Lx Spine Ax/Glides/Manips Flashcards
Lx spine ROM/OP - flex
**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)
Lx spine ROM/OP - ext
**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)
Lx spine ROM/OP - side flex
**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)
Lx Spine ROM/OP - rotation
**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)
Lx spine RISOM - flex, ext, rotation, side flex
Lx spine - how to R/O LE
Lx spine palpation - femoral, popliteal, tibial, dorsalis pedis artery
Lx spine - passive accessory (PA) glide
-
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
Lx spine - combined “H” in flexion
**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)
Lx spine - combined “I” in flexion
**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)
Lx spine - combined “H” in extension
**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)
Lx spine - combined “I” extension
**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)
Lx spine - PPIVM - flex and ext
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
Lx spine - exercises for strenghtening IU and OU ms
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
Neurological Exam - dermatomes Ax procedure
*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
Neurological Exam - myotome Ax procedure
* 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
Neurological exam - reflex Ax procedure
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
How to perform the UMN lesion tests (3)
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
Lx spine - traction
Results:
Traction & compression – Ax disc patho or VB Fx (+)ve =
Compression = ↑ pain
Traction = ↓ pain
Lx spine - compression
Results:
Traction & compression – Ax disc patho or VB Fx (+)ve =
Compression = ↑ pain
Traction = ↓ pain
Lx spine - ASIS GAP
Ax level of reactivity of the SIJ & provokes SIJ pain
- Ligament tears (acute phase)
- Systemic arthritis (RA, SA)
Lx spine - ASIS compression
Ax level of reactivity of the SIJ & provokes SIJ pain
- Ligament tears (acute phase)
- Systemic arthritis (RA, SA)
Lx spine - what are the red flag signs for cauda equina?
Lx spine how to treat disc pathologies
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
Lx spine - neurodynamic assessment SLR
Lx spine scan
- slides 1-17 (Lab Lx Scan PART 1)
Lx spine - how to test centrilization/peripheralization
–
Lx spine - how to treat/correct reducable posterior derrangement syndrome
slides 24-30
Lx spine - PPIVMs (from last semester)
- 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
Lx spine - PA’s
- 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
