Lecture 3: LBP - Lumbar, Piriformis, Short Leg Syndrome, Psoas Flashcards
What are the viscerosomatic levels for the upper and lower extremities?
- Upper = T2-T7
- Lower = T11-L2
Abnormal stimulation of what elicits the stretch reflex and maintains a muscle spasm?
Gamma motor neuron
What is the most common presenting sx’s of Piriformis Syndrome?
Pain w/ sitting, standing, or lying longer than 15-20 mins
Right-sided piriformis syndrome would cause what type of sacral SD and L5 compensatory rotation?
Left on left sacral torsion w/ L5 RR
What is the Freiburg sign for Piriformis Syndrome?
Pain during passive internal rotation of the hip
Strengthening of which hip muscles has been shown to be of benefit for Piriformis Syndrome?
ADductor ms.
What is the Pace sign for piriformis syndrome?
Pt is seated and ABducts against resistance –>> pain
Which lumbar vertebrae and SD finding is commonly seen with Psoas Syndrome?
L1 FLEXED Rotated and SB towards side of tight psoas
Stage 1 of Psoas syndrome is characterized by what?
Bilateral spasm
Which tx’s should NOT be used in the acute setting of Psoas Syndrome?
- Don’t do direct** stretching or **direct ME
- Don’t use heat!
Which TP point is being treated here?
Low ilium
Which TP is being treated here?
iliacus
Which type of stretch should be used in stage one (acute setting) of Psoas Syndrome?
Passive stretch (rolled up towel TID)
Stage 2 of Psoas Syndrome is characterized by what?
Unilateral spasm
What is the key SD finding in stage 2 of a right psoas spasm?
L1 F RR SR
What are the 3 steps and in what order for tx of Stage 2 of Psoas Syndrome?
- 1st = L1
- 2nd = L2-L5
- 3rd = Psoas stretch
What occurs in stage 3 of Psoas Syndrome?
Add sacral torsion and side shit
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?
- Axis of torsion = same side of SD
- Shift of pelvis AWAY from side of SD
If Psoas Syndrome is chronic in stage 3 there may be what innominate and leg SD’s present?
Posterior innominate SD –> Short leg = both on side of dysf. Psoas
Which stage of Psoas Syndrome do you add a Piriformis spasm?
Stage 4
Which side will the Piriformis spasm seen in stage 4 of Psoas syndrome be on and what will the finding be on OSE?
OPPOSITE side –> R. Psoas will see L. LE external rotation
What is seen in stage 5 of Psoas syndrome and what should be added to tx?
Add sciatica –> add low-dose steroid
Patients with Psoas syndrome will complain of difficulty lying in which position?
Prone
What is the key finding at the level of L5 in L5-S1 ambulatory compensation for short leg syndrome?
L5 SB towards axis, rotates opposite (towards deep sulcus)
