assessment of lumbar spine Flashcards
flexion ROM
0-80 deg
extension ROM
0-25 deg
lateral flexion ROM
0-35 deg
rotation ROM
0-45 deg
end feel for all 4 motions
firm
loose packed position
midway between flexion and extension
close packed position
full extension
capsular pattern
side bend = rotation > extension
osteoporotic vertebral compression fracture or wedge deformity critera
age > 52
no leg pain
BMI < 22
does not exercise regularly
female
2 or less criteria rule out
4 or more criteria rule in
iliac crests
L4-5 interspace
PSIS
med and inf from iliac crest
helper line: S2 is between PSIS
ischial tuberosity
start at gluteal folds until you feel a bony prominence
sacral sulcus
from PSIS move sup and med
dip inward
inferior lateral angle
inferior to PSIS
where bone drops off
coccyx
top of gluteal cleft
sacrotuberous ligaments
from ILA to ischial tuberosity
spinous processes
L5: start at PSIS and move medial and superiorly at a 30-45 deg angle
L1-4 count superiorly
transverse processes
move lateral from SP
farther out than you think
T12 SP
locate L5 and count sup
slightly smaller than L1
12th rib
move laterally from T12 SP
quadratus lumborum
in quadrant created by lumbar SP, 12th rib, iliac crest
ASIS
distal and med from iliac crest
psoas
from midpoint between ASIS and umbilicus, apply direct pressure toward spine
iliacus
from ASIS move med and apply pressure downward to ilium
pubic tubercles
pt places thumb on abdomen and slides down to pelvis.
examiner places thumbs on top of pt’s
greater trochanter
have pt ER/IR hip to assist
piriformis
helper line: PSIS to greater trochanter
1-2 cm inferior to middle 1/3 of helper line
sciatic nerve
helper line: ischial tuberosity to greater trochanter
medial 1/3 to halfway of helper line
spinalis
most medial
longissimus
middle
ilicostalis
most lateral
goni ROM: flexion/extension
fulcrum over greater trochanter
flexion: 80
extension: 25
goni ROM: lateral flexion
fulcrum over SP of S1, follow SP of c7
normal: 35
goni ROM: rotation
fulcrum on center of cranium
normal: 45
inclinometer
take the difference between S1 and T12
flexion: 60
extension: 25
trunk flexion strength test
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
trunk extension strength test
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
trunk rotation strength test
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
lower abdominal strength test
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
mytomes
L2 - hip flexion
L3 - knee extension
L4 - ankle dorsiflexion
L5 - great toe extension
S1 - plantar flexion
S2 - knee flexion
reflexes
patellar: L4
achilles: S1
dermatomes
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”
central PA glides (spring test)
elbow extended
over spinous process
use small areas of hand to lessen sensory overload
unilateral PA glides
contact over facet joints on both sides
straight leg raise
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
slump test
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
prone instability test
provides PA glide
client lifts both legs off the floor
positive: pain disappears with legs off the floor
