LPHC Kinematics And Examination Of Lumbo-Pelvic Mobility

Question 1

What is a PPIVM (Passive physiologic intervertebral mobility)?

Answer 1

Osteokinematics

Seeing what the bones are doing

Question 2

What is a PAIVM (passive accessory intervertebral motion)?

Answer 2

Arthrokinematics

Feeling what the jts are doing

Question 3

What is the pt positioning for the FB PPIVM?

Answer 3

Sidelying

Question 4

What is the therapists position for the FB PPIVM?

Answer 4

Grasping the top leg in some knee flexion with their knee at your ASIS

Question 5

What is the technique for the FB PPIVM?

Answer 5

Move the hip into flexion with palpating the SP gapping

Question 6

What are we feeling for with the FB PPIVM?

Answer 6

Quality and relative quantity of SP gapping to sense the overall contribution of each spinal segment

Question 7

T/f: we may get a reproduction of symptoms with a FB PPIVM

Answer 7

True

Question 8

When doing the FB PPIVM, we should not let the pt’s leg move in what direction?

Answer 8

Adduction

Question 9

What is the pt position for the SB PPIVM?

Answer 9

Prone

Question 10

What is the therapist position for the SB PPIVM?

Answer 10

Hold the flexed knee close to you

Question 11

What is the technique for the SB PPIVM?

Answer 11

Move the hip into increasing abduction to create a hip hike and SB at the spine while palpating just next to the SP

Question 12

What is an alternate way to perform the SB PPIVM other than with the pt in prone as the therapist brings them into hip abduction?

Answer 12

With the pt in SL, grab their legs together up towards the ceiling to create hip hike and spinal SB, then pull the legs towards the floor to create SB the other way

Question 13

What is the pt position for the Rotation PPIVM?

Answer 13

Prone

Question 14

What is the therapist position for the rotation PPIVM?

Answer 14

Grasping the ASIS or legs

Question 15

What is the technique for the rotation PPIVM?

Answer 15

Move the hip into rotation by pulling up on the ASIS or legs with one hand while palpating two adjacent SPs with the other hand

Question 16

When you pull up on the R ASIS in the rotation PPIVM, what direction are the two segments rotating?

Answer 16

The lower segment will rotate R (SP will protrude L)
The upper segment will rotate L (SP will protrude R)

Question 17

When you pull up on the L ASIS in the rotation PPIVM, what direction are the two segments rotating?

Answer 17

The lower segment will rotate L (SP will protrude R)
The upper segment will rotate R (SP will protrude L)

Question 18

What is the pt position for the central anterior PAIVM (central PA)?

Answer 18

Prone

Question 19

What is the technique for the central anterior PAIVM?

Answer 19

Very similar to the mobilization

Using horse and jockey or spit finger technique, apply slow anterior force straight down on the SP to assess mobility and reproduction of symptoms

Apply force until you feel the first resistance (R1) followed by “quicksand” feeling then the second resistance where no more motion will occur (R2/L1)

Question 20

Why would we use a central anterior PAIVM?

Answer 20

To assess mobility and reproduction of symptoms

Question 21

T/f: normally, R2 should be the same point as L

Answer 21

True

Question 22

If P1 comes b4 R1, is the pt more reactive or stiff?

Answer 22

Reactive

Question 23

If R1 comes b4 P1, is the pt more reactive or stiff?

Answer 23

Stiff

Question 24

What is the technique for a unilateral anterior PAIVM?

Answer 24

Use thumb over thumb contact at the TP and apply an anterior force straight down to create rotation

Question 25

What does the unilateral anterior PAIVM test for?

Answer 25

Assess mobility of rotation and reproduction of symptoms

Question 26

By pushing on the L TP in a unilateral anterior PAIVM, what rotation is being created?

Answer 26

R rotation

Question 27

By pushing on the R TP in a unilateral anterior PAIVM, what rotation is being created?

Answer 27

L rotation

Question 28

With L lumbar rotation, what segment is opening and what is closing?

Answer 28

The L above opens The L below closes The R above closes The R below opens

Question 29

With R lumbar rotation, what segment is opening and what is closing?

Answer 29

The R above opens The R below closes The L above closes The L below opens

Question 30

What is the technique for the transverse PAIVM?

Answer 30

With thumb over thumb contact on the side of the SP, apply a translatory force

Question 31

What does the transverse PAIVM assess?

Answer 31

Mobility of rotation and reproduction of symptoms

Question 32

What is R1?

Answer 32

The initial resistance we feel

Question 33

What is P1?

Answer 33

Initial perceived onset of pain

Question 34

What does the relationship between R1 and P1 determine?

Answer 34

If the patient is stiffness dominant or pain dominant

Question 35

If R1 comes before P1, the patient is ____ dominant

Answer 35

Stiffness

Question 36

If P1 comes before R1, the patient is ____ dominant

Answer 36

Symptom

Question 37

With a stiffness dominant patient, what mobs are we doing?

Answer 37

Higher grade mobs

Question 38

With a symptom dominant patient, what mobs are we doing?

Answer 38

Low grade mobs

Question 39

Do PAIVMs have better reliability for provocation of symptoms or assessment of motion

Answer 39

Provocation of symptoms

Question 40

T/f: real determination of end feel is difficult but determination of reactivity is better

Answer 40

True

Question 41

What is anterior iliosacral rotation?

Answer 41

The sacrum moving posterior (counternutation)

Question 42

What is posterior iliosacral rotation?

Answer 42

Sacrum moves anterior (nutation)

Question 43

What is the PSIS FB test for?

Answer 43

Testing for anterior rotation of the ilium

Question 44

What is the technique of the PSIS FB test?

Answer 44

Palpate the PSIS during FB and look for symmetry of motion

Question 45

What is a (+) PSIS FB test?

Answer 45

One side moves first, fastest, furthest Reproduction of sx

Question 46

When the R PSIS moves more with the PSIS FB test, the __ may be stuck forward or the ___ may be stuck backward

Answer 46

R, L

Question 47

When the L PSIS moves more in the PSIS FB test, the __ may be stuck forward or the __ may be stuck backward

Answer 47

L, R

Question 48

What is the Marcher’s Gillet Test testing for?

Answer 48

Tests for posterior rotation of the ilium

Question 49

What is the technique for Marcher’s Gillet test?

Answer 49

Palpate the PSIS with thumbs during hip flexion >120 deg Have the pt march with one leg at a time

Question 50

During the Marcher’s Gillet test, the PSIS should move ____ and _____

Answer 50

Inferior, medial

Question 51

T/f: if the PSIS is stuck anterior, you won’t see a lot of motion with the Marcher’s Gillet test

Answer 51

True

Question 52

What is a (+) Marcher’s Gillet test?

Answer 52

The PSIS moves <4.5-9mm inf and 2.5-6.5mm med Reproduction of symptoms

Question 53

What does the flare test test for?

Answer 53

Inflare/outflare of the ilium

Question 54

What is the technique for the Flare test?

Answer 54

Palpate the PSIS with thumbs during ER/IR of the hip by having the pt standing and moving their foot in and out on the floor

Question 55

What is a (+) flare test?

Answer 55

Moves <2.5mm med (outflare) or lat (inflare) translation Reproduction of symptoms

Question 56

What is the weight shift test a test for?

Answer 56

It tests up slip and down slip of the ilium

Question 57

What is the technique for the weight shift test?

Answer 57

In standing, palpate the PSIS with thumbs while the patient shifts their weight slowly from right to left

Question 58

In stance during the weight shift test, the PSIS on the stance side should move ____ and the PSIS on the NWB side should move ____

Answer 58

Superior, inferior

Question 59

What is a (+) weight shift test?

Answer 59

Asymmetry in the amount of motion noted Reproduction of symptoms

Question 60

Inflare is associated with ____, outflare is associated with ____

Answer 60

IR/ER

Question 61

During stance phase, the ilium ____, during swing phase the ilium _____

Answer 61

Upslips, downslips

Question 62

What are the sacroiliac tests?

Answer 62

Sit slump test Sitting rotation test SI FB SI FB, flex, nutation SI BB, ext, counternutation SI, forward torsion SI backward torsion

Question 63

What is the sit slump test a test for?

Answer 63

It tests for sacral flexion and extension

Question 64

What is the technique for the sit slump test?

Answer 64

Palpate over the sacral base/sulci during FB/BB in sitting

Question 65

With slumping, the sulci become ____, with sitting, the sulci become _____

Answer 65

Shallow, deep

Question 66

How do we provide over pressure on the sacrum with slumping?

Answer 66

Put pressure at the apex

Question 68

How do we provide counterpressure on the sacrum with slumping?

Answer 68

Put pressure a the base of the sacrum

Question 69

How do we provide over pressure on the sacrum with sitting (extension)?

Answer 69

Put pressure on the base of the sacrum

Question 70

How do we provide counterpressure on the sacrum with sitting (extension)?

Answer 70

Put pressure on the apex of the sacrum

Question 71

What is a (+) sit slump test?

Answer 71

Overall reduced motion compared with normal Asymmetric motion Reproduction of symptoms

Question 72

What is the point of overpressure and counterpressure of the sacrum with the sit slump test?

Answer 72

To see if they can lessen symptoms or increase motion

Question 73

T/f: overpressure at the base of the sacrum with lumbar extension could be providing stabilization for motion at L5/S1

Answer 73

True

Question 74

What is the technique for the sitting rotation test?

Answer 74

Palpate the sacral sulci during rotation (can provide over and counter pressure)

Question 75

With L lumbar rotation, the ____ sulci becomes deeper and the ____ sulci becomes shallower

Answer 75

R, L

Question 76

With R lumbar rotation, the ___ sulci becomes deeper and the ___ sulci becomes shallower

Answer 76

L, R

Question 77

How can we provide overpressure to the sacrum in L rotation?

Answer 77

By pushing on the R

Question 78

How can we provide overpressure to the sacrum in R rotation?

Answer 78

Put pressure on the L

Question 79

How can we provide counterpressure to the sacrum in L rotation?

Answer 79

Put pressure on the L

Question 80

How can we provide counterpressure to the sacrum in R rotation?

Answer 80

Put pressure on the R

Question 81

What is a (+) sitting rotation test?

Answer 81

Overall reduced motion compared to normal Asymmetrical movt Reproduction of symptoms

Question 82

How do we assess mobility/sx of SI FB, flex, nutation?

Answer 82

Contact the sacral base and apply an anterior force

Question 83

How do we assess mobility/sx of SI BB, ext, counternutation?

Answer 83

Contact the sacral apex and apply an anterior force

Question 84

How do we assess mobility/sx of SI R on R forward torsion?

Answer 84

Contact the L sacral sulcus and apply an anterior force

Question 85

How do we assess mobility/sx of SI L on L forward torsion?

Answer 85

Contact the R sacral sulcus and apply an anterior force

Question 86

How do we assess mobility/sx of SI L on R backward torsion?

Answer 86

Contact the R inferior lateral angle and apply an anterior force

Question 87

How do we assess mobility/sx of SI R on L backward torsion?

Answer 87

Contact the L sacral sulcus and apply an anterior force

Question 88

T/f: the SI passive mobility tests are not usually going to detect a lot of motion, but the will show us a reproduction of symptoms

Answer 88

True