Lx Spine Ax/Glides/Manips Flashcards

1
Q

Lx spine ROM/OP - flex

A

**Assess: Quantity, Quality, Pain, EF!!

Will help you identify if you have a:

  • Hypomobility
  • Hypermobility OR
  • Instability

Should be done:

  • If not enough information from AROM/OP
  • To confirm your hypothesis after AROM/OP & (PAs)
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2
Q

Lx spine ROM/OP - ext

A

**Assess: Quantity, Quality, Pain, EF!!

Will help you identify if you have a:

  • Hypomobility
  • Hypermobility OR
  • Instability

Should be done:

  • If not enough information from AROM/OP
  • To confirm your hypothesis after AROM/OP & (PAs)
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3
Q

Lx spine ROM/OP - side flex

A

**Assess: Quantity, Quality, Pain, EF!!

Will help you identify if you have a:

  • Hypomobility
  • Hypermobility OR
  • Instability

Should be done:

  • If not enough information from AROM/OP
  • To confirm your hypothesis after AROM/OP & (PAs)
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4
Q

Lx Spine ROM/OP - rotation

A

**Assess: Quantity, Quality, Pain, EF!!

Will help you identify if you have a:

  • Hypomobility
  • Hypermobility OR
  • Instability

Should be done:

  • If not enough information from AROM/OP
  • To confirm your hypothesis after AROM/OP & (PAs)
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5
Q

Lx spine RISOM - flex, ext, rotation, side flex

A
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6
Q

Lx spine - how to R/O LE

A
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7
Q

Lx spine palpation - femoral, popliteal, tibial, dorsalis pedis artery

A
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8
Q

Lx spine - passive accessory (PA) glide

A
  • Finding L5 – palpate for psis – from there move on medial part of sacrum (let fingers slide down the sacrum (fingers curled), the first depression you feel will be L5
    • Make sure fingers are very light
  • For glide – pt supine push anteriorly
  • If you are assessing R side, PT is on the L side – don’t need to use pillow under stomach
  • Hand 1: for palpation - hypothenar eminence (pinkie side of hand) – pisiform (not the side of hand!!)
  • Hand 2: for pushing down on other hand (place on top of other hand)
    • Look for the feel first – is it the same at every level?
    • Assess unaffected side first
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10
Q

Lx spine - combined “H” in flexion

A

**Assess: Quantity, Quality, Pain, EF!!

Will help you identify if you have a:

  • Hypomobility
  • Hypermobility OR
  • Instability

Should be done:

  • If not enough information from AROM/OP
  • To confirm your hypothesis after AROM/OP & (PAs)
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11
Q

Lx spine - combined “I” in flexion

A

**Assess: Quantity, Quality, Pain, EF!!

Will help you identify if you have a:

  • Hypomobility
  • Hypermobility OR
  • Instability

Should be done:

  • If not enough information from AROM/OP
  • To confirm your hypothesis after AROM/OP & (PAs)
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12
Q

Lx spine - combined “H” in extension

A

**Assess: Quantity, Quality, Pain, EF!!

Will help you identify if you have a:

  • Hypomobility
  • Hypermobility OR
  • Instability

Should be done:

  • If not enough information from AROM/OP
  • To confirm your hypothesis after AROM/OP & (PAs)
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13
Q

Lx spine - combined “I” extension

A

**Assess: Quantity, Quality, Pain, EF!!

Will help you identify if you have a:

  • Hypomobility
  • Hypermobility OR
  • Instability

Should be done:

  • If not enough information from AROM/OP
  • To confirm your hypothesis after AROM/OP & (PAs)
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14
Q

Lx spine - PPIVM - flex and ext

A

PPIVM : Passive physiological intervertebral movement

  • Intervertebral = at each segment (Z joint)
  • Done if from your Lx Scan, your hypothesis is an hypomobility
  • Will help you confirm the level of hypomobility

* for ext same thing as flex but bring Lx spine into unilateral ext (applying an ant-sup force at pelvis)

  • Extension on L: Pt side lying L and 1 hand pushing on greater trochanterish area (push up and anteriorly), second hand feeling spinus process
  • Flexion on L: Pt L side lying (push down and anteriorly – hand position hand on pt greater trochanter to greater traction – can also use arm on greater trochanter instead of hand
  • Do up until t10
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15
Q

Lx spine - exercises for strenghtening IU and OU ms

A

You cannot strengthen a ms your brain cannot activate

Normal = activation of IU ms before contraction of OU ms

Can use PBU as an objective measurement

First GOAL: activate each IU ms (without any OU ms contraction)

Practice activation of each IU ms in different positions (sit, stand, squat)

Then practice co-activation of all IU ms

Progress by adding OU ms (next semester) move

* Practice in different positions: 4 point kneeling, Sitting, Standing, Squatting

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16
Q

Neurological Exam - dermatomes Ax procedure

A

*work distal to proximal, 2 seconds btw each stimulus

*ask “do you feel anything - then does it feel the same on both sides”?

*pain assessed after light touch

Grading: (From American Spinal Injury Association)

0 = If no sensation
1 = Decreased sensation
2 = Normal sensation

Overall neurological exam results:

Sensation testing alone does not seem to be useful for radiculopathy

When tested in isolation, weakness with MMT & reduced reflexes = radiculopathy

When changes in reflexes, ms strength, & sensation are found in conjunction with a (+)ve SLR, Lx radiculopathy is highly likely

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17
Q

Neurological Exam - myotome Ax procedure

A

* compare side to side and if possible assess the 2 sides silmultaneously

* HOLD 5 SECONDS!

* repeat 5 times to confirm the fatiguability

* if +’ve use the alternative muscles

Grading:
0 = No contraction

1 = Ms contraction without movt

2 = Movt without gravity

3 = Movt with gravity

4 = Movt against resistance

5 = Normal ms strength

Overall neurological exam results:

Sensation testing alone does not seem to be useful for radiculopathy

When tested in isolation, weakness with MMT & reduced reflexes = radiculopathy

When changes in reflexes, ms strength, & sensation are found in conjunction with a (+)ve SLR, Lx radiculopathy is highly likely

18
Q

Neurological exam - reflex Ax procedure

A

Grading

0: Absent
1: Diminished
2: Average
3: Exaggerated
4: Clonus, very brisk

Hyporeflexia = Lesion of spinal n root

Hyperreflexia = UMN lesion

Abnormal deep tendon reflexes are not clinically relevant unless they are found with sensory or motor abnormalities

Overall neurological exam results:

Sensation testing alone does not seem to be useful for radiculopathy

When tested in isolation, weakness with MMT & reduced reflexes = radiculopathy

When changes in reflexes, ms strength, & sensation are found in conjunction with a (+)ve SLR, Lx radiculopathy is highly likely

19
Q

How to perform the UMN lesion tests (3)

A

1) Clonus
- knee slightly flexed, push ankle abruptly into DF, > 5 beats is positive
2) Babinski (plantar response)
- see image
3) Oppenheimer
- stroking of ant-med surface of tibia: (+) = Extension first toe with spaying of the other toes

20
Q

Lx spine - traction

A

Results:

Traction & compression – Ax disc patho or VB Fx (+)ve =

Compression = ↑ pain

Traction = ↓ pain

21
Q

Lx spine - compression

A

Results:

Traction & compression – Ax disc patho or VB Fx (+)ve =

Compression = ↑ pain

Traction = ↓ pain

22
Q

Lx spine - ASIS GAP

A

Ax level of reactivity of the SIJ & provokes SIJ pain

  • Ligament tears (acute phase)
  • Systemic arthritis (RA, SA)
23
Q

Lx spine - ASIS compression

A

Ax level of reactivity of the SIJ & provokes SIJ pain

  • Ligament tears (acute phase)
  • Systemic arthritis (RA, SA)
24
Q

Lx spine - what are the red flag signs for cauda equina?

A
25
Q

Lx spine how to treat disc pathologies

A

LX traction

Indication for spinal traction in a prone position:

  • Spinal nerve root compression = neuro exam (+)ve
  • Peripheralization of the leg pain with Lx extension
  • Positive crossed SLR test (45)
  • L/E pain that centralizes with Lx traction

Positional distraction

  • Would allows frequent intermittent unloading of the effected n root
  • Can be done in clinic & at home
  • For the intervention to be effective: Pt should feel relief of pain shortly after the placement in the position, Rx: 10-20 mins; 3-6x/day
26
Q

Lx spine - neurodynamic assessment SLR

A
34
Q

Lx spine scan

A
  • slides 1-17 (Lab Lx Scan PART 1)
62
Q

Lx spine - how to test centrilization/peripheralization

A

63
Q

Lx spine - how to treat/correct reducable posterior derrangement syndrome

A

slides 24-30

64
Q

Lx spine - PPIVMs (from last semester)

A
  • Went over PPIVMs from last semester (use superior aspect of greater tuberosity) for flexion and extension – for extension use forearm and trunk instead of hand to apply motion
  • flexion = ant/inf force, ext = ant/sup force
  • see last years notes
66
Q

Lx spine - PA’s

A
  • PA’s (use hypothenar eminence (~60 degr from horizontal) – stand on opp side of PA’s
  • *move legs towards side you are assessing – this adds some ispi side flexion (extension component)* do this is you are having difficulty finding anything in neutral position PA’s – move legs towards opposite side SF for flexion component