Lecture 3: LBP - Lumbar, Piriformis, Short Leg Syndrome, Psoas

Question 1

What are the viscerosomatic levels for the upper and lower extremities?

Answer 1

• Upper = T2-T7
• Lower = T11-L2

Question 2

Abnormal stimulation of what elicits the stretch reflex and maintains a muscle spasm?

Answer 2

Gamma motor neuron

Question 3

What is the most common presenting sx’s of Piriformis Syndrome?

Answer 3

Pain w/ sitting, standing, or lying longer than 15-20 mins

Question 4

Right-sided piriformis syndrome would cause what type of sacral SD and L5 compensatory rotation?

Answer 4

Left on left sacral torsion w/ L5 RR

Question 5

What is the Freiburg sign for Piriformis Syndrome?

Answer 5

Pain during passive internal rotation of the hip

Question 6

Strengthening of which hip muscles has been shown to be of benefit for Piriformis Syndrome?

Answer 6

ADductor ms.

Question 7

What is the Pace sign for piriformis syndrome?

Answer 7

Pt is seated and ABducts against resistance –>> pain

Question 8

Which lumbar vertebrae and SD finding is commonly seen with Psoas Syndrome?

Answer 8

L1 FLEXED Rotated and SB towards side of tight psoas

Question 9

Stage 1 of Psoas syndrome is characterized by what?

Answer 9

Bilateral spasm

Question 10

Which tx’s should NOT be used in the acute setting of Psoas Syndrome?

Answer 10

• Don’t do direct** stretching or **direct ME
• Don’t use heat!

Question 11

Which TP point is being treated here?

Answer 11

Low ilium

Question 12

Which TP is being treated here?

Answer 12

iliacus

Question 13

Which type of stretch should be used in stage one (acute setting) of Psoas Syndrome?

Answer 13

Passive stretch (rolled up towel TID)

Question 14

Stage 2 of Psoas Syndrome is characterized by what?

Answer 14

Unilateral spasm

Question 15

What is the key SD finding in stage 2 of a right psoas spasm?

Answer 15

L1 F RR SR

Question 16

What are the 3 steps and in what order for tx of Stage 2 of Psoas Syndrome?

Answer 16

• 1st = L1
• 2nd = L2-L5
• 3rd = Psoas stretch

Question 17

What occurs in stage 3 of Psoas Syndrome?

Answer 17

Add sacral torsion and side shit

Question 18

What side will the axis of the sacral torsion be and in which direction will the pelvis side shift during stage 3 of psoas syndrome?

Answer 18

• Axis of torsion = same side of SD
• Shift of pelvis AWAY from side of SD

Question 19

If Psoas Syndrome is chronic in stage 3 there may be what innominate and leg SD’s present?

Answer 19

Posterior innominate SD –> Short leg = both on side of dysf. Psoas

Question 20

Which stage of Psoas Syndrome do you add a Piriformis spasm?

Answer 20

Stage 4

Question 21

Which side will the Piriformis spasm seen in stage 4 of Psoas syndrome be on and what will the finding be on OSE?

Answer 21

OPPOSITE side –> R. Psoas will see L. LE external rotation

Question 22

What is seen in stage 5 of Psoas syndrome and what should be added to tx?

Answer 22

Add sciatica –> add low-dose steroid

Question 23

Patients with Psoas syndrome will complain of difficulty lying in which position?

Answer 23

Prone

Question 24

What is the key finding at the level of L5 in L5-S1 ambulatory compensation for short leg syndrome?

Answer 24

L5 SB towards axis, rotates opposite (towards deep sulcus)