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A 60-year-old semi-retired female with a diagnosis of degenerative spondylolisthesis (DS) was referred to physical therapy by an orthopaedic spine surgeon. She first experienced pain about 4 weeks ago after walking a golf course and using a pull cart during a tournament. She indicates that she generally rides in a golf cart; however, use of golf carts was prohibited during tournament play. She notices that her pain is localized to her central low back, buttocks, and posterior thighs. Her symptoms worsen as the day progresses. She denies bowel or bladder signs/symptoms, sensation changes, weakness, or episodes of her legs "giving way." She is moderately overweight (BMI = 28 kg/m2) and does not participate in a regular exercise program aside from her biweekly golf game. Her previous medical history includes a history of episodic low back pain and a cesarean section associated with the birth of her second child 35 years ago. She has a history of hyperlipidemia and type 2 diabetes mellitus. Her goals are to reduce her pain to allow her to cook meals for her family and to resume 18 holes of golf twice weekly without use of a golf cart.

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Based on the patient's diagnosis, what do you anticipate may be the contributing factors to her condition?

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What are the most appropriate examination tests?

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What are the most appropriate physical therapy interventions?

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What are possible complications that may limit the effectiveness of physical therapy?

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What is her rehabilitation prognosis?

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DEGENERATIVE SPONDYLOLISTHESIS (DS): Acquired anterior displacement of one vertebra over the subjacent vertebra, associated with degenerative changes and without a disruption or defect in the vertebral ring

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NEUROGENIC CLAUDICATION: Pain, paresthesias, and cramping of one or both legs due to neurologic compromise; typically brought on by standing or walking and relieved with sitting

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SEGMENTAL INSTABILITY: Decreased capacity of the spine's stabilizing system to maintain the spinal neutral zones within physiological limits so that there are no neurologic deficits, major deformities, or incapacitating pain

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SPINAL STENOSIS: Narrowing of the central spinal canal or intervertebral foramen at a single or multiple levels that can compress nerves and adjacent structures

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SPONDYLOLYSIS: Defect in the pars interarticularis portion of the vertebrae; typically occurs in the lower lumbar vertebrae

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SPONDYLOSIS: Degenerative changes in the intervertebral discs and osteophytic changes in the associated vertebral bodies

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  1. Describe degenerative spondylolisthesis (DS) and potential risk factors associated with this condition.

  2. Provide appropriate educational interventions for the individual with DS.

  3. Design and implement manual therapy interventions to address the impairments common to individuals with DS.

  4. Prescribe appropriate strength, endurance, flexibility, and motor control exercises for individuals with DS.

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PT considerations during management of the individual with ...

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