Lumbar Spine Practical Flashcards
(33 cards)
purpose of PAVIM
segmental mobility assessment
pain provocation assessment - more reliability for pain provocation
purpose of transverse PAVIM
treatment
how to conduct lumbar side flexion PPVIM
Patient in side flexion/sidelying
PT in front facing patient
using left hand to rest on back and stabilise vertebrae from formarm to elbow
moving hand grasp patients uppermost innominate under ischial tuberosity
bring patient into hip flexion
compare opposite side
describe rotation PPIVM
Side lying with his and knees flexed
physio - forearm resting on back, other hand holds hip fingers spread over ilium/greater trochanter
movement - stabilise thorax and pelvis rotated away from therapist. palpate relative movement of distal spinous process in relation to proximal one.
describe flexion/extension PPIVMS
Patient position - side lying, hips and knees flexed
physio position - in front facing patient
moving hand grasps back of flexed knees posteriroly and hips will grasp knees anteriorly
palpating hand - feel space gap in flexio and narrow in extension
movement - flex hips by rocking the patients knees towards patients chest to flex and extend lumbar spine
normal response to SLR NDT
ROM 50-120 degree hip flexion
posterior thigh, knee calf pulling
relieved by neck extension
abnormal response to SLR NDT
eproduces leg pain +/- LBP
Asymmetrical ROM
Different to expected normal response.
What sensitising manoeuvres can be used for SLT NDT
Hip Add
Hip MR
Passive neck flexion
Opposite SLR (B/L)
Ankle DF
PF/Inv
the sensitising manoeuvre add what type of stress on what tissue
longitudinal stress on neural tissue - sciatic nerve
when would SLR NDT be indicated
if patient presents with spinal or leg pain
used to highlight disc pathology in isolation
tests sciatic nerve - L4-S1
Purpose of Passive neck flexion NDT
loads connective and conductive tissue of spinal cord
stresses cervical, thoracic and lumbosacral nerve root and cervical meningeal structures
red flag in passive neck flexion NDT
foot P&Ns or numbness
abnormal response to passive neck flexion NDT
Symptoms reproduced e.g. pain, neurological symptoms etc.
What is a desensitising manoeuvre for passive neck flexion NDT
Hip and knee flexion
What is a sensitising manoeuvre for passive neck flexion NDT
SLR
Cervical sideflexion
Upper limb BPPT
Purpose of prone knee bend NDT and how is it conducted
patient in prone
hold foot and passively flex knee till heel reaches buttock
stabilis elower back
test femoral nerve L2-L4
Purpose of adding sensitising manoeuvres to prone knee bend in NDT
delineate neuropathodynamics from quads, psoas muscle tightness
when would it be indicated to conduct a prone knee bend NDT
lumbar pain
anterior hip pain
thigh and knee symptoms
normal response to PKB NDT
Heel reaches buttock and patient feels stretching sensation in anterior thigh.
Abnormal response to PKB NDT
Reproduces symptoms or is asymmetrical
Sensitising manoeuvres for PKB NDT
Hip Extension
Hip Adduction
Slump (cervical and trunk flexion) in side lying
Hip rotation
Ankle DF / Ever
Bilateral PKB
Purpose of slump test NDT
provides indication of longitudinal mobility of nerve tissue in caudad and cephalad directions
indications for slump test
Spinal symptoms
Lumbar or thoracic radiculopathy
Sciatic tract symptoms
Provocative activities that indicate that slump may be aggravating e.g. pain aggravated by kicking, dance (leg kick) or driving (bucket seat).
contraindications for slump test
Irritable disorder
Unstable disc pathology
Recent progressing neuro changes
Cord or Cauda equine symptoms.