L3 Thoracolumbar Exam Flashcards
categorize impairment based on need for
symptom modification
movement control
functional optimization
Categorize based on response to
manipulation
stabilization
traction
directional preference
Manual skills are good but
not site specific
audible pop doesn’t always happen
manipulations are safe
For non-specific LBP
manipulation
traction
stabilization
directional preference
SI joint dysfunction
LBP with known pathology or dysfunction
Refer and Treat
stenosis
spndyolisthesis
scoliosis
post-operative
LBP with potentially serious pathology
Refer
tumor
infection
fracture
AAA
visceral
Cauda Equina Syndrome
Natural Course of LBP
16% are sick listed due to LBP at 6 mo
60% report relapses
33% need a break from work again
2x risk of LBP w/hx of LBP
Thoracolumbar RF for Acute Episode
-Female
-Individuals with monotonous jobs or lots of lifting
-previous significant episodes of LBP
-weak spinal extensors (<58s on Sorenson’s)
-Not associated with ROM
Thoracolumbar RF for development of Chronic LBP
age
obesity
smoking
higher levels of baseline disability
depression/anxiety
non-concordant care
Who may not get better from LBP
-persistent LBP prognostic factors or non recovery at 3 mo
-> 45 years of age
-smokers
-2 or more neuro signs
-high scores on psychological screening
-high levels of distress
Altered Lumbopelvic Rhythm
forward bending = hip motion > than lumbar spine motion during the first 1/3 of movement OR lumbar spine motion > hip motion during last 1/3 of movement
standing up = lumbar motion > hip motion in first 1/3 OR hip motion > lumbar motion in last 1/3
Gower’s Sign
return to upright stance performed by using hands to climb up the thighs
Deviation from sagittal plane
movement away from the primary sagittal plane, including rotations and/or lateral flexion
movement lasting more than a few degrees of primary sagittal plane movement
Instability, catch, shake, judder
sudden acceleration, stop, or deceleration; observations of a momentary quiver, vibration, shake seen in the paravertebral muscles or brief out of plane movements
Painful arc of motion
pain noted by patient that increases through a portion of total arc of movement, general increase in pain throughout the motion does not constitute painful arc
Functional Testing for Thoracolumbar
single leg balance
squat
step down
Vertical Compression Test
-patient standing relaxed
-PT applies downward force through pts shoulders
-look for buckling and/or pain
-retest after intervention/re-education
standing stability test
Elbow Flexion Test
standing stability tests
force must be straight down
assesses how much force they can withstand, buckling, pain
retest after intervention/re-education
Hip Clearing Tests
Squat
FABER
FADIR
Prone Instability Test
- find the painful segment during PA testing with feet on ground, paraspinals relaxed
- repeat PA with bilateral hip extension
Positive test if S/S are reduced with LE extended
this combined with aberrant movement increases likelihood pt will positively respond to lumbar stabilization
SI Joint Provocation Tests
Thigh thrust, distraction, compression, sacral thrust, Gaenslen’s
if the first two are positive, no further tests are needed
if one test is +, add compression
after compression is negative, add sacral thrust
if 3+ are positive, high SN/SP for SIJ pathology
Key Exam Findings for Manipulation/MOb
- no s/s distal to knee
- recent onset (<16 days)
- Low FABQ
- Lumbar hypomobility
- Hip IR PROM >35°
Contraindications for Manipulation
-patient reported poor/adverse outcome previously
-lack of dx
-lack of proper set up
-unable to find ed range due to pain/resistance
-lack of consent
If patient fits the manipulation rule…
it will help them feel better quicker/decrease their ODQ score
Combo of MT and Exercise…
better than MT alone and better than advice to stay active
STM prior to SMT…
may be helpful for a successful SMT outcome or in patients where SMT is not indicated
Massage is effective…
in the short term for pain and function but not recommended as a stand-alone tx OR expect long term improvements
does not change ROM significantly, but will help improve comfort
Key Exam Findings for Mobs
- No symptoms distal to knee
- Recent onsent <16 days
- Low FABQ <19
- lumbar hypomobility
- hip IR PROM >35°
interventions include mob, manip, AROM, address regional deficits, stabilziation
Initial Potential Exercise Interventions following SMT
Manual therapy effects can be short lived so its imperative the pt moves more afterwards
movement is what keeps people better
