Clinical Assessment - Lumbar Spine

Question 1

Dermatome L1 - L4

Answer 1

L1 - Upper Anterior Thigh, Below inguinal lig. from iliac crest to groin
L2 - Middle Ant. Thigh
L3 - Ant thigh, proximal to patella
L4 - Patella, medial leg, medial foot

Question 2

Dermatome L5-S2

Answer 2

L5 - Lateral Leg, back of foot, between first two toes
S1 lateral malleolus, lateral foot , bottom of foot
S2 - back of leg and thigh

Question 3

Myotome L2 - L4

Answer 3

L2 - hip flexion
L3 - knee extension
l4 - ankle dorsiflexion (patellar reflex)

Question 4

Myotome L5-S2

Answer 4

L5 - first toe extension
S1 - foot eversion (achillies reflex)
S2 - knee flexion or hip extension

Question 5

Straight Leg Raise

Answer 5

Reason DISC HERNIATION - Sciatic N pain
Stage 1 - in Supine, Lift straight leg slowly until 70 degrees or pain.
Stage 2 - Add Passive dorsiflexion of foot - is positive if pain returns. (bragards test)
Stage 3 - If no positive from stage 2, ask patient to flex neck.
Positive for Poterolateral disc herniation due to dural tension pulling nerve toward herniation. Stage 2,3 positive may also be positive for meningial irritation. next flexion may me meningitis.
Can be done seated or side lying (slump test)

Question 6

Well Leg Raise

Answer 6

Positive is pain in AFFECTED leg, POSITIVE for space occupying lesion
Supine , patient lifts good leg until end range or pain

Question 7

Slump Test

Answer 7

Positive for DURAL SHEATH

Slump on end of table, apply pressure to shoulders down. Then passive flex next and dorsiflex leg.

Question 8

Bowstring Sign

Answer 8

IF SLR positive, or sciatic expected,
In supine, raise leg with knee extended until pain or numbness, then palpate popliteal fossa directly (just medial to biceps femoris tendon.. strum or pressure will feel like braided cord if inflammed.

Question 9

Femoral Nerve Stretch

Answer 9

Positive is for Lesion or Irritation of FEMORAL N.

Prone - extend hip passively 15 degrees, with knee extended, if no pain that flex knee until heel to buttocks.

Question 10

Valsalva Test

Answer 10

Positive for Space occupying lesion , herniated disc, and osteophyte or tumor.

high seated, press like pooping for 6s.

Question 11

Milgram’s Test

Answer 11

Positive for Intrathecal or extrathecal pathology

supine - raise legs 2 inches off ground and hold 30s

Question 12

Hoover’s Test

Answer 12

the lying test, you know what

Question 13

Kemp’s Test

Answer 13

Positive for FACET JOINT issue

localized pain may also come from either shortened or lengthened sides, pain in gluteal-hip area

Question 14

Pheasant Test

Answer 14

positive for Unstable SPINAL SEGMENT

Prone - place one hand on lumbar spine and gently compress, other hand at ankles flex knees to buttocks

Question 15

Segmental Instability Test

Answer 15

Positive for unstable SPINAL SEGMENTS
Prone- patient off table and resting feet on ground, therapist presses on one segment and then patient contracts. Positive when pain is present when relaxed, but gone when muscles engaged. this means muscles protect segment.

Question 16

Spondylosis

Answer 16

degeneration of the IVD

Question 17

Sponylolysis

Answer 17

defect in pars interacticularis, fracture of lamina and pedicle. over extension and pressure on SP’s

Question 18

Spondylolythesis

Answer 18

forward displacement of one vertebrae over another

Question 19

Hernation - 4 types and severity

Answer 19

Disc Bulge (herniation), disc protrusion, disc extrusion, sequestration

Question 20

Active Free ROM - Lumbar
flexion
extension
side bending
rotation

Answer 20

Flexion - 40-60
extension 20-35
side bending 15-20
rotation 3 - 18

Question 21

During Active Resisted Side Bending, 
What does \_\_ mean?
-flexes forward or rotates toward table
-rotates up to ceiling
-extension

Answer 21

• flexes forward or rotates toward table - EXT obliques
• rotates up to ceiling - INT obliques
• extension - QL or Lats