AAT Midterm Study Guide PDF

 Know your listings, prone set-ups, prone mobilizations, side postures & motion/ restrictions o If you don’t know them, do better. I won't list them here.  Lumbopelvic biomechanics o Sacrum  Open-packed position  Less lordosis...

 Know your listings, prone set-ups, prone mobilizations, side postures & motion/ restrictions o If you don’t know them, do better. I won't list them here.  Lumbopelvic biomechanics o Sacrum  Open-packed position  Less lordosis  Facets spread apart  Disc more vulnerable to damage  MC disc herniation when in flexion + rotation  Closed-packed position  More lordosis  At risk for facet syndrome  If PS-SB  Sacral compression test (gentle pressure on SB: P->A)  Could relieve pain  If AI-SB, could increase pain if you do a compression test  Facets of L5 + Sacrum could approximate further o PI ilium  More common  Signs  Low crest & PSIS/ High ASIS  Short leg  Decreased prone thigh extension  Prominent PSIS o AS ilium  Signs  High crest & PSIS/ low ASIS  Long leg  Increased prone thigh extension  Less prominent PSIS o SI Syndrome  Provocative (increases pain)  Weight-bearing,  Sit -> stand  Walking  Palliative (decreases pain)  Laying down  Findings  Pain from SI joint  ~50% of LBP caused by SI issues  Local tenderness  Leg-length inequality  Lig. laxity  Trauma  Sprain/ strain  Pregnancy  Hypomobility  Guarded gait, compensatory mechanisms  Lumbar joints & pathology  Rotational ROM  10-15 degrees  2.5 degrees per joint  Articular cartilage must compress 60% to allow 3 degrees of rotation  >3 degrees of rotation -> micro failure of annular fibers  12 degrees of rotation -> complete macro failure of annular fibers  Facets   Protect IVD from rotational stresses  In flexion facets spread out  Disrupts posterior annular fibers  Disruption greater w/ rotation  Cauda Equina Syndrome (CES)  Caused by midline IVD herniation @ L3, L4, or L5  Signs  Bilateral radiculopathies  Distal paralysis of lower limbs  Sacral sensory loss  Sphincter paralysis  Causes of LBP o Red flags for LBP  Unsteady when standing/ walking  Difficulty passing OR controlling bladder/ bowels  Numbness in bladder/ bowel area could mean cauda equina syndrome  Requires surgery  Previous cancer or osteoporosis  Can still adjust w/ osteopenia but need to keep eye on  LBP w/ unexplained weight loss/ fever o Musculoskeletal  Musculo-lig. injuries  MC cause = lumbar strain/ sprain  Chronic strain/ sprain MC caused by faulty biomechanics of weak muscles  Diagnosis based on  Mode of injury, location of pain, exclusion of nervous system injury & systemic disease  Signs  Pain on palpation  No weakness in legs/ feet  Muscle spasms  Usually relieved by rest  Can be immediate or gradual within 24 hours  Acute trauma/ repetitive micro trauma  Poor biomechanics  Imaging  Xray to rule out fracture, MRI for soft tissues  Treatment  Prolonged bedrest slows recovery  Decreased motion -> decreased strength, flexibility, circulation  Gentle stretching & exercises preferred  Unless it increases pain  HVLA contraindicative if severe/ acute  IVD/ facet degeneration  Degeneration can lead to root impingement through IVF  Facet hypertrophy  Herniated disc into IVF  Facet pain refers to buttocks & posterior thigh  Nerve root irritation  Causes  Direct mechanical pressure  Usually unilateral  Rootlets exiting IVF more susceptible to pressure as there's no epineurium covering them  Chemical changes  Study found that nucleus pulposus caused inflammation   Spinal stenosis (narrowing)  Viral infection  Herpes varicella (chickenpox, shingles)  You'll have shingles only where you had chickenpox  Lumbar radiculopathy  Causes  Herniated disc  Facet arthritis  Spondylolisthesis  Absolute contraindicative to HVLA  Tumors, cysts, hematomas, malignancies  Bone cysts, osteoblastoma  Disc herniation w/ progressive neurological degeneration  Fracture/ dislocation  MC patient w/ lumbar radiculopathy will present w/ sciatica  Dermatomes  L4  Anterolateral thigh, wrapped around to anteromedial foreleg & foot  L5  Posterolateral thigh, wrapped around to anterior foreleg & foot  Sciatica  S1-S5  Buttocks -> posterior legs -> lateral ankles   Myotomes  Muscles stimulated by single spinal n.  L3 = hip flexors  L4 = knee extensors  L5 = knee flexors  S1 = plantar flexors o Visceral  Can refer LBP from abdominal & pelvic organs  e.g. gallstones, kidney stones, aorta, lymph nodes o Systemic  Cancer  MC systemic disease affecting spine  Only accounts for 50 y/o  80% pt w/ malignant spinal neoplasm are >50 y/o  History of cancer  Think it's cancer until you prove it isn't  Red flags  Unexplained weight loss  Pain > 1 month w/o improvement to conservative therapy  Pain not better w/ rest  High sensitivity/ Low specificity  MC source of spinal malignancy  Breast, lung, & prostate cancer  Spinal infection  Absolute contraindication to HVLA  Osteomyelitis  Septic discitis  Spinal TB  Red flags  History of UTI, catheters, skin infections, injection sites, IV drug users  Fever  Medium sensitivity/ high specificity  Compression fractures  MC in pt w/ osteoporosis  Red flags  Osteoporosis  Corticosteroid usage  >50 or >70 y/o  Hx of trauma  Contraindications o Definitions  Contraindication  Problem identified before the procedure  Absolute contraindication  Contraindicative to ANY form of thrust manipulation  Relative contraindication  Potential contraindication depending on severity/ stage  Complications  Problem that occurs after procedure performed  Reversible complication  Pathological condition that is reversible  Onset within 2 days  Tissue damage but can be reversed  Irreversible complication  Onset within 2 days  Permanent tissue damage  Reaction  Episodes of increased symptoms that resolve spontaneously  Normal reaction  Minor increase in discomfort  MC in pt w/ successful treatment  Adverse reaction  Significant discomfort  Least common  Adequate reaction  Normal product of manual therapy  Onset 6-12 hours  Local soreness, tiredness, headache   No decrease in work, ADL's  Duration