Lab 2: Lumbar Spine Exam

Question 1

LBP is more common in (men/women)

Answer 1

women

Question 2

length of sx:
acute, subacute, chronic

Answer 2

acute: 3-4 wks
subacute: < or equal 12 wks
chronic: >12 wks

Question 3

Age:
- disc herniation
- Ankylosing spondylitis
- OA/degenerative spondylosis
- spine tumor

Answer 3

disc hernia: 15-40 y/o
ankylosing spondylitis: 18-45 y/o
OA/degenerative: >45
spine tumor: >50 y/o

Question 4

if the radiation of symptoms is leg dominant, patient is ____

if the radiation of symptoms is back dominant, patient is ___

Answer 4

disc hernia

mechanical LBP

Question 5

if pain increases with intrathecal pressure, it will increase with?

Answer 5

cough, sneeze, deep breathing, laughing

Question 6

SUBJECTIVE HISTORY
symptomology questions

Answer 6

• 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

Question 7

structural vs functional deformity

Answer 7

structural: doesn’t change with body position
functional: changes with body position

Question 8

slide 6 medical screenings question

Answer 8

cancer, infection, vertebral fx, AAA, mental, emotional, vigilance, pain catasrophizing, fear avoidance, self-efficacy, lacking insight to condition or best pratice tx options

Question 9

flattened spine

Answer 9

stenosis, lateral shifting, disc hernia

short hamstrings, weak hip flexors

Question 10

excessive lordosis

Answer 10

possible pelvic crossed syndrome

short ES and hip flexors, core and hip ext weak

Question 11

swayback (reversed lordosis)

Answer 11

thoracic kyphosis + posterior pelvic tilt

hips hyperextension

Question 12

scanning exams and observation slides 9-13

Question 13

double limb squat: looking for?

Answer 13

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

Question 14

trendelenberg sign

Answer 14

+ : contralateral hip drop
- : hip neutral

Question 15

poor balance

Answer 15

normal: > or equal to 30 sec each side

abnormal: <30 sec each side

Question 16

Lumbar spine AROM/Resisted Testing

Answer 16

AROM
Overpressure
Measure w/ inclinometer if one side is different from the other
resisted isometric movements*

Question 17

resisted isometric movements during lumbar spine AROM/resisted testing

Answer 17

test in lengthened position if no pain w/ AROM
test in neutral positions if pain w/ AROM

Question 18

FOR RADIATING PAIN ONLY use:

Answer 18

repeated motions testing

perform lateral shift FIRST if needed

later assess flexion and extension positions

Question 19

repeated motions testing:

Answer 19

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”)

Question 20

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)

Answer 20

AROM

Question 21

after you did lumbar ROM, assessed the joints above and below, you should___

Answer 21

MMT

• hips, knee, ankle, foot

Question 22

performing this test if you suspect patient lacks back extensor endurance

Answer 22

Sorensons Test

5: 20-30 second hold
4: 15-20 second hold
3: 10-15 second hold
2: 1-10 second hold

Question 23

performing this test if you suspect patient lacks back flexors endurance

Answer 23

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.

Question 24

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:

Answer 24

repeat the same test 3-5 reps looking for mm fatiguability

Question 25

toe walking and heel walking

Answer 25

toe: S1-2 “walk away from me on your toes”

heel: L4 “walk towards me on your heels”

Question 26

Neuro examination runthrough

Answer 26

Dermatomes
Myotomes
Deep tendon reflexes
UMN Signs (Ankle Clonus, Babinski)

compare to opposite side

Question 27

Ely’s Test
Modified Thomas test
which muscles?

Answer 27

Rectus Femoris muscle length
Psoas muscle

Question 28

slide 28 about flexibility of the piriformis and hamstrings

Question 29

hamstring muscle length

Answer 29

between 20 degrees = normal

Question 30

if you note an anterior pelvic tilt while patient is in prone

Answer 30

tight hip flexors

Question 31

slump test

Answer 31

• 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

Question 32

SLR

Answer 32

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

Question 33

Well/Crossed leg SLR test

Answer 33

pain/sx reproduction into involved leg w/ uninvolved SLR

(+) test = large disc herniation that may benefit from lumbar traction

Question 34

SLR variations

Tibial N
Superficial peroneal N
Sural N

Answer 34

Tibial - DF, Eversion

Superficial peroneal- PF, Inversion
Common fib nerve- PF, Inversion

Sural N: DF, Inversion

Question 35

Prone knee bend test (femoral nerve)

Answer 35

Prone, PROM knee flexion until Sx reproduced in anterior thigh (L2-3 Derm pattern)

Question 36

positive prone knee bend test

Answer 36

Sx reproduced b/t 80-100 degrees KF
- 0-80 degrees is just knee joint problems
- >100 is RF tightness or lumbar S dysfunction

Question 37

negative prone knee bend test

Answer 37

absent sx
sx below 80 deg KF
sx >100 indicates RF tightness or lumbar spine dysfunction

Question 38

slides about joint play assessment 34-35

Question 39

Prone instability test

Answer 39

• 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

Question 39

Bicycle or Stoop test for intermittent claudication

Answer 39

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)

Question 40

(+) prone instability test

Answer 40

less pain with mm activation during 2nd part of test (feet lifted)

Question 40

positive bicycle / stoop test

Answer 40

Sx IMPROVED with STOOPED posture

Question 41

waddell’s test for non-organic symptoms : STIMULATION

Answer 41

axial compression: GENTLY push on head and lumbar spine sx reproduced

trunk rotation: twist hips with hand at sides

Question 42

waddell’s test for non-organic symptoms: REGIONAL

Answer 42

sensory and weakness deficits

Question 43

waddell’s test for non-organic symptoms: TENDERNESS

Answer 43

superficial and non-surgical

Question 44

waddell’s test for non-organic symptoms: DISTRACTION (not of the joint but literally distracting them)

Answer 44

(not of the joint but literally distracting them)

SLR
Bend
limping

Question 45

which waddell’s test is less reliable than other signs?

Answer 45

over-reaction

Question 49

all components of waddell’s test for non-organic sx

Answer 49

1. stimulation
2. regional
3. tenderness
4. distraction
5. over-reaction

Question 49

positive waddell’s test

Answer 49

> or equal 3/5 tests indicates sx exaggeration

Question 50

Outcome measures for the lumbar spine

Answer 50

1. modified oswestry disability index
2. roland-morris back pain disability questionnaire
3. fear avoidance behavior questionnaire (FABQ)
4. patient specific functional scale (PSFS)