Lumbar Spine Exam

Question 1

Hsitory

Answer 1

All aspects of history are important because conditions may be related to age, gender, occupation, and family history

Question 2

Disc lesions generally have

Answer 2

insidious onset caused by repeated slump sitting, lifting, and forward bending.

Question 3

Facet Joint locking

Answer 3

is often caused by a sudden unguarded movement.

Question 4

Inflammatory and systemic disorders

Answer 4

present with subtle onset

Question 5

Sprains and strains

Answer 5

involve aggravation or trauma.

Question 6

Include pain drawing

Answer 6

Used to record area, type, depth, ad intensity

May

Question 7

Address actions or positions

Answer 7

that cause or alleviate pain

Question 8

Mechanical problems such as herniated disc, spondylolisthesis, or osteoarthritic facet joints know precisely

Answer 8

which factors aggrivate and which relieve their symptoms

Question 9

Facet joint pain

Answer 9

often relieved by sitting and forward bending but painful with walking

Question 10

Annular tear is

Answer 10

generally aggrivated

Question 11

Radiculopathy causes

Answer 11

specific dermatomal patterns with paresis, loss of sensation and reflex loss

Question 12

Radiculopathy resulting from disc herniation

Answer 12

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.

Question 13

Assess behavior over a

Answer 13

24 hour period

Question 14

Chronic degenerative disc disease

Answer 14

morning stiffness that resolves to allow activity with minimal pain
Pain will worsen with heavy use or poor positioning

Question 15

Postural Dysfunction

Answer 15

worst at the end of the day

Question 16

Outcome measures

Answer 16

Modified Oswestry Disability Index
Roland Morris Disability Questionnaire
Fear Avoidance Beliefs Questionnaire
-4 item physical activity
-7 item work subscale
-Dutton 152

Question 17

Walking Observation

Answer 17

1. Requires optimal lumbo-pelvic-hip function
2. Leg length discrepancy and accompanying increase or decreased lordosis
3. Reflex inhibition of glute med leading to Trendelenburg gait
4. Sidebending of trunk away from painful side

Question 18

Other things to look at in observation

Answer 18

Getting up from sitting

Removing clothes and shoes

Question 19

General Static Posture

Answer 19

–  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

Question 20

Lumbar Exam

Answer 20

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

Question 21

Active Movements: Extension

Answer 21

•  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

Question 22

Active Movements: Flexion

Answer 22

•  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

Question 23

Active Movements: Sidebending

Answer 23

•  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

Question 24

Active Movements: Trunk Rotation

Answer 24

•  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