendinopathy?

Pain with overhead activity, tenderness with palpation over tendon most commonly supraspinatus (+ teres minor tendon), painful arc often between 70-120 degrees.

What are the special tests used for diagnosing rotator cuff tendinopathy?

Impingement tests: Neers, empty/full can, Hawkins Kennedy, apprehension test, ER against resistance (weakness with supraspinatus).

What are the recommended treatments for rotator cuff tendinopathy?

Ice/rest/avoid agg activity, strengthen rotator cuff, progress to eccentric exercises, scapula control exercises, surgery for full thickness tears in younger athletes.

What are the monitoring methods and strategies for promoting adherence to physical activity?

Monitoring methods: Pain (0-10, VAS 0-100), self-reported function (disease specific), functional strength testing (30s STS), walking (10MWT, stair climb test), balance (step test, functional reach). Strategies for promoting adherence: Positive therapeutic alliance, agreed SMART goals, consideration of barriers and facilitators, individualized care plan. Signup and view all the answers

Explain the structural changes that precede knee osteoarthritis (OA) following ACLR.

Structural changes precede OA diagnosis, including cartilage volume and thickness due to swelling, not actual cartilage growth, cartilage defects, bone marrow lesions post-ACLR, and cartilage composition/degeneration. Signup and view all the answers

What are the contributing factors to structural changes and early onset knee OA following ACLR?

Contributing factors include neuro-biomechanical, biomechanical, and joint structure factors. Signup and view all the answers

What are some of the neuro-biomechanical changes post-ACLR that contribute to early onset knee OA?

Neuro-biomechanical changes post-ACLR include increased knee extension, external tibia rotation, weakness, reduced quad contraction/force, increased co-contraction, and reduced knee flexion movement. Signup and view all the answers

How are joint forces related to the onset of knee OA following ACLR?

Lower knee joint forces/loading are associated with increased risk of OA, suggesting underloading may be more concerning than overloading in OA pathogenesis. Signup and view all the answers

What does the evidence show about underloading in both TFJ and PFJ contact forces following ACLR?

Evidence shows underloading in both TFJ and PFJ contact forces following ACLR, increasing the risk of OA. Signup and view all the answers

What are some strategies for knee OA prevention following ACLR?

Strategies include early return to play (RTP), weight management, physical activity, muscle strength, fear of movement, diet, inaccurate/unrealistic beliefs, playing/running surface, and footwear. Signup and view all the answers

What is lacking in terms of evidence for the most effective exercise protocol for back pain?

Evidence is lacking for the most effective exercise protocol for back pain. Signup and view all the answers

What are the three main domains to assess when evaluating back pain?

The three main domains to assess are patho-anatomy, movement, and psycho-social factors. Signup and view all the answers

What is included in the patho-anatomy of back pain?

Patho-anatomy includes vertebral segments, discs, spinal cord, dura mater, conus medullaris, epidural fat, and cauda equina. Signup and view all the answers

How is disc degeneration categorized, and does it always present with pain?

Disc degeneration is categorized as specific vs. non-specific, and evidence shows disc degeneration does not necessarily present with pain. Signup and view all the answers

What driver of lower back pain is supported by moderate evidence?

Moderate evidence supports a movement-based driver of lower back pain. Signup and view all the answers

How do emotional responses to pain impact injury and recovery?

Understanding emotional responses to pain impacts injury and recovery. Signup and view all the answers

Explain the difference between peripheral sensitisation and central sensitisation in the context of pain perception.

Peripheral sensitisation refers to pain originating at the peripheral nerves, while central sensitisation is pain originating from the brain/spinal cord where modulation of the pain pathway occurs and interferes with how pain is experienced. Signup and view all the answers

List the multifactorial nature of low back pain (LBP) as mentioned in the text.

Genetic factors, pathoanatomical factors, physical factors, neurophysiological factors, psychological factors, and social factors. Signup and view all the answers

Describe the subjective assessment considerations for chronic LBP.

Considerations include recurrent, chronic, acute, specific vs non-specific, mechanical vs non-mechanical vs mixed type of pain, social factors, general health, family history, co-morbidities, and psychological factors. Signup and view all the answers

Explain the movement-based classifications of LBP mentioned in the text.

The movement-based classifications include movement impairment syndromes and the McKenzie approach for mechanical diagnosis and therapy. Signup and view all the answers

Define the difference between movement impairment and control impairment in the context of chronic LBP classification.

Movement impairment refers to pain provoked due to maladaptive loading patterns leading to muscle guarding and co-contraction, while control impairment refers to pain provoked due to the patient not being able to avoid performing provocative movement. Signup and view all the answers

Discuss the physical assessment methods for chronic LBP mentioned in the text.

Physical assessment methods include provocation testing (slump test, SLR), sensory testing (sharp pressure, two-point discrimination, hot/cold), myotome/dermatome/reflex testing, and observation of static posture and dynamic movement. Signup and view all the answers

Explain the summary of physiotherapy management of LBP as outlined in the text.

The summary includes addressing and changing unhelpful mindset/perspective, behavior, encouraging an active lifestyle, educating about the positive effects of exercise, and utilizing cognitive functional therapy, strengthening exercises, lifestyle management, and manual therapy. Signup and view all the answers

Describe the MDT approach mentioned in the text for managing LBP.

The MDT approach involves routine assessment of activity limitations, thrust manipulations, non-thrust mobilization, trunk coordination/strengthening/endurance exercises, and repeated exercises in specific directions to improve mobility and reduce pain. Signup and view all the answers

Explain the concept of peripheral pain sensitisation in the context of tissue damage.

When tissue damage occurs, it increases the sensitivity of peripheral nerves, leading to sensations such as primary hyperalgesia and allodynia. Signup and view all the answers

Discuss the potential causes of SIJ dysfunction and the physical examination for SIJ pain.

SIJ dysfunction can be due to hypermobility (e.g., with pregnancy) or hypomobility. Physical examination for SIJ pain includes observing static posture/dynamic movement, checking for leg length discrepancy, observing gait, trigger point assessment, and specific tests like Laslett’s test. Signup and view all the answers

Explain the purpose of SIJ injection in diagnosing SIJ pain.

SIJ injection is used to confirm the diagnosis of SIJ pain, as pain relief after the injection indicates SIJ dysfunction as the source of pain. Signup and view all the answers

Summarize the potential referral criteria for MRI/imaging in the management of LBP.

MRI/imaging should only be referred if serious pathology is suspected. Signup and view all the answers

Explain the categories of low back pain presentations mentioned in the text.

The categories of low back pain presentations include specific causes, isolated LBP, LBP with limb dominant, and abnormal pain behavior. Signup and view all the answers

What are the management strategies for each category of low back pain?

Management strategies include referral, therapy, medication, and surgical options for each category of low back pain. Signup and view all the answers

What conditions are encompassed by the umbrella term 'spondylarthritis'?

The umbrella term 'spondylarthritis' includes conditions like ankylosing spondylitis, reactive arthritis, and psoriatic arthritis. Signup and view all the answers

What are the criteria for diagnosing inflammatory back pain (ankylosing spondylitis) and its clinical manifestations?

The criteria for diagnosing inflammatory back pain include specific symptoms and clinical manifestations such as morning stiffness and improvement with exercise. Signup and view all the answers

How is ankylosing spondylitis assessed and differentially diagnosed?

Assessment and differential diagnosis for ankylosing spondylitis involve distinguishing it from conditions like mechanical back pain and osteitis condensans ilii. Signup and view all the answers

How are hamstring injuries classified, and what are the types mentioned in the text?

Hamstring injuries are classified into high-speed running and excessive stretching types. Signup and view all the answers

What are the prognosis and management options for hamstring tears mentioned in the text?

The prognosis and management of hamstring tears involve different phases of treatment and specific exercises. Signup and view all the answers

What does the neurological assessment for hamstring pain include?

The neurological assessment for hamstring pain includes indications and contraindications for certain tests. Signup and view all the answers

What is the mechanism of ACL injury and what are the treatment options mentioned in the text?

The mechanism of ACL injury involves understanding how the ligament tears, and treatment options include conservative and surgical approaches. Signup and view all the answers

What outcomes are mentioned following ACL reconstructions?

Outcomes following ACL reconstructions include thigh muscle strength and knee function. Signup and view all the answers

What risk is associated with knee osteoarthritis in ACL injury patients 10-15 years post-injury?

There is an increased risk of knee osteoarthritis in ACL injury patients 10-15 years post-injury. Signup and view all the answers

What is the importance of muscular strength, endurance, and agility in conservative treatment of ACL injuries?

Muscular strength, endurance, and agility play an important role in the conservative treatment of ACL injuries, aiding in rehabilitation and prevention of re-injury. Signup and view all the answers

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Study Notes

Rheumatology, Spinal Conditions, and Musculoskeletal Injuries Overview

Categories of low back pain presentations: specific causes, isolated LBP, LBP with limb dominant, and abnormal pain behavior
Management strategies for each category of low back pain, including referral, therapy, medication, and surgical options
Spondylarthritis as an umbrella term for conditions like ankylosing spondylitis, reactive arthritis, and psoriatic arthritis
Criteria for diagnosing inflammatory back pain (ankylosing spondylitis) and its clinical manifestations
Assessment and differential diagnosis for ankylosing spondylitis, including mechanical back pain and osteitis condensans ilii
Classification of hamstring injuries into high-speed running and excessive stretching types
Prognosis and management of hamstring tears, including phases of treatment and specific exercises
Neurological assessment for hamstring pain, including indications and contraindications for certain tests
Mechanism of ACL injury and treatment options, including conservative and surgical approaches
Outcomes following ACL reconstructions, such as thigh muscle strength and knee function
Increased risk of knee osteoarthritis in ACL injury patients 10-15 years post-injury
Importance of muscular strength, endurance, and agility in conservative treatment of ACL injuries

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