L8 Special Considerations

Question 1

Key Exam Findings for SI joint dysfunction

Answer 1

• does not centralize with repeated lumbar movements
• need 2/4 positive tests of the SI joint tests
• positive active SLR test

Question 2

Interventions for SI Joint Dysfunction

Answer 2

• lumbosacral regional manip
• MET
• stabilization, belt, tapping
• stabilization exercise

Question 3

Sacrum Joint Overview

Answer 3

• sacrum and two innominates
• large stable joint due to convoluted surface and very strong anterior and posterior ligamentous structures
• 35 muscles attaching on the sacrum and innominates

Question 4

Incidence and Prevalence of SI Joint Disorders

Answer 4

very wide range

.4% to 98% depending on diagnostic criteria

more widely accepted to be 10-22% of idiopathic back and butt pain

Question 5

RF for SI Joint Dysfunction

Answer 5

• post operative lumbar fusions (depends on # of fused vertebrae)
• pregnancy due to increased laxity and altered COM
• hypermobility
• high energy trauma such as fall or MVA
• previous hx of BP

maybe related to leg length discrepancy, scoliosis, hip OA

Question 6

Possible causes of dysfunction

Answer 6

• rotation of innominate
• torsion
• nutation/counternutation
• upslip/downslip
• inflare/outflare

Question 7

Posterior Rotation might present as

Answer 7

• decreased hip extension during long stride gait
• apparent leg length shorter on that side
• LBP during squat

Question 8

Anterior Rotation might present as

Answer 8

• decreased gluteal activation on that side
• tight spasmed parapspinals
• limited hup flexion during squat
• adaptively shortened hip flexors and rectus femoris if chronic

Question 9

SIJ Dysfunction Common things seen in exam

Answer 9

• pain is reported inferomedial to PSIS
• alterations in gait
• should observe squatting, lateral step down, SLS, hopping
• loss of sagittal and frontal plane motion with pain
• overpressure may be provocative

Question 10

SIJ Provocation Tests

Answer 10

1. Thigh Thrust = 3-4 downward thrusts
2. Distraction = forces on ASIS
3. Compression = greater trochanter for 10s
4. Sacral Thrust = 3-4 thrust on post sacrum
5. Gaenslen’s = maxxing hip flex and hip ext

Question 11

SIJ Management

Answer 11

• manual therapy - joint mob, manip, MET, manual stretching, STM
• gait training
• postural re-ed
• strengthening
• taping to support correction

Question 12

Anteriorly Rotated on the Right SIJ MET

Answer 12

right glues push and L hip flexors pull 3-5 seconds for 3-5 sets

need extensors to pull pelvis back

Question 13

Posteriorly Rotated on the Right SIJ MET

Answer 13

right hip flexors pull and R glutes push 3-5s for 3-5 sets

need flexors to pull pelvis forward

Question 14

Shotgun Technique

Answer 14

• using the abd/add to reset SIJ and pubic symphysis
• pt is supine hooklying
• abduct into PT’s hands 5 seconds at multiple progressive angles
• PT forearm placed between knees and pt adducts into 5s
• reassess for symptoms and impairments

Question 15

Lumbar fusions

Answer 15

rates continue to go up, especially post-traumatic and elderly populations

good for spondylolisthesis and scoliosis, not great for DDD or DJD

Question 16

Indications for Lumbar Fusions

Answer 16

progressive, neurologic symptoms and/or severe instability

failed conserative care

Question 17

Types of surgical approaches for lumbar fusions

Answer 17

PLIF = decompression of lateral foramen

TLIF = complete removal of facet joint

ALIF = anterior approach for revision after failure

Question 18

Post-Operative Complications for Lumbar Fusions

Answer 18

LOTS of complications

Myocardial infarcation
pulmonary embolus
CSF leaking
vertebral fractures

Question 19

Post Fusion Rehab

Answer 19

• preferably pt had PT before surgery
• watching for numerous complications
• protect incision and surgical site until anatomic fusion occurs
• focus on ADLs initially
• most likely won’t be totally pain-free

Question 20

Stabilization Clinical Findings

Answer 20

• younger age <40
• 3+ prior episodes
• increasing frequency of episodes
• aberrant movement patterns
• SLR > 91°
• pos prone instability test
• general hypermobility

Question 21

Interventions for Stabilization

Answer 21

local activation of deep core
general strengthening
postural awareness

Question 22

Aberrant movement patterns

Answer 22

gower’s sign
altered lumbopelvic rhythm
deviation from sagittal plane
painful arc of motion
instability catch or judder

Question 23

Indictors of Failure with stabilization program

Answer 23

neg prone instability
hypomobility to spring test
aberrant motion absent
FABQ score <9

Question 24

Sorenson’s test predictive values

Answer 24

LBP <176s
no LBP >198s

3x more likely to have LBP <58s

Question 25

Grade 5 prone plank

Answer 25

120s or more

Question 26

Grade 4 prone plank

Answer 26

<90 seconds

Question 27

Grade 3 Prone Plank

Answer 27

can assume but can't hold it

Question 28

Grade 2 Prone Plank

Answer 28

on knees instead of toes

Question 29

Normal timing for side plank test

Answer 29

94s males 72s females

Question 30

Motor Control Exercises for Sagittal

Answer 30

promoting flexion activities like bridges, bird/dog watching for anterior/poterior pelvic tilt error

Question 31

Motor Control Exercise for Frontal Plane

Answer 31

Abduction/Adduction motion fire hydrant, walking with kettle bells in each hand watching for lateral ean error

Question 32

deadlift clinical progression

Answer 32

1. Assessment for adequate mobility and stability 2. Hip hinge with dowel 3. Hip hinge with dowel press 4. Wall touch 5. Banded pull through 6. Banded pull up 7. Banded extension 8. Elevated deadlift

Question 33

Squat Teaching Progression

Answer 33

1. Watch in all three planes with body weight 2. Assess for adequate mobility and stability 3. Squat sit to stand with dowel 4. Wall sit to assisted squat to chair/box squat 5. goblet squat to back squat to front squat to overhead squat