Lumbar Spine Practical Flashcards
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.
method of slump test
pt - sits plinth thighs fully support arms behind back
flex trunk
flex cervical spine
knee extension - on asymptomatic side
ankle dorsiflexion
repeat on symptomatic leg
if symptomatic - extend neck
then rest and add B/L knee extension and ankle DF
Normal response to slump test
Trunk flexion – nil
Add cervical flexion – 50% normals report pain in T8/9 region – why?
Add knee extension – discomfort & pulling in posterior knee / thigh / hams and symmetrical restriction – most people can’t fully extend knee.
Add DF – intensifies above
Release neck – decreases all symptoms and increases knee extension possible.
abnormal response to slump test
Reproduces patient’s symptoms
Asymmetry
Symptoms moved by other movement of distant body parts.
when are central PAVIM PAs indicated as a treatment
Indicated when pain or muscle reactivity is provoked on exam, but performed short of both of
when are unilateral PAVIM PA indicated as a treatment
Very effective when muscle reactivity or pain is provoked on exam and in treatment, angle can be varied as indicated by response to technique or whether IVF is to be opened
when would transverse PAVIM be indicated as a treatment
More likely to produce improvement in symptoms if done from painless side, pushing spinous process towards painful side. This opens joint / IVF on painful side. In lower lumbar spine, not as useful as rotation or PAs, due to difficulty accessing
when is rotation PPIVM indicated as a treatment
Very useful technique in treating low back pain –
* Most valuable when pain is unilateral or with central pain with unilateral signs
how is the patient and therapist positioning for grade III rotation PPIVM
patient - Lying on side, with uppermost (left) leg flexed with foot hooked behind lower knee. Lower leg extended.
therapist - To apply rotation, therapist stands behind patient again and stabilises thorax at anterior aspect of left shoulder, while producing rotation via pelvis.
how is the patient and therapist positioning for grade IV rotation PPIVM
patient -Same as for Grade III except left leg is now allowed to drop over edge of bed. Stabilising pressure can alternately be provided through patient’s left hand on abdomen – this reduces strain on thoracic spine during technique
therapist -Same as for Grade III except different amplitude.
