Term
| what are the 3 basic components of a lumbar screen |
|
Definition
| subjective exam, objective exam, treatment ideas |
|
|
Term
| what does a subjective exam entail |
|
Definition
| history, special questions, health-related quality of life instruments |
|
|
Term
| what does an objective exam entail |
|
Definition
| lumbar screen, biomechanical testing |
|
|
Term
|
Definition
| have patient paint the picture for you. Get complete information on ADLs |
|
|
Term
| how can you get the patient to paint the picture for you |
|
Definition
| get the who what when where why of the chief complaint |
|
|
Term
| what can info about ADLs tell you |
|
Definition
| what factors may have predisposed this patient to the problem or might delay recovery |
|
|
Term
| what to ask about pain in lumbar subjective exam |
|
Definition
| aggs/eases, 24-hour pain cycle, pain diagram/where is pain, pain description, |
|
|
Term
| what can pain info from subjective exam help you to form |
|
Definition
|
|
Term
| what special topics should be asked about in subjective lumbar exam |
|
Definition
| bilateral cord symptoms, sleep positoin, pain with cough or sneeze |
|
|
Term
| what special questions to ask about bilateral cord symptoms |
|
Definition
| bilateral numbness/weakness? Drop attacks? Bladder/bowel function? |
|
|
Term
| if a patient has drop attacks preceded by pain, is it neural or muscular |
|
Definition
|
|
Term
| what does pain with cough or sneeze tell you |
|
Definition
| increased pressure on low back/intra-abdominal pressure combined with herniated disc causes pain in back/shoots down leg = nerve compression = herniated disc |
|
|
Term
| why is it good to have a health related quality of life instrument |
|
Definition
| asks the kinds of questions you want to know answers to |
|
|
Term
| what are the 3 purposes of the lumbar screen |
|
Definition
| 1. identify the exact location of the patient's source of complaint; 2. eliminate confusing information; 3. rule out non-PT pathology such as visceral origin, neoplasm, fracture |
|
|
Term
| what parts of the lumbar objective exam are done in standing |
|
Definition
| observation, trunk AROM, repeated flexion/extension, L4/S1 myotomes |
|
|
Term
| what to observe in regular standing and as the patient enters the room |
|
Definition
| willingness to move, compensatory movements, gait |
|
|
Term
| is a visual inspection of posture reliable/valid |
|
Definition
|
|
Term
| what are better options for measuring postue |
|
Definition
| flexicurve ruler, pneumap |
|
|
Term
| what AROM movements are done in standing |
|
Definition
| flexion, extension, sidebend |
|
|
Term
|
Definition
| signs of lumbar instability |
|
|
Term
| what are signs of lumbar instability in AROM |
|
Definition
| painful arc in flexion, painful arc in return from flexion, instability catch, gower sign, reversal of lumbopelvic rhythm |
|
|
Term
| what is the lumbar painful arc |
|
Definition
| when you flex forward at the hip and come back up, there's an area of movement that hurts and then goes away |
|
|
Term
| does a painful arc in flexion implicate something in particular |
|
Definition
|
|
Term
| what will you see if someone has a painful arc on return from flexion |
|
Definition
|
|
Term
|
Definition
| walking up thighs to return to standing from flexion |
|
|
Term
| what is reversal of lumbopelvic rhythm |
|
Definition
| when coming back up from flexion, putting spine in lordosis to guard/lock out low back pain and pull up from hips. Not allowing vertebrae to stack one on top of another |
|
|
Term
| all combined, what does positive gowers, instability catch, painful arc, and reversal of lumbopelvic rhythm suggest |
|
Definition
| aberrant movements during lumbar flexion |
|
|
Term
| what are motion patterns seen in patients with chronic LBP |
|
Definition
| asymmetry in lateral flexion, abnormal extension:flexion ratio |
|
|
Term
| what causes asymmetry in lateral flexion in patients with chronic LBP |
|
Definition
| possibly due to abnormal coupling pattern of lateral flexion and ispilateral rotation as opposed to normal lumbar coupling of lateral flexion with contralateral rotation |
|
|
Term
| normally, how much extension can you get compared to flexion in lumbar spine |
|
Definition
| extension is 40% of flexion |
|
|
Term
| if someone is very flexible in extension and limited in flexion, what is that called |
|
Definition
| abnormal extension:flexion ratio |
|
|
Term
| what is a good and easy way to measure trunk sidebend AROM |
|
Definition
|
|
Term
| if someone's pain starts to peripheralize, what should you do? |
|
Definition
|
|
Term
|
Definition
| pain comes more medial/proximal to low back |
|
|
Term
| what is peripheralization |
|
Definition
| pain spreads more distal/lateral away from low back |
|
|
Term
| what parts of the lumbar objective exam are done in sitting |
|
Definition
| observation, active/passive/resisted trunk rotation, dermatomes, myotomes, reflexes, IR/ER |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| extend big toe/evert foot |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what does slump test tell you |
|
Definition
|
|
Term
| what is a positive slump test |
|
Definition
| patient has pain in butt or low back in test position and pain changes with movement of head or feet |
|
|
Term
| what reflexes are tested in lumbar objective screening exam |
|
Definition
| patellar tendon L3, achilles tendon S1, babinski, clonus |
|
|
Term
| what parts of the lumbar objective exam are done in supine |
|
Definition
| SLR, modified SLR, SIJ provocation tests, ASIS palpation |
|
|
Term
| what is the purpose of SLR |
|
Definition
| test mechanical movement of sciatic nerve and test its sensitivity to mechanical stress/compression |
|
|
Term
| in SLR, what is the range of pain to be considered attributable to sciatic nerve tension |
|
Definition
|
|
Term
| what happens to sciatic nerve in 35-70 deg SLR |
|
Definition
| sciatic roots tense over IV disc |
|
|
Term
| if you have pain in SLR past 70 deg, what is the likely cause |
|
Definition
|
|
Term
| what is the difference between regular SLR and modified/Lasegue's SLR |
|
Definition
| in modified, pt's leg is adducted and internally rotated |
|
|
Term
| when do you stop raising leg in modified SLR |
|
Definition
| when patient complains of pain or tightness in back or back of leg |
|
|
Term
| what to do after reaching point of pain in modified SLR |
|
Definition
| slowly lower leg until pt feels no pain/tightness. Next, passively dorsiflex foot and/or pt flexes neck. |
|
|
Term
| what is a positive Lasegues/modified SLR |
|
Definition
| reproduction of sciatic pain with dorsiflexion or neck flexion |
|
|
Term
| how many SIJ provocation tests are there |
|
Definition
|
|
Term
| which of the 5 SIJ provocation tests are done in supine |
|
Definition
| gapping, torsion/gaenslens, posterior shear |
|
|
Term
| which of the 5 SIJ provocation tests are done in sidelying |
|
Definition
|
|
Term
| which of the 5 SIJ provocation tests are done in prone |
|
Definition
|
|
Term
| in gapping, which side is closest to PT, affected or unaffected side |
|
Definition
|
|
Term
| what part of the SIJ is compressed in gapping |
|
Definition
|
|
Term
| what part of the SIJ is is stressedin compression testing |
|
Definition
|
|
Term
| in the torsion/gaenslen's test, is the affected or unaffected side close to the PT |
|
Definition
|
|
Term
| in the torsion/gaenslen's test is the affected or unaffected side lowered |
|
Definition
|
|
Term
| in the posterior shear test, is the affected side or unaffecte side next to the PT |
|
Definition
|
|
Term
| in posterior shear test, does the force pushed through the knee of the affected or unaffected side |
|
Definition
|
|
Term
| in compression, is the affected side up or the unaffected side |
|
Definition
|
|
Term
| in compression test, to what angle are the hips flexed |
|
Definition
|
|
Term
| in compression test, to what angle are the knees flexed |
|
Definition
|
|
Term
| how many of the 5 SIJ compression tests must be positive in order to say that this is really an SIJ problem |
|
Definition
|
|
Term
| in the compression test, is the anterior SIJ compressed or stressed |
|
Definition
|
|
Term
| in the compression test, is the posterior SIJ compressed or stressed |
|
Definition
|
|
Term
| is the compression test a test of the anterior or posterior SIJ and why |
|
Definition
| posterior: it stresses the posterior SIJ |
|
|
Term
| what is the sacral thrust |
|
Definition
| an anterior shearing force of the sacrum on the ilia |
|
|
Term
| at what part of the sacrum is the sacral thrust |
|
Definition
| palm of the hand at S2. find PSIS, come to center, push down |
|
|
Term
| what is a sacral base thrust |
|
Definition
| move superior on sacrum to push at S1 |
|
|
Term
| is there an increase in hip internal or external rotation with a posteriorly rotated innominate |
|
Definition
| increase in external rotation |
|
|
Term
| has research shown an increase in internal rotation with an anteriorly rotated innominate |
|
Definition
| no, but you'd think there would be |
|
|
Term
| when someone has LE pain of insidious onset, what should you screen first |
|
Definition
|
|
Term
| if symptoms include limp, groin pain, and limited IR, what is the likely cause |
|
Definition
|
|
Term
| if someone has positive femoral nerve tension, what is the likely source of the problem |
|
Definition
|
|
Term
| where does hip arthritis often hurt |
|
Definition
| low back/back of butt and/or anterior hip/groin pain |
|
|
Term
| if someone has limited hip IR and a positive femoral nerve tension, what is the likely source of the problem |
|
Definition
|
|
Term
| is there high reliability/validity in ASIS palpation in supine |
|
Definition
|
|
Term
| what to look for in ASIS palpation to find anterior/posterior rotation in the sagittal plane |
|
Definition
| compare heights of L/R ASIS to umbilicus |
|
|
Term
| what to look for in ASIS palpation to find inflare/outflare in the horizontal plane |
|
Definition
| orientation of L/R ASIS compared to umbilicus |
|
|
Term
| what parts of the lumbar objective screening exam are performed in prone |
|
Definition
| SIJ sacral thrust, prone knee bend, palpation of paravertebral muscles, torsion test of lumbar spine, P-A central mobilization/provocation |
|
|
Term
| what does the prone knee bend test? |
|
Definition
| quads flexibility, femoral nerve tension |
|
|
Term
| how to make prone knee bend a femoral nerve tension test |
|
Definition
| have pt flex head and look under table. If pain changes when they lift their head back up, femoral nerve is implicated. |
|
|
Term
| what is a positive prone knee bend test for femoral nere tension |
|
Definition
| unilateral pain in lumbar area |
|
|
Term
| describe torsion test of lumbar spine |
|
Definition
| patient prone. Hand on lumbar spine to stabilize. Lift up at opposite ASIS to put torsion in lumbar spine. |
|
|
Term
| PA at any lumbar spine level moves how many vertebrae |
|
Definition
|
|
Term
| what segments are flexed when you do PA at L5 |
|
Definition
|
|
Term
| what segments are extended when you do PA at L5 |
|
Definition
|
|
Term
| what segments are flexed when you do PA at L4 |
|
Definition
|
|
Term
| what segments are extended when you do PA at L4 |
|
Definition
|
|
Term
| what segments are flexed when you do PA at L3 |
|
Definition
|
|
Term
| what segments are extended when you do PA at L5 |
|
Definition
|
|
Term
| what segments are flexed when you do PA at L2 |
|
Definition
|
|
Term
| what segments are extended when you do PA at L2 |
|
Definition
|
|
Term
| what segments are flexed when you do PA at L1 |
|
Definition
|
|
Term
| what segments are extended when you do PA at L1 |
|
Definition
|
|
Term
| when you push at L3-L5, what happens |
|
Definition
| you get all extension in lumbar spine |
|
|
Term
| when you push at L1-2, what happens |
|
Definition
| you get flexion at L45 and extension at L123 |
|
|
Term
| if I want to flex someone at L45 but they're in a lot of pain with active flexion, what can I do |
|
Definition
|
|
Term
| what are 4 types of detailed biomechanical tests for the lumbar spine |
|
Definition
| combined motion tests, PPIVMs, PAIVMs, prone instability tests |
|
|
Term
| what are detailed biomechanical tests in standing for combined motion testing |
|
Definition
| movement in pattern of capital H to look for pain or limited motion |
|
|
Term
| what movements are performed in standing detailed biomechanical tests for combined motion testing |
|
Definition
| L SB and flex; L SB and ext; R SB and flex; R SB and ext |
|
|
Term
| when does combined motion testing indicate hypomobility |
|
Definition
| when the full quadrant position cannot be reached |
|
|
Term
| when does combined motion testing indicate instability |
|
Definition
| when the full range of motions can be reached in one route but not another |
|
|
Term
| what movements are done with PPIVMs in lumbar spine |
|
Definition
| flexion, extension, sidebend |
|
|
Term
|
Definition
| patient sidelying facing PT. PT blocks/holds lumbar spinous process with cephalic hand. PT flexes hips by holding ankles with caudal hand |
|
|
Term
|
Definition
| patient prone. P-A force on lumbar spinous processes with PT's hypothenar eminence |
|
|
Term
|
Definition
| mobility of each segment is normal, hypermobile, hypomobile. Note presence or absence of pain |
|
|
Term
| if instability is suspected based on detailed biomechanical testing, what is the gold standard for diagnosis |
|
Definition
| flexion and extension radiographs |
|
|
Term
| what is the possible history that results in instability |
|
Definition
| recurrent LBP, short term relief from manipulation, history of trauma, reduced symptoms with bracing, ligamentous laxity |
|
|
Term
| what are the 9 points of the beighton ligamentous laxity screening |
|
Definition
| hyperextension of elbow greater than 10 deg, hyperextension of 5th finger past 90 deg, passive abduction of thumb to contact forearm; hyperextension of knees greater than 10 deg; able to flex trunk and place hands on floor |
|
|
Term
| what is the patient's initial position in the prone instability test |
|
Definition
| prone with torso on table, feet on the floor (bending over onto table) |
|
|
Term
| what does the PT do in prone instability test |
|
Definition
|
|
Term
| if PAIVM is painful in prone instability test, what is the next step |
|
Definition
|
|
Term
| what is the purpose of pt raising legs into air in prone instability test |
|
Definition
| muscles contract, stabilizing LB |
|
|
Term
| what does PT do after pt raises legs into air in prone instability test |
|
Definition
|
|
Term
| what is a positive prone instability test |
|
Definition
| pain with initial PAIVM, relief with 2nd PAIVM |
|
|
Term
| what are treatments for lumbar hypomobility |
|
Definition
| joint mobilizations/PAIVMs, stretching, assess for hypermobility above and below |
|
|
Term
| what are treatments for lumbar hypermobility |
|
Definition
| check for hypomobility above/below and mobilize there; core stabilization training; segmental muscle re-education |
|
|
Term
| how to do segmental muscle re-education |
|
Definition
| manual resisted seated trunk rotation: eccentric and concentric |
|
|
Term
| what are treatment ideas for non-acute sciatica |
|
Definition
| McKenzie exercises, gentle nerve flossing that stays just short of the pain as in SLR; mechanical traction |
|
|
Term
| when is static traction helpful |
|
Definition
|
|
Term
| how much body weight to use in static traction |
|
Definition
| start at 50% body weight and increase as needed to get centralization |
|
|
Term
| how much body weight is the minimum needed to begin a traction force |
|
Definition
|
|
Term
| when to use prone traction |
|
Definition
|
|
Term
| when to use supine traction |
|
Definition
| joint hypomobility and DDD |
|
|
Term
| when palpating the psoas, what can you do to be sure that you are really on the posas |
|
Definition
| ask your patient to flex their hip very slightly. If you are on the psoas, yo uwill feel the contraction |
|
|
Term
| what do you do once you have found the pubic tubercles with the heel of your hand |
|
Definition
| turn hand and relocate thetubercles. Palpate medially and laterally. Note the distabce between pubic tubercles and whether there is any asymmetry |
|
|
Term
| what is the patient position for palpating inguinal ligament |
|
Definition
| patient supine, knee slightly flexed and supported |
|
|
Term
| how to know you're in the femoral triangle |
|
Definition
| feel pulse of femoral artery |
|
|
Term
| how to feel for motion at the SIJ |
|
Definition
| press medial to PSIS at SIJ an dpassively IR/ER ipsilateral hip You should feel a small amount of motion at the SIJ |
|
|
Term
| patient position for palpating sacral base |
|
Definition
|
|
Term
| how to palpate/find sacral base |
|
Definition
| palpate the space between the 2 PSIS's. this is the base of the sacrum |
|
|
Term
| where to palpate for sacral sulcus |
|
Definition
|
|
Term
| how to palpate/find piriformis |
|
Definition
| locate PSIS, coccyx, greater trochanter. These points make a T. palpate along the bottom of the T to feel the piriformis, moving from sacrum to greater trochanter |
|
|
Term
| how to palpate/find sacrotuberous ligament |
|
Definition
| patient prone. Find ischial tuerosity with the base of yoru palm. Replace palm with thumb pads and palapate diagonally toward the sacrum, strumming the ligament along the way. Note pain/tenderness |
|
|
Term
| what is the grade for an absent reflex |
|
Definition
|
|
Term
| what is the grade for a hypoactive reflex |
|
Definition
|
|
Term
| what is the grade for a normal reflex |
|
Definition
|
|
Term
| what is the grade for a hyperactive reflex with no clonus |
|
Definition
|
|
Term
| what is the grade for a hyperactive reflex with clonus |
|
Definition
|
|
Term
| what to look for in standing trunk AROM in lumbar spine |
|
Definition
| scoliosis; symmetrical movement; hinging |
|
|
Term
| if you get 2 beats in clonus, what does that mean |
|
Definition
|
|
Term
| how many clonus twitches must occur for a sign of UMN lesion |
|
Definition
|
|
Term
| what is positive babinski |
|
Definition
| big toe, other toes extend |
|
|
Term
| what is the objective of slump test |
|
Definition
| assess dural mobility of L4-S3 |
|
|
Term
| do babinski, clonus test for UMN or LMN lesions |
|
Definition
|
|
Term
| what is another term for the modified SLR |
|
Definition
|
|
Term
| what is the objective of SLR |
|
Definition
| test movement of neurological tissues and test their sensitivity to mechanical stress or compression |
|
|
Term
|
Definition
| dorsiflexing patient's foot or flexing head/neck during modified SLR |
|
|
Term
| what are the 3 different positives for SLR |
|
Definition
| sicatic pain in 35-70 deg, sciatic pain with dorsiflexion, sciatic pain with neck flexion |
|
|
Term
| what does Gaenslen's test do |
|
Definition
|
|
Term
| what are some reasons for decreased motion on symptomatic side in forward flexion test |
|
Definition
| tight hamstrings, decreased iliofemoral flexion, posteriorly rotated innominate |
|
|
Term
| what are some reasons for increased motion on symptomatic side in forward flexion test |
|
Definition
| weak hamstrings, increased iliofemoral flexion, anteriorly rotated innominate |
|
|
Term
| if a person can't maintain 90 deg pelvis in SLS, what does that indicate |
|
Definition
|
|
Term
| what does the gillet test |
|
Definition
| movement of the innominate bone posteriorly on the sacrum |
|
|
Term
| how to assess level of ASIS |
|
Definition
| patient supine. Have them do a bridge, then PT lowers pt legs flat on table. Pt places finger in belly button for centering point. Stand next to pt so that dominant eye is next to patient. Place thumbs under eac ASIS. |
|
|
Term
| what does a caudad position of one malleolus in long sitting indicate |
|
Definition
| posterior rotation of the innominate |
|
|
Term
| what does cephalad positining of malleolus indicate in long sitting |
|
Definition
| anteriorly rotated innominate |
|
|
Term
| for long sitting test to be positive, what must also happen |
|
Definition
| standing flexion test must be positive on the same side |
|
|
Term
| what is a treatment to counternutate the sacrum |
|
Definition
|
|
Term
| what to look for in palpation fo sacral sulcus |
|
Definition
| asymmetry; one side higher than the other |
|
|
Term
| for the following questions, say what is the problem for the test result |
|
Definition
|
|
Term
| supine to sit test: in supine, the leg was longer. In sitting, the leg is shorter |
|
Definition
| anterior innominate rotation |
|
|
Term
| supine to sit test: in supine, the leg was shorter. In sitting, the leg is longer. |
|
Definition
| posterior innominate rotation |
|
|
Term
| ipsilateral ASIS an dPSIS are higher |
|
Definition
|
|
Term
| ipsilateral ASIS and PSIS are lower |
|
Definition
|
|
Term
| ipsilateral quadratus lumborum in spasm; tight hip adductors |
|
Definition
|
|
Term
| forward flexion test: involved side PSIS moves first and farther |
|
Definition
| posterior innominate rotation |
|
|
Term
| tight hamstrings and adductors; tight TFL and piriformus; glute med weak |
|
Definition
| posterior innominate rotation |
|
|
Term
| increased tension on sacrotuberuous ligament, long posterior SI ligament, and interosseous ligaments |
|
Definition
|
|
Term
| increased tension on ipsilateral anterior SIJ capsule and ligaments, deep iliolumbar ligament, and across symphysis pubis |
|
Definition
|
|
Term
| in forward flexion tests, involved side PSIS moves first and farthest superiorly |
|
Definition
| anterior innominate rotation |
|
|
Term
| weak abs, glutes; tight hip flexors on involved side |
|
Definition
| anterior innominate rotation |
|
|
