Deck 15: The Spine: Management Guidelines

Question 1

Your patient has nerve root symptoms and has been diagnosed as having degenerative joint disease of the spine.The approach for treating the cause of the symptoms should be:

A) Heat and massage.
B) Interventions that temporarily increase the size of the intervertebral foramina.
C) Intermittent setting exercises with the extensor muscles in the shortened position.
D) Relaxation exercises,including head rolls and conscious tension-release techniques.

Answer 1

B

Question 2

A serious complication of rheumatoid arthritis in the spine is:

A) Subluxation due to ligamentous necrosis.
B) Joint effusion.
C) Synovial hypertrophy.
D) Pain.

Answer 2

A

Question 3

Your patient has signs of an acute lumbar intervertebral disk protrusion.On testing,he experiences decreased symptoms when applying manual traction.To use mechanical traction effectively as part of the treatment plan during the early stages:

A) Use sustained traction for 20 minutes with a dosage of at least 50% of the body weight.
B) Use intermittent traction for 20 minutes with a dosage of at least 50% of the body weight.
C) Use sustained traction for less than 10 minutes with a dosage of at least 50% of the body weight.
D) Use intermittent traction for less than 15 minutes with a dosage of less than 50% of the body weight.

Answer 3

C

Question 4

Which of the following is contraindicated for a patient who has undergone L4/L5 laminectomy?

A) Extension exercises of the trunk
B) Joint manipulation at the thoracolumbar junction
C) Flexion exercises of the trunk
D) Strengthening of the transverse abdominals

Question 5

Scheuermann's disease:

A) Is a rheumatic disorder.
B) Results from weakened vertebral end plates.
C) Begins with radicular signs that diminish over time.
D) Requires functionally increasing the lumbar lordosis to prevent development of kyphosis.

Question 6

To prevent adhesions from forming around a nerve root when an individual has an inflammation from a disk lesion,trauma,or surgery:

A) Passive press-ups should be taught.
B) Passive joint mobilizations should be done.
C) Passive straight-leg raises should be done.
D) Passive knee to chest should be done.

Question 7

One day following onset of pain and muscle guarding in the low back region,your patient stands with lumbar flexion and a sciatic scoliosis.Repeated flexion tests increase pain into the buttock.Repeated extension done after side-gliding increases the pain in the midback and decreases the pain in the buttock.You begin treatment by:

A) Positioning the patient supine and having him bring both knees to his chest.
B) Placing the patient in intermittent traction at less than half his body weight for 20 minutes.
C) Having the patient lie prone and attempting passive extension with press-ups or prone propping maneuvers after side-gliding the thorax.
D) Placing the patient on complete bed rest for at least 4 days;applying modalities and massage during that time.

Question 8

All of the following statements are true about functional position (bias)of the spine except:

A) The functional position may change as tissues heal and the individual gains mobility and strength.
B) If a person has an extension bias,it means they have a disk lesion.
C) A person with a non-weight-bearing bias is sensitive to the effects of gravity and feels greatest relief when lying down.
D) The functional position is not a static position but a range where nontraumatic or safe activity can occur.

Question 9

All of these are reasons to assess the thoracic spine during evaluation of patients who present with cervical spine dysfunction except:

A) The thoracic spine becomes unstable with pain and soft tissue dysfunction in the cervical spine.
B) The thoracic spine is prone to hypomobility.
C) There are common muscle attachments between the cervical and thoracic areas.
D) Joint manipulation performed along with high-velocity thrust of the thoracic spine often improves outcomes in patients with cervical complaints.

Question 10

Treating the soft tissue of the back:

A) Is more difficult than treating the extremities because of the way it is innervated.
B) Is usually not necessary because most back pain comes from dysfunction of the facets or disks.
C) Involves using heat rather than cold,massage rather than exercise,and principles that in general are different from those used when treating the extremities.
D) Is no different in principle than treating soft tissues in the extremities.

Question 11

Following recovery of a posterolateral disk protrusion,your patient will be returning to a job that requires prolonged forward bending and stooping.Your instructions to the patient must include:

A) Interruption of the flexed postures at frequent intervals by standing upright and bending backward.
B) Advice to quit that job.
C) No advice-forward bending helps maintain mobility in the spine.
D) Preparing for the forward bending by posterior tilting of the pelvis before bending and stooping

Question 12

The vertebral arteries:

A) Are protected in positions of extreme cervical extension.
B) Cause tension headaches when they are occluded.
C) Are compromised with severe TMJ dysfunction.
D) Enter the transverse foramen of C6 bilaterally in their course to C1.

Question 13

Which of the following SI impairments will probably not respond to muscle energy techniques?

A) Pubic symphysis hypomobility
B) Posterior rotated innominate
C) Anterior rotated innominate
D) Up-slipped innominate

Question 14

All of the following are techniques to increase temporomandibular joint motion except:

A) Placing tongue blades between the front teeth and progressively adding more as tolerated.
B) Placing your thumb and index finger against the patient's incisors and pressing the mandible caudally.
C) Placing dental rolls between the patient's molars and asking him to attempt to close the front teeth.
D) For home exercises,having the patient chew gum for at least 10 minutes,three times a day.

Question 15

All resistive flexion and extension activities and exercises are contraindicated when there is an acute disk lesion because:

A) They cause increased pain.
B) They cause swelling of the nucleus against pain-sensitive structures.
C) They increase the intradiscal pressure.
D) Resisted extension is all right-but not flexion because it increases the bulge.

Question 16

Your patient complains of facial pain,especially when under tension and when eating.All of the following are appropriate except:

A) Jaw relaxation by clicking the tongue and resting the tongue on the hard palate behind the front teeth.
B) Stretching and progressing the strength in the muscles of mastication so they can withstand the stress.
C) Jaw control by placing and keeping the tongue behind the front teeth and opening the mouth only as far as allowed.
D) Relaxation techniques and controlled breathing.

Question 17

Your patient has acute joint trauma to the cervical spinal facets.Every time she attempts neck motions,there is increased pain and muscle guarding.A possible way to maintain integrity in the contractile units of the muscles is to:

A) Apply cold.
B) Do PROM to the cervical spine.
C) Apply heat.
D) Reverse muscle action using gentle scapular motions.

Question 18

Disk lesions are more common in the 30- to 45-year age span because:

A) The annulus begins degenerating,loses tensile strength,and begins to tear with excessive forces.
B) The nucleus pulposus changes in chemical composition during this time and is capable of imbibing greater than normal amounts of water,causing greater than normal pressure against pain-sensitive structures.
C) The facets are wearing out and the entire joint complex is placed under greater stress.
D) This is not the most common age span for disk lesions.

Question 19

Your patient has complaints of increasing low back pain during the day.Her job requires repetitive lifting and reaching overhead (25 lb maximum).On examination,you note that on forward bending she has difficulty moving smoothly midrange and that on side bending to the left there is an acute angle in the midlumbar region.Additional tests lead you to hypothesize that she has clinical instability in the midlumbar region.This could be caused from all of the following except:

A) Degeneration of the intervertebral disk.
B) Poor neuromuscular control of the deep segmental stabilizing musculature.
C) Ligamentous laxity.
D) Advanced spondylitis.