Lumbar Spine Exam Flashcards
Hsitory
All aspects of history are important because conditions may be related to age, gender, occupation, and family history
Disc lesions generally have
insidious onset caused by repeated slump sitting, lifting, and forward bending.
Facet Joint locking
is often caused by a sudden unguarded movement.
Inflammatory and systemic disorders
present with subtle onset
Sprains and strains
involve aggravation or trauma.
Include pain drawing
Used to record area, type, depth, ad intensity
May
Address actions or positions
that cause or alleviate pain
Mechanical problems such as herniated disc, spondylolisthesis, or osteoarthritic facet joints know precisely
which factors aggrivate and which relieve their symptoms
Facet joint pain
often relieved by sitting and forward bending but painful with walking
Annular tear is
generally aggrivated
Radiculopathy causes
specific dermatomal patterns with paresis, loss of sensation and reflex loss
Radiculopathy resulting from disc herniation
starts off as back pain that progresses to predominantly lefgpain and worsens with increase in intra-abdominal pressure such as coughing, sneezing, as well as sitting
Will also show positive nerve-stretch signs.
Assess behavior over a
24 hour period
Chronic degenerative disc disease
morning stiffness that resolves to allow activity with minimal pain
Pain will worsen with heavy use or poor positioning
Postural Dysfunction
worst at the end of the day
Outcome measures
Modified Oswestry Disability Index Roland Morris Disability Questionnaire Fear Avoidance Beliefs Questionnaire -4 item physical activity -7 item work subscale -Dutton 152
Walking Observation
- Requires optimal lumbo-pelvic-hip function
- Leg length discrepancy and accompanying increase or decreased lordosis
- Reflex inhibition of glute med leading to Trendelenburg gait
- Sidebending of trunk away from painful side
Other things to look at in observation
Getting up from sitting
Removing clothes and shoes
General Static Posture
– Standing, sitting without back support, and long-sitting
– Head and shoulder alignment
– Spinal curves
– Level of pelvis
– Weight bearing equality or lateral pelvic tilt may clue in to leg length
discrepancy
Lumbar Exam
Clear Related Joints
-HIP
-SIJ
Active Movements
-all active movements should be performed to end of ROM or to the point of pain
-Over pressure can be provided if no pain present at end ROM
Active Movements: Extension
• Pt position: In stance with feet shoulder width apart
hands NOT placed on hips
• Pt instruction: Extend back to the point of end ROM
or pain.
• Overpressure is NOT applied in EXT
• Aid the pt in returning to the starting position by
giving support at the thoracic level
Active Movements: Flexion
• Pt Position: In stance with feet shoulder width apart • Pt Instruction: Bend forward while sliding hands down the front of the leg • Document where finger tips reach in reference to landmark • Overpressure by compressing downward at the upper most shoulder • The PT should be looking for – a reversal of lumbar lordosis – Quality of movement – pt unable to straighten back to neutral suggests instability
Active Movements: Sidebending
• Pt Position: Standing with Feet shoulder width
apart
• Pt Instruction: Place hand on lateral thigh and
slide down leg in that direction to the point of
pain or end of ROM
• Document where fingertips reach in reference to
an anatomical landmark
• Overpressure can be applied by placing one hand
on the side-bent hip and applying a downward
force at the contralateral shoulder
• Note the quality of the curve of the spine
Active Movements: Trunk Rotation
• Pt position: Sitting in order to stabilize the
pelvis
• Pt Instruction: Cross arms at shoulder height
and rotate head and body to the same side to
the point of pain or end of ROM
• Overpressure can be applied by placing the
hands on the anterior surface of the ipsilateral
shoulder and on the posterior surface of the
contralateral shoulder
