Spinal Flexion Exercises Classification

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Questions and Answers

What does centralization signify during movement testing?

Pain intensifies and spreads distally from the spine.

A new paresthesia appears while moving.

No change in pain is observed during movement.

Pain or paresthesia moves centrally towards the spine. (correct)

What does the term peripheralization refer to in movement testing?

Symptoms do not change with movement.

Pain moves centrally towards the spine.

Pain or paresthesia moves distally, away from the spine. (correct)

Paresthesia is abolished after the movement.

Which of the following represents the Is Status Quo (ISQ) condition?

Pain intensity decreases immediately after the movement.

Neither centralization nor peripheralization is produced. (correct)

There is a transient increase in pain observed.

The pain moves distally during the movement.

During which activity is a person likely classified under flexion?

Sitting. Signup and view all the answers

Which movement testing method is NOT used to identify specific exercise classification?

Elastic band resistance. Signup and view all the answers

Which of the following is a symptom of spinal stenosis?

Weakness and heaviness in the legs Signup and view all the answers

What is the primary compensation seen in a flatback postural syndrome?

Posterior pelvic tilt Signup and view all the answers

What type of claudication is associated with obstruction of blood flow to the nerve?

Neurogenic claudication Signup and view all the answers

Which of the following interventions should be avoided in stenosis treatment?

Extension exercises Signup and view all the answers

In which position during the bike test would symptoms typically increase for patients with neurogenic claudication?

In neutral position Signup and view all the answers

What characteristic is associated with the hyperlordotic postural syndrome?

Anterior pelvic tilt Signup and view all the answers

Which diagnostic tool is typically used to assess spinal stenosis?

X-ray Signup and view all the answers

What symptoms likely improve with flexion in patients with flexion classification?

Pain enhancement with extension Signup and view all the answers

What might patients with flatback syndrome exhibit as a secondary compensation?

Compression of the posterior vertebral elements Signup and view all the answers

A significant characteristic of the treadmill test for patients with spinal stenosis is:

Pain tolerance during normal walking pace Signup and view all the answers

Study Notes

Specific Exercise - Flexion Category

The presentation focuses on spinal flexion exercises and classifications.
Patient history is crucial for identifying directional preferences (sitting vs. standing/walking).
Spinal posture preferences classify exercises as flexion or extension.

Specific Exercise Classification - Identifying Factors

Examination: Centralization during movement testing is key.
- Single test movements (flexion, extension, pelvic translocation) are used.
- Repeated/sustained movements are also considered, especially for chronic cases.

Definitions - Centralization

Centralization: Pain or paresthesia moves towards the spine.
Paresthesia resolves during the movement.
Symptom reduction lasts at least 30 seconds after the movement ends.

Definitions - Peripheralization

Peripheralization: Pain or paresthesia moves away from the spine.
New paresthesia may appear.
Symptoms increase in intensity.
Increased symptom intensity lasts at least 30 seconds after the movement ends.

Definitions - Status Quo (ISQ)

No centralization or peripheralization occurs.
Transient pain increases/decreases, while no changes occur.

Flexion Classification

Stenotic, degenerative spine and postural syndromes.
- Flatback, swayback, and hyperlordotic postures are mentioned.
Special cases like spondylolithesis, adherent root syndromes, and post-surgical sequelae are considered.

Spinal Stenosis

AKA: neurogenic claudication.
Narrowing of the central canal or intervertebral foramina.
- Central stenosis and lateral stenosis are defined.
Male/female ratio is approximately 8:1.
Secondary stenosis occurs due to disc issues.
Older age (> 65 years) and disc wear and tear are contributing factors.
Neurogenic claudication results from neural compromise due to altered blood flow to the nerve.

Subjective Symptoms

Symptoms are mostly bilateral (3:1 ratio).
Common symptoms include localized pain, numbness, pins and needles in legs/calves/buttocks.
Walking short distances can cause weakness, tiredness, and heaviness in the legs.
Physical activity endurance decreases.
Pain is aggravated by extension, prolonged standing/walking, downhill walking and lying flat.
Pain relief is obtained by leaning on objects, flexion, sitting, squatting, walking uphill, and bicycle riding.

Objective Exam/Stenosis

Key aspects include flat lumbar posture and limited/painful extension.
Central and unilateral pain/stiffness are common indicators.
Peripheral pulses should be checked.
X-ray, CT scan, or MRI are diagnostic for evaluation

Objective Exam - Bike Test

In a neutral position, symptoms are worse.
When in a flexed position, symptoms decrease; related to stenosis.
In a flexed position, no change or vascular claudication may occur.
Also, consider treadmill testing, where pain might occur with normal-level or downhill walking but the patient can handle inclines

Intervention

Instructions emphasize ADL (activities of daily living) with a neutral spine.
Flexion exercises and mobility-enhancing exercises (e.g., William's flexion) are recommended.
Stretching of the hamstrings and hip flexors is beneficial..
Intermittent traction, spinal stabilization exercises, and joint mobilization (especially rotation) are further therapeutic options.
Joint mobilization increases space, lessens soft-tissue restriction, and facilitates segmental movement.

Intervention - Other Considerations

Abdominal and gluteal muscle strengthening exercises are also crucial.
No extension exercises are needed to avoid exacerbating the problem.
NSID and epidural steroid injections are medicaments options.

Intervention - Further Considerations

Laminectomy and fusion surgery are potential treatment options for severe stenosis.

Postural Syndrome - Flatback

Increased lumbar flexion, associated posterior pelvic and hip extension.
Compensations include posterior pelvic tilt, hamstring tightness, hip flexor weakness, and stretched posterior longitudinal ligaments.

Postural Syndrome - Swayback

Lumbar flexion, associated posterior pelvic tilt, hip extension, thoracic kyphosis, and forward pelvic displacement.
Compensations involve stretched anterior hip ligaments/muscles, and compression of the posterior vertebral elements.

Postural Syndrome - Hyperlordotic

Increased or excessive lumbar lordosis.
Compensations include anterior pelvic tilt, stretched anterior longitudinal ligaments, lower abdominal muscle stretching, compression of posterior vertebral elements, and shortening of low back extensors/hip flexor muscles.

Flexion Classification - AROM Pattern

Status quo or improvement with flexion.
Pain potentially peripheralizes with extension.
History often shows a preference for flexion.

Flexion Classification - General Considerations

Typical symptoms improve with flexion and worsen with extension in the lumbar spine.
Patients often exhibit a postural and directional preference for specific exercises.
Patients are typically older than 50.
Imaging often reveals lumbar stenosis.

Treatment Program

The treatment program focuses on flexion-oriented exercises, lumbar spine mobilization, de-weighted treadmill ambulation, and individual impairment-specific exercises.
Avoid extension of the lumbar spine.
Aquatic therapy is mentioned as an option.

Unloading

Unloading techniques are a part of the treatment plan for conditions mentioned.

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Description

This quiz covers the classification of spinal flexion exercises and the essential factors in patient assessment. It highlights the importance of patient history, centralization, and peripheralization in identifying movement preferences. Test your knowledge on spinal health with this focused quiz.