Lumbar Exam/Interventions Flashcards
special tests for ruling out lumbar radiculopathy
- slump test
- straight leg raise test
special tests for ruling out z joint pain
extension rotation test
+ slump test results
pt has symptoms provoked during motion and symptoms relieved when neck is extended while in slumped position
What are potential position for sensitizing the straight leg raise test?
- cervical flexion
- Hip IR
- Hip ADD
- Ankle DF
- Ankle DF and inversion for sural nerve bias
- PF and inversion for fibular nerve bias
how to bias sural nerve on SLR test
SLR + ankle DF and inversion
how to bias fibular nerves on SLR test
SLR + PF and Inversion
CPR for lumbar stenosis
- bilateral symptoms
- Leg pain > back pain
- pain with walking/standing
- pain relieved with sitting
- age > 48 y/o
special tests for confirming discogenic symptoms and/or lumbar radiculopathy
centralizations with repeated motions
special tests for confirming lumbar radiculopathy
- well leg raise test
- femoral nerve tension test
- CPA/spring testing
special tests for confirmation of neuromuscular instability
- catch sign
- passive lumber extension test
- prone instability test
+ test for well leg raise test
lift non-involved side and + test if symptoms are reproduced on involved side
What is the Revised Oswestry Disability Index?
10 item self-report questionnaire that is designed to measure disability related to LBP
- higher score = higher disability
- lower score = lower disability
MDIC of Revised Oswestry Disability index
30% from baseline score
What is the Roland-Morris Disability Questionnaire? What are scores?
24-item questionnaire that measures physical disability secondary to LBP
- 0 (no disability) - 24 (max disability)
MCID of Roland-Morris Disability Questionnaire (RMDQ)?
changes of 2-3 points
- change in baseline by 30% (5 point improvement)
interventions for spondylolysis/spondylolysthesis
- address muscle guarding w/ AROM, soft tissue mobs, low intensity-high frequency
- stretching of shortened hip musculature
- progress lumbar stabilization exercises
interventions for disc pain
Will see multidirectional ROM limitations
- address muscle guarding
- low intensity-high frequency exercises
- progress lumbar stabilization
interventions for radiculopathy/radicular pain
- AROM exercises
- neuro mobilizations
- progress lumbar stabilization exercises
want to centralize symptoms
interventions for lumbar spine stenosis
- sustained hold mobs for hypomobile segments
- oscillations for muscle guarding and pain
- muscle performance tests
interventions for z-joint arthropathy
- address muscle guarding
- low-intensity/high frequency and duration exercises
- joint mobs
best intervention for acute LBP
thrust and non-thrust mobs
- pt education
best intervention for chronic LBP
- exercise training interventions
- trust and non-thrust mobs
- pain neuroscience pt education
How to determine if a patient fits into LBP with cognitive or affective tendencies?
patient will have the presence of fear avoidance, pain catastrophizing, or depression
Patients who have chronic LBP with related generalized pain
chronic is > 3 months
- patient will have the presence of fear avoidance, pain catastrophizing, or depression
treatment for chronic LBP with related generalized pain
- prioritize interventions to address biopsychosocial contributors to pain
- pain neuroscience education
- general exercise training, aerobic exercises, and active education and advice
- cognitive functional therapy
how to rule in acute/chronic LBP with movement coordination impairments
- symptoms reproduced with mid-range motion and worse with end-range motion
- observed gowers sign or hitch in giddy up (movement coordination impairments)
- diminished strength and endurance
- mobility deficits
- lumbar hypermobility
how to rule out acute/chronic LBP with movement coordination impairments
- adequate L/R passive straight leg raise and thorax rotation
- normal trunk flexor, trunk extensors, lateral abdominals, hip abductors, hip and thigh muscle performance
interventions for acute/chronic LBP with movement coordination impairments
- specific trunk activation training
- trunk muscle strengthening and endurance exercises
- thrust and non-thrust joint mobs, soft tissue mobs, and massage
- pt education to purse an active lifestyle
how to rule in acute LBP with related radiating LE pain
centralized pain with positioning, manual procedures, and/or repeated movements
how to rule in actue LBP with radiating pain
symptoms reproduced with mid-range and worsen with end-range testing
how to rule in chronic LBP with radiating pain
symptoms reproduced with sustained end-range lower-limn nerve tension/straight leg raise and/or slump test
How to rule in acute LBP with mobility deficits
- Pt reports “tweaked my back when I did….”
- lumbar ROM limitations
- onset of symptoms often linked with recent awkward movement
interventions for acute mobility deficits
- thurst, non-thrust joint mobs, soft tissue mobilization and massage
- general exercise training
cluster that best determines if a patient would benefit from a spinal manip
- duration of symptoms </= 16 days
- no symptoms distal to the knee
- FABQ score < 19
- at least one hip > 35 deg IR ROM
- hypomobility in lumbar spine
