assessment of lumbar spine

Question 1

flexion ROM

Answer 1

0-80 deg

Question 2

extension ROM

Answer 2

0-25 deg

Question 3

lateral flexion ROM

Answer 3

0-35 deg

Question 4

rotation ROM

Answer 4

0-45 deg

Question 5

end feel for all 4 motions

Answer 5

firm

Question 6

loose packed position

Answer 6

midway between flexion and extension

Question 7

close packed position

Answer 7

full extension

Question 8

capsular pattern

Answer 8

side bend = rotation > extension

Question 9

osteoporotic vertebral compression fracture or wedge deformity critera

Answer 9

age > 52
no leg pain
BMI < 22
does not exercise regularly
female

2 or less criteria rule out
4 or more criteria rule in

Question 10

iliac crests

Answer 10

L4-5 interspace

Question 11

PSIS

Answer 11

med and inf from iliac crest
helper line: S2 is between PSIS

Question 12

ischial tuberosity

Answer 12

start at gluteal folds until you feel a bony prominence

Question 13

sacral sulcus

Answer 13

from PSIS move sup and med
dip inward

Question 14

inferior lateral angle

Answer 14

inferior to PSIS
where bone drops off

Question 15

coccyx

Answer 15

top of gluteal cleft

Question 16

sacrotuberous ligaments

Answer 16

from ILA to ischial tuberosity

Question 17

spinous processes

Answer 17

L5: start at PSIS and move medial and superiorly at a 30-45 deg angle
L1-4 count superiorly

Question 18

transverse processes

Answer 18

move lateral from SP
farther out than you think

Question 19

T12 SP

Answer 19

locate L5 and count sup
slightly smaller than L1

Question 20

12th rib

Answer 20

move laterally from T12 SP

Question 21

quadratus lumborum

Answer 21

in quadrant created by lumbar SP, 12th rib, iliac crest

Question 22

ASIS

Answer 22

distal and med from iliac crest

Question 23

psoas

Answer 23

from midpoint between ASIS and umbilicus, apply direct pressure toward spine

Question 24

iliacus

Answer 24

from ASIS move med and apply pressure downward to ilium

Question 25

pubic tubercles

Answer 25

pt places thumb on abdomen and slides down to pelvis.
examiner places thumbs on top of pt’s

Question 26

greater trochanter

Answer 26

have pt ER/IR hip to assist

Question 27

piriformis

Answer 27

helper line: PSIS to greater trochanter
1-2 cm inferior to middle 1/3 of helper line

Question 28

sciatic nerve

Answer 28

helper line: ischial tuberosity to greater trochanter
medial 1/3 to halfway of helper line

Question 29

spinalis

Answer 29

most medial

Question 30

longissimus

Answer 30

middle

Question 31

ilicostalis

Answer 31

most lateral

Question 32

goni ROM: flexion/extension

Answer 32

fulcrum over greater trochanter
flexion: 80
extension: 25

Question 33

goni ROM: lateral flexion

Answer 33

fulcrum over SP of S1, follow SP of c7
normal: 35

Question 34

goni ROM: rotation

Answer 34

fulcrum on center of cranium
normal: 45

Question 35

inclinometer

Answer 35

take the difference between S1 and T12
flexion: 60
extension: 25

Question 36

trunk flexion strength test

Answer 36

0: no muscle activity
1: muscle activity without movement
2: depression of rib cage toward pubic symphysis
3: completes ROM with arms outstretched
4: completes ROM with arms crossed over chest
5: completes ROM with hands behind head

scapula must clear the table

Question 37

trunk extension strength test

Answer 37

0: no muscle activity
1: muscle activity without movement
2: completes partial ROM from full body on table
3: completes ROM with arms at side of body
4: may waver, hands behind head
5: holds position with out wavering

Question 38

trunk rotation strength test

Answer 38

0: no muscle activity
1: muscle activity without movement
2: client unable to complete motion, but rib cage depresses
3: scapula clears table with arms outstretched
4: scapula clears table with arms crossed the chest
5: scapula clears table with hands behind head

Question 39

lower abdominal strength test

Answer 39

arms folded across chest
posteriorly tilt pelvis until lower back flat
hold low back flat as slowly lowering the legs

90-75 = fair
75-60 = fair +
60-45 = good -
45-30 = good
30-15 = good +
15-0 = normal

Question 40

mytomes

Answer 40

L2 - hip flexion
L3 - knee extension
L4 - ankle dorsiflexion
L5 - great toe extension
S1 - plantar flexion
S2 - knee flexion

Question 41

reflexes

Answer 41

patellar: L4
achilles: S1

Question 42

dermatomes

Answer 42

L1 - upper anterior thigh
L2 - mid anterior thigh
L3 - medial femoral condyle
L4 - medial malleolus
L5 - dorsum of great toe
S1 - lateral malleolus or heel
S2 - popliteal fossa

ask “same, different, or none”

Question 43

central PA glides (spring test)

Answer 43

elbow extended
over spinous process
use small areas of hand to lessen sensory overload

Question 44

unilateral PA glides

Answer 44

contact over facet joints on both sides

Question 45

straight leg raise

Answer 45

hold above malleolus and above knee
clinician raises client’s leg and feels for resistance

pos requires all three:
reproduction of symptoms
symptoms different than other side
symptoms affected by distant movement

Question 46

slump test

Answer 46

client slumps
flex cervical spine
actively extend good leg first
gently extend head

postive:
reproduction of symptoms
symptoms different than other side
symptoms affected by distant movement

Question 47

prone instability test

Answer 47

provides PA glide
client lifts both legs off the floor

positive: pain disappears with legs off the floor