Examination

Question 1

Red Flags and Symptoms

Answer 1

Cancer- >50 yrs, family history, unexplained weight loss, PAIN is insidious and constant (worse at night)
Spinal Infection- Immunosuppression, recent infection, PAIN is dull and continuous
Compression Fracture- Trauma, >50, corticosteroid use, osteoporosis, PAIN is acute w/ radiation across back
Inflammatory Arthritis- morning stiffness, better w/ exercise, slow onset before age 40, PAIN for >3 months
Vascular or Visceral- PAIN not related to activity, night pain, GI or GU symptoms

Question 2

Types and Symptoms of Neuro Compromise

Answer 2

Sciatica- Sharp, burning radiates down lateral/post aspect of 1 or both legs below knee. Can have sensory or motor impairments, worse w/ Valsalva (98% are L5-S1 roots)
Cauda Equina Synd- EMERGENCY, symptoms progress from PAIN–> motor/sensory (saddle anesthesia) dysfxn–> loss of bowell&bladder. Urinary retention= 90% sens, 95% spec
Neurogenic Claudication- PAIN in leg w/ any back extension, relief w/ flxn (could be severe stenosis)

Question 3

Psychological Factors

Answer 3

Fear avoidance, belief that LBP is harmful, withdrawal from ADL’s, Depression/anxiety, belief in PASSIVE tx over active, Catastrophizing

Question 4

What joint should be cleared in exam?

Answer 4

HIP!!!

Question 5

Prognosis for Shifts

Answer 5

Contralateral shift –> Good prognosis

Ipsilateral Shift–> much worse prognosis

Question 6

PPIVM- motions

Answer 6

Flexion, extension, side bending, rotation

Question 7

PAIVM- motions, pain points, and resistance points

Answer 7

1) ID segment or segments involved
2) Determine if motion is normal
3) Determine sequence of pain and resistance (P1, P2 and R1, R2)
4) Determine if impairment is of pain or stiffness

MOTIONS:
Central PA
Unilateral PA
Transverse vertebral pressure

Question 8

SI Joint Assessment

Answer 8

Prone Spring
Squish Test (aka posterior shear)

Question 9

Strength Tests 
L1-2
L3-4
L4
L5
L5-S1
S1-2
S3

Answer 9

L1-2 - Hip flxn (sitting)
L3-4 - knee extension (sitting)
L4 - Ankle dorsiflxn
L5 - EHL
L5-S1 - Hip extension, ankle eversion
S1-2 - PF ankle (standing), knee flexion (prone)
S3 - Foot intrinsics

Question 10

Common substitutions for TrA activation

Answer 10

Post tilt/ spinal flxn
Rib cage depression (Ext. oblique)
Rib cage elevation (scalenes, SCM)

Question 11

Multifidi common substitutions

Answer 11

Post tilt/ spinal flxn
Ant tilt
Contraction of erector spinae and ext. oblique

Question 12

What is the recurrence rate of LBP w/ and without intervention?

Answer 12

with= 35%
Without= 75%