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OPP Exam 1 > 2-5-2013 forum lumbar and sacral > Flashcards

2-5-2013 forum lumbar and sacral Flashcards

1
Q

What is the goal of treatment in lumbar muscle energy?

A

place patient in all three planes of motion
coronal - sidebending
horizontal - rotation
sagittal - flex/extend

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2
Q

what vertebra is at iliac crest?

A

L4

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3
Q

Type I Fryettes

A

Neutral, group, sidebent and rotates opposites

example: L1-L3 N Rr Sl

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4
Q

Type II Fryettes

A

can be within a type 1 group curve
flexed or extended, single segment, sidebent and rotated to the same side
Have pt curl up (flexion) or prop on elbows (extension) and check where it gets better
i. name for position in which it improves
ii. example: L3 E RrSr

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5
Q

Type I treatment - laying down

A
  1. Have pt lay convex up/lateral recumbent - rotated side UP
  2. With 1 hand, monitor for movement at segment, flex body until movement felt
  3. Physician lifts both ankles toward ceiling until motion at segment is felt
    a) pt pulls ankles back toward table against resistance (isometric contraction)
    b) repeat 3 times, and then reassess
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6
Q

Type I or II treatment - sitting down

A
  1. Make sure pts feet are firm on the ground for balance
  2. Stand/sit on patient’s side opposite of roation
  3. Have patient put hand of rotated side behind head, other hand on that elbow
  4. Physician grabs bicep and pulls patient into the position opposite of diagnosis
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7
Q

type II FDR

A

flexed somatic dysfunction, down, recumbent

  1. have pt lay recumbent (on side with dysfunction side down)
  2. Lift the knees toward the chest until you feel motion at the segment of dysfunction
  3. Have pt straighten out bottom leg, keeping the top leg bent
    a. this locks out the spine/sacrum below the site of dysfunction and assures that you are only treating the dysfunctional segment!
  4. next, rotate the pts upper body so that the pts chest faces the ceiling. Do this until you feel motion at the segment that you’re treating
    a. you can pull on the arm thats touching the table to help you
    b. This locks out the spine above the site of dysfunction
  5. lift top leg up, holding above the ankle (causing sidebending), pt pulls back to table for 3 seconds
  6. relax for 2 seconds
  7. Repeat 3 times then do a passive stretch
  8. reassess
  9. Dysfuntion side is down and pt is pushing down
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8
Q

Type II - SUE (Sims, up, extension SD)

A

dysfunction side up, pt is pushing up.

  1. Patient lays in sim’s position (lay on side with dysfunction side up)
  2. Lift the knees toward the chest until you feel motion at the segment of dysfunction
  3. Monitor segment while pt rotates torso/closing chest into barrier
    a. ask pt to hug the table
    b. have pt take a deep breath, and when they breathe out push down on their shoulder to ensure they are locked out
  4. Drop patients legs off table&raquo_space;ask if the patient wants cushion for knees
  5. Physician pushes down on ankles while patient pushes up for 3 seconds
  6. relax 2 seconds
  7. repeat 3 times, passive stretch
  8. reassess
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9
Q

spring test

A
  • Pt prone, place heel of one hand over the lumbosacral junction [L5-S1], place the other hand on top.
  • Apply gentle but rapid downward pressure
  • Nice Normal Negative or Painful Posterior Positive
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10
Q

motion test about transverse axis

A
  • Cephalad hand over sacrum with fingers pointing caudad
  • Caudad hand over the first facing opposite (fingers cephalad)
  • Apply alternating pressure with tips of fingers and heel of hand
  • Assess the quality and quantity of motion and note which is freer
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11
Q

sacral mobility

A
  • Physician at the side of the table
  • Both palms on the ILA’s with fingers in the sulci
  • Direct a force cephalad from the ILA into the sacroiliac joint on the same side.
  • Force should NOT be directed obliquely to prevent false positives
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12
Q

motion testing about an oblique axis

A
  • Index and middle fingers monitor the PSIS and Deep Sulcus on one side while the other hand performs a pumping motion on the posterior ILA of the contralateral side.
  • Apply downward (anterior) pressure on the ILA of sacrum about an oblique axis
  • Assess both sides
  • If sacral base has rotated forward and become restricted (ie deep sulcus), posterior motion of the sacral base at the sulcus is restricted.
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13
Q

backward bending or sphinx test

A

evaluates sacral somatic dysfunction at the upper arm of the SI joint

  • If base is anterior to one side then it will continue to move forward during test
  • place thumbs in the sacral sulci
  • ask patient to prop up on elbows relaxing the lower back
  • note the depth of the sacral sulci
  • then motion test (anterior pressure) on both sides
  • note improvement or worsening
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14
Q

backward bending or sphinx test (forward torsion and backward torsion)

A

forward torsion - the assymetries decrease (as you extend the lumbar spine, the sacrum goes into flexion)
backward torsion - the assymetries increase (the sacrum is stuck in extension)

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15
Q

What are the steps to diagnosing the sacrum?

A

standing flexion test&raquo_space; seated flexion test&raquo_space; spring test (or equivalent)&raquo_space; asymmetry of landmarks
NEED 3 things:
1. deep sulcus
a. pt prone, find PSIS with thumbs, then slide medial and slightly superior to sink into sulci
2. posterior ILA
a. palpate straight down the sulci until you fall of the ledge. then get back on
3. Spring test or seated flexion or sphinx or oblique axis test

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16
Q

positive seated flexion test and negative spring test

A

forward sacral dysfunction (flexed)

17
Q

postive seated flexion test and postive spring test

A

backward sacral dysfunction (extended)

18
Q

L on L

A

. Forward sacral torsions (Flexed)

  1. Left on left
    • deep sulcus: R
    • inferior/posterior ILA: L
    • Seated flexion test: +R
    • Spring test: -
19
Q

R on R

A

forward sacral torsion (flexed)

  1. Right on right
    • deep sulcus: L
    • inferior/posterior ILA: R
    • Seated flexion test: +L
    • Spring test: -
20
Q

unilateral sacral flexion?

A 
forward sacral torsion (flexed) 
Unilateral sacral flexion
   - Spring test is negative
1. Left unilateral
   -deep sulcus: L
   -inferior/posterior ILA: L
   -Seated flexion test: +L
2. Right unilateral
   -opposite left above
21
Q

L on R

R on L

A

backward sacral torsion (extended)

  1. Left on right
    • deep sulcus: R
    • inferior/posterior ILA: L
    • Seated flexion test: +L
    • Spring test: +
  2. Right on left
    • deep sulcus: L
    • inferior/posterior ILA: R
    • Seated flexion test: +R
    • Spring test: +
22
Q

unilateral sacral extension

A 
backward sacral torsion (extended)
D. Unilateral sacral extension
   - Spring test positive
1. Left unilateral extension
   - deep sulcus : R
   - inferior/posterior ILA: R
   - Seated flexion test: +L
2. Right unilateral extension
   - deep sulcus: L
   - inferior/posterior ILA: L
   - Seated flexion test: +R
23
Q

bilateral sacral dysfunction

A

-ILA’s and sacral sulci are even

  1. Bilateral flexed
    -motion decreased bilaterally
    -sacrum flexes but is restricted in
    extension
    -Seated flexion test: + bilaterally
    -Spring test: -
  2. Bilateral extended
    -motion decreased bilaterally
    -sacrum extends but is restricted in
    flexion
    -Spring test: +
24
Q

sacral treatment

A
  1. Patient is prone with knees bent
    (looks like pyriformis test)
  2. stand at the foot of the table supporting the knees exerting a lateral force on the legs
  3. ask the pt to push the ankles medially against resistance
  4. engage the new barrier and repeat 3 times
  5. return to neutral and recheck

OPP Exam 1 (6 decks)

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