CHIR12009 WEEBLY QUESTIONS WEEK TWO

Refer to the notes and powerpoints on instability and hypermobility and answer the following questions:

1. Define idiopathic hypermobility

Idiopathic hypermobility Is defined as a range of joint movement in excess of the usually accepted range,
affecting all joints of the body. This condition is also referred to as ‘loose back syndrome’ and is clinically
silent unless there is some additional stimulus, frequently trauma.

2. Describe the signs and symptoms for ‘loose back syndrome’.

Both peripheral and spinal joint laxity, with usually no pain unless they have sustained poor posture or
trauma.

3. What is the clinical difference between hypermobility and instability?

Muscular control determines the difference between idiopathic hypermobility and instability. In
hypermobility there is excess joint mobility which can be controlled by muscle activity/ In instability, there
is an excess of abnormal range of movement which cannot be controlled by voluntary muscular activity.

4. What is the difference between early and classic lumbar stability?

Early Lumbar instability is defined as a functional condition in which excessive, abnormal segmental
motion and positive instability tests with no neurological deficits. Deformation under load exceeds the
capacity for the tissues to recover and there may be early signs of incipient disc degeneration that occurs
before classic disc involvement.
Classic Lumbar stability is defines as the ability of the spine under physiological loads to maintain
relationships between the vertebrae in such a way as to prevent spinal cord, nerve root damage or
incapacitating deformity.

5. What are the symptoms of Classic Instability?

 Chronic low back pain, interspersed with acute episodes of locking.
 The pain will be described as difficult to localize and as a deep aching and burning.
 The pain is localized and sharp when acute.
 Pain may increase on standing or extending from a bent or a straight position.
(DYNAMIC)
• History of LBP and morning stiffness
• Increase in pain when extremes of movement are maintained for 15 to 20 seconds
• A catch or twinge distorting one or more lumbar movements-usually flexion but sometimes others
• A tendency to grasp thighs when returning from flexion
• Excessive movement on passive physiologic movement testing by comparison with adjacent segments.

6. Describe the lumbar spinal Instability test.

 Patient’s torso is prone on couch with knees on floor.
 Examiner applies a pressure over the motion segment, while the patient relaxes.
 Patient isometrically contracts the lumbar paraspinal musculature and hip extensor muscles, lifting the
legs off floor.
 Test is positive if pain is produced only during the relaxation phase, and disappears during the contraction
phase. (This indicates muscle action is masking an unstable segment).

7. In general, how would you treat early and classic instability?

 The acute phase treated initially with rest & Ice
 Gentle lumbar flexion distraction to normalize movement in adjacent hypomobile joints.
 Manipulation of hypomobile joints.
 CHIR12009 WEEBLY QUESTIONS WEEK TWO
 Stretching of tight muscles eg. Hamstrings(PNF).
 Coordination training daily on a balance board.
 Stabilisation exercises (preceded by stretching).
 Correction of posture.
 Avoidance of end-range stress.
 Correction of leg length deficiency.
 Back support used to relieve mechanical stresses.
 Trochanteric belt for SI instability

8. What is meant by functional proprioceptive assessment?

The patient balances on one leg at a time with his/her eyes closed. If the patient sways or is unable to
maintain balance a functional impairment in proprioceptive coordination is indicated. This usually occurs with
biomechanical dysfunction due to trauma, whiplash, poor posture etc.

9. The magnitude of shear motion is dependent on a number of factors, what are they?
 Anatomical level
 Magnitude of flexion motion
 Degree of degeneration
 Position of axis of motion.

10. What is the most common location for classic lumbar instability? Explain your answer
Classic lumbar instability occurs more commonly in males usually in the third or fourth decades, and is most
common at L4 level.
.

11. Prepare an illness script for a patient with symptoms from idiopathic hypermobility.

Definition: a range of joint movement in excess of the usually accepted range, affecting all joints of the body
(hypermobility can be controlled by muscle activity). This condition is also referred to as ‘loose back syndrome’
and is clinically silent unless there is some additional stimulus, frequently trauma.
Clinical Notes
- Typically affects young females
- Test findings are usually normal expect for a generalised increase in ROM
- X-ray Examination findings are normal
- Hypermobility is accompanied by decreased stability and these individuals are less likely to adapt to static
overstrain and should avoid jobs which require spending long periods of time in one position.
- Overtime poor coordination and increased frequency of recurring pain occurs due to this disturbed
locomotor function and are unable to form movement patterns to guarantee adequate function for any
length of time, while their nervous system is less capable of dealing with painful stimuli.

Refer to the PDF on the ‘Code of Conduct’ from the Chiropractic Board of Australia and answer the following
questions. Refer to ‘Providing good care’ Section 1

The Code is used to assist the National Board in its role of protecting the public by setting and maintaining
expectations of good practice. TRUE
 CHIR12009 WEEBLY QUESTIONS WEEK TWO
Patients rely on health practitioners to protect confidentiality. TRUE
Good practice is centred on the practitioner not the patient. FALSE
Professionalism only applies to the practitioner patient relationship. FALSE
It is not considered a duty for a professional to keep their skills and knowledge up to date. FALSE