L Spine Exam & Eval Flashcards
L spine physical exam must include assessment of NMSK and vascular structure of
L spine
pelvic region
hip region
LEs
which back/abdominal related impairment is suspect for 10-20 yo?
spondylolisthesis
which back/abdominal related impairment is suspect for >65 yo?
cancers
compression fxs
stenosis
AAA
which back related impairment is suspect for 15-40 yo?
disc herniation/dysfunction
which back related impairment is suspect for >45 yo?
OA/spondylosis
T/F: most pts with acute LBP present with at least one red flag (>80%)
T
what is the ultimate goal of treating LBP?
self-management by the pt
which approach works better with spine dysfunction: structure-based (Cyriax) or Treatment-based (McKenzie & Maitland)
Treatment-based (McKenzie & Maitland)
piriformis syndrome is typically a diagnosis of
exclusion
which motions increase sx with piriformis syndrome?
stooping or lifting
spondylolysis is a defect in the
pars interarticularis (isthmus)
which level does spondylolysis usually occur?
L5
which position does spondylolysis pts prefer?
flexion
list the susceptibility to compression of spinal structures in order of most to least
END-PLATE
vertebral body
disc
disc protrusion
disc bulge without annulus fibrosus rupture
disc prolapse
only outer layers of AF contain NP
disc extrusion
AF perforated and disc material moves into epidural space
disc sequestration
disc fragments from AF & NP disconnect
sx of end-plate fx
acute pain/spasm
- SLR
+ compression test
sx of internal disc disruption
LBP and/or referred hip/upper leg pain
- SLR
dx with discogram
sx of disc protrusion and prolapse (contained)
LBP and/or referred hip/upper leg pain
pain w/ cough & sneeze
- SLR
sx of disc extruision and sequestration
LBP
pain with cough and sneeze
TRUE SCIATICA (radicular pain)
+ SLR
nerve compression (via disc) usually affects which nerve root
lower segment
Ex: L4/L5 –> effects L5
S&S of spinal stenosis
persistent buttock pain
limping
lack of sensation in LEs (claudication)
decreased walking/standing ability
is localized or referred pain more common with facet joint dysfunction?
localized
what is the hallmark sign in instability (for any joint)?***
inconsistent symptomology
how is fibromyalgia diagnoses?
11/18 tender points w/o other reason for tenderness
when is herpes zoster contagious?
when sores open and oozing
what rash is in a dermatomal pattern?
herpes zoster
impairments with acute or sub-acute LBP with mobility deficits
segmental or global hypomobility
pain in back, buttock, groin, or thigh
impaired functional movements
- neuro test!!
onset of sx < 3 mo
impairments with acute, sub-acute, or chronic LBP with movement coordination impairments
pain worsens with end range movements
+ prone instability test
impairments with acute LBP with referred LE pain
+ repeated measures test
onset of sx < 3 days
hypo or hyper mobile
impairments with acute or sub-acute LBP with radiating pain
+ neuro exam
+ neurodynamic tests
+ repeated measures tests
radiating pain in dermatomal pattern
impairments with acute or sub-acute LBP with related cognitive or affective tendencies
inconsistent MSK exam results
onset of sx <3 months
+ Waddell’s test
high FABQ scores
impairments with chronic LBP with related generalized pain
no structural issue for pain
inconsistent with MSK dysfunction
changes in brain & sensory structures
onset of >3 mo
high FABQ scores
manual therapy criteria
no sx distal to knee
less than 16 days
score of less than 19 on FABQ-W
at least 1 hypomobile segment in L spine
at least 1 hip w/ >35 deg IR
stabilization criteria
<40 yo
post-partum
SLR >91 deg
instability catch or aberrant movements during flx/ext ROM
+ prone instability test
post-partum criteria for instability
+ posterior pelvic provocation
+ ASLR
+ modified Trendelenburg test
OR
pain with palpation of long dorsal SI lig or pubic symphysis
criteria for extension direction-specific
sx distal to buttock
symptoms centralize with L ext
symptoms peripheralize with L flx
direction preference for ext
criteria for flexion direction-specific
> 50 yo
directional preference for flex
L spinal stenosis
criteria for lateral shift direction-specific
visible frontal plane shift of shoulders relative to pelvis
directional preference for lateral translation movements of pelvis
T/F: pt does not have to have radiating pain for directional preference category
F
interventions manual therpay category
lumbopelvic HVLAT
L and LE ROM exercises
interventions for stabilization
- isolated contraction and co-contraction of deep stabilizer (multifidi and TA)
- strengthen large spinal stabilizers (ES, internal & external obliques)
interventions for extension preference
end range extension exercises
mobilize to promote extension
avoid flexion
interventions for flexion preference
mobilize & manipulate spine
strength & flexibility exercises
body-weight supported treadmill training
(non WB exercises)
interventions for lateral shift preference
exercises to correct lateral shift
traction
which impairment must be addressed first before categorizing (if present)?
lateral shift
____% of patients fit >1 classification group
25%
presence of ___ & ______ weaken a treatment effect
psychosocial factors & co-morbities
