Lumbar Spine Examination Flashcards
Observation
Gait - ataxia (uncontrolled)/ unstable, Antalgic (limb), drop foot (no dorsiflexion)
Spinal alignment - scoliosis/ lordosis, neural offloading (shift, avoiding knee extension, sitting with weight through one side), avoiding spine extension hypervigilance in sitting
Muscle wasting
Functional movements - sit to stand, putting on/ taking off shoes and socks, picking something off the floor
Breathing pattern
Active range of motion
Flexion - 60 degrees, bend to touch their toes, limited by hamstrings so ask them to sit and repeat
Extension - 35 degrees, bend backwards, walk fingers down the back of their legs
Side flexion - 25-30 degrees, lean to side and drag their fingers down their leg
Add over pressure
Dermatome testing
Dermatome - area of skin that is supplied by a single nerve root
Light touch
Sharp vs blunt
Test - circumferentially or Dermatome comparing sides and areas of the limb, cotton wool, feels the same on both sides
Myotome testing
Myotome - groups of muscle innervated by a single spinal nerve
L2 - hip flexion
L3 - knee extension
L4 - ankle dorsiflexion
L5 - toe extension
S1 - ankle plantar flexion
Isometric resisted movement
Graded on oxford scale
Comparing both sides
Reflex testing: patella tendon
Never root of L3
Sitting or supine
Fine patella tendon
Use a reflex hammer to hit the tendon
Good result - lower leg extends and kicks forwards
Reflex testing: Achilles tendon
Nerve root of S1
Sitting or supine (ankle over the other leg)
Hold foot in dorsiflexion
Find Achilles tendon
Use a reflex hammer to hit the tendon
Goof result - foot plantar flexes and points their toes
Reflex testing: clonus
Passive movements of the ankle
Then quicker speed dorsiflexion the ankle
Positive result - spasms or high muscle tone
Reflex testing: babinski
With sharp, pointed object (other end of reflex hammer or a pen)
Trace from the bottom of the sole of the foot up laterally to the little toe then across to the big toe
Normal response - nothing or toes will flex/ bend inwards
Positive result - big toe extension or slaying of all the toes
Neural sensitivity testing: straight leg raise (SLR)
Sciatic nerve
Supine
Raise patients leg up with the knee straightened
Add dorsiflexion and/or cervical neck flexion - increase neural tension
Distinguish between Redicular pain and hamstring tightness
Document range e.g. P1 reproduced at 30 degrees
Neural sensitivity testing: prone knee bend (PKB)
Femoral nerve
Prone or side lying
Bend the patients knee/ leg towards their buttock
Document range e.g. P1 reproduced at 30 degrees
PAIVM
Passive accessory intervertebral movement
PAIVM: PA on spinous process
L4 by using the iliac crest
With your thumbs or pisiform of the hand place them on the spinous process of the identified vertebrae
Push down until resistance, stiffness or pain
Reduce the range of movement
Push with straight arms and use your body
PAIVM: unilateral on transverse process
Find spinous process then move laterally around the width of two thumbs to find the transverse process
With your thumbs push down until resistance, stiffness or pain
Reduce range of movement
Push with straight arms and use your body
PAIVM: transverse glide on spinous process
Find spinous process of vertebrae and drop your thumbs to the side of the spinous process
Patient needs to be relaxed so the muscle isn’t in the way
Push the spinous process in a horizontal line
Push with straight arms and use your body
PPIVM
Passive physiological intervertebral movements
PPIVM: flexion
Side lying
Stand in front of them
Place your fingers in the dips/ spaces between the spinous processes
Lift their legs or just the top leg up and move them up towards their chest to flex the spine
Spaces should get bigger as the spine flexes
PPIVM: extension
Side lying
Stand behind them
Place your fingers in the dips/ spaces between the spinous processes
Lift their top leg and move it backwards to arch their back
Spaces should get smaller as the spine extends
PPIVM: rotation
Side lying
Stand behind them
Lift their legs up and move them towards their chest to flex the spine
Have the patient rotate their upper body so their upper body is more supine
Move around to their back
Place both hands on their pelvis (ilium)
Push forward down the line of the femur to rock and rotate their upper body spine
