Lab 2: Lumbar Spine Exam Flashcards
LBP is more common in (men/women)
women
length of sx:
acute, subacute, chronic
acute: 3-4 wks
subacute: < or equal 12 wks
chronic: >12 wks
Age:
- disc herniation
- Ankylosing spondylitis
- OA/degenerative spondylosis
- spine tumor
disc hernia: 15-40 y/o
ankylosing spondylitis: 18-45 y/o
OA/degenerative: >45
spine tumor: >50 y/o
if the radiation of symptoms is leg dominant, patient is ____
if the radiation of symptoms is back dominant, patient is ___
disc hernia
mechanical LBP
if pain increases with intrathecal pressure, it will increase with?
cough, sneeze, deep breathing, laughing
SUBJECTIVE HISTORY
symptomology questions
- Location
- Duration
- Intensity
- MOI vs gradual/insidious onset
- Behavior
- 24 hr report
- Aggravating/relieving factors
- Previous hx of similar problem
- Functional status
- Current and previous
- Pt goals
- ADLs, occupational and leisure
structural vs functional deformity
structural: doesn’t change with body position
functional: changes with body position
slide 6 medical screenings question
cancer, infection, vertebral fx, AAA, mental, emotional, vigilance, pain catasrophizing, fear avoidance, self-efficacy, lacking insight to condition or best pratice tx options
flattened spine
stenosis, lateral shifting, disc hernia
short hamstrings, weak hip flexors
excessive lordosis
possible pelvic crossed syndrome
short ES and hip flexors, core and hip ext weak
swayback (reversed lordosis)
thoracic kyphosis + posterior pelvic tilt
hips hyperextension
scanning exams and observation slides 9-13
double limb squat: looking for?
general clearing of lumbar, pelvic, hip, knee, foot and ankle regions
compensation
unlikely an issue with hip, knee, foot, or ankle joints IF the squat was good
trendelenberg sign
+ : contralateral hip drop
- : hip neutral
poor balance
normal: > or equal to 30 sec each side
abnormal: <30 sec each side
Lumbar spine AROM/Resisted Testing
AROM
Overpressure
Measure w/ inclinometer if one side is different from the other
resisted isometric movements*
resisted isometric movements during lumbar spine AROM/resisted testing
test in lengthened position if no pain w/ AROM
test in neutral positions if pain w/ AROM
FOR RADIATING PAIN ONLY use:
repeated motions testing
perform lateral shift FIRST if needed
later assess flexion and extension positions
repeated motions testing:
extension position: prone, 10 reps and re-asses
flexion: supine, 10 reps and re-asses
lateral shift: PT perform side glide for 10 reps and re-assess (“hug from behind”)
during lumbar ROM, you have to screen joint _____ above and below lumbar spine at minimum
(T-Spine, Hips)
may assess ROM in additional joints as indicated (knee, ankle, foot)
AROM
after you did lumbar ROM, assessed the joints above and below, you should___
MMT
- hips, knee, ankle, foot
performing this test if you suspect patient lacks back extensor endurance
Sorensons Test
5: 20-30 second hold
4: 15-20 second hold
3: 10-15 second hold
2: 1-10 second hold
performing this test if you suspect patient lacks back flexors endurance
Dynamic abdominal endurance test
5: 20-30 second hold
4: 15 second hold
3: 10-15 second hold
2: 1-15 second hold
1: unable to raise greater than the head off table.
for Myotomes testing, we assess strength with 5 second mm contraction
if there’s no weakness or deficits but PT suspects involvement at that level:
repeat the same test 3-5 reps looking for mm fatiguability
toe walking and heel walking
toe: S1-2 “walk away from me on your toes”
heel: L4 “walk towards me on your heels”
Neuro examination runthrough
Dermatomes
Myotomes
Deep tendon reflexes
UMN Signs (Ankle Clonus, Babinski)
compare to opposite side
Ely’s Test
Modified Thomas test
which muscles?
Rectus Femoris muscle length
Psoas muscle
slide 28 about flexibility of the piriformis and hamstrings
hamstring muscle length
between 20 degrees = normal
if you note an anterior pelvic tilt while patient is in prone
tight hip flexors
slump test
- Pt sits w/ hands behind back
- ask them to flex head and neck then flex thoracic and lumbar spine
- PT extends knee, then DF
- if Sx increase, ask Pt to lift head and neck
(+) test when posterior back/thigh symptoms change with proximal/distal mvmt
SLR
PT lift legs while keeping knee straight
“go as high as you can”
assess when Pt responds..
(+) test: Sx at 30-70 degrees
REFER AND TREAT if you test one leg and the other side caused pain
Well/Crossed leg SLR test
pain/sx reproduction into involved leg w/ uninvolved SLR
(+) test = large disc herniation that may benefit from lumbar traction
SLR variations
Tibial N
Superficial peroneal N
Sural N
Tibial - DF, Eversion
Superficial peroneal- PF, Inversion
Common fib nerve- PF, Inversion
Sural N: DF, Inversion
Prone knee bend test (femoral nerve)
Prone, PROM knee flexion until Sx reproduced in anterior thigh (L2-3 Derm pattern)
positive prone knee bend test
Sx reproduced b/t 80-100 degrees KF
- 0-80 degrees is just knee joint problems
- >100 is RF tightness or lumbar S dysfunction
negative prone knee bend test
absent sx
sx below 80 deg KF
sx >100 indicates RF tightness or lumbar spine dysfunction
slides about joint play assessment 34-35
Prone instability test
- prone, hips flexed and feet resting on floor
- PT cues for pt to relax trunk muscles then applies PA force over most symptomatic spinous process then releases (assess for any sx)
- then pt will hold sides of table and this time lift feet off the floor, PT will apply same PA Force over SP; assess any changes in sx
Bicycle or Stoop test for intermittent claudication
1st position: upright
- record time until sx arise
2nd position: stooped
- record time until sx arise
can also perform test by walking (flat ground vs uphill)
(+) prone instability test
less pain with mm activation during 2nd part of test (feet lifted)
positive bicycle / stoop test
Sx IMPROVED with STOOPED posture
waddell’s test for non-organic symptoms : STIMULATION
axial compression: GENTLY push on head and lumbar spine sx reproduced
trunk rotation: twist hips with hand at sides
waddell’s test for non-organic symptoms: REGIONAL
sensory and weakness deficits
waddell’s test for non-organic symptoms: TENDERNESS
superficial and non-surgical
waddell’s test for non-organic symptoms: DISTRACTION (not of the joint but literally distracting them)
(not of the joint but literally distracting them)
SLR
Bend
limping
which waddell’s test is less reliable than other signs?
over-reaction
all components of waddell’s test for non-organic sx
- stimulation
- regional
- tenderness
- distraction
- over-reaction
positive waddell’s test
> or equal 3/5 tests indicates sx exaggeration
Outcome measures for the lumbar spine
- modified oswestry disability index
- roland-morris back pain disability questionnaire
- fear avoidance behavior questionnaire (FABQ)
- patient specific functional scale (PSFS)
