M2: Lumbar Objective 1 Flashcards
Components of the standard objective exam (13)
- observations
- posture
- gait
- balance
- functional tests
- AROM
- PROM (physiological, accessory, segmental)
- neuro screen
- muscle length tests
- muscle performance (MMT, endurance)
- screen regions above/below
- special tests
- palpation
What are the types of postural deviations?
- protective
- non-protective
- structural
- behavioral
What is a protective postural deviation?
Attempt to either consciously or unconsciously lessen sx (i.e. lateral shift)
What are the two types of non-protective postural deviations?
- non-protective structural
- non-protective behavioral
When is scoliosis considered a non-protective, structural deformity?
- not correctable with movement
- attempts to correct it do not alter sx
What may cause a non-protective behavioral deformity?
- emotional state
- personality
- poor body awareness
Non-protective behavioral deformity - significance of correction
- correctable actively and passively by the clinician without change in sx
- may still be relevant to the problem
- think slumped posture
Theory of muscle imbalance: which muscles does it occur between?
- tonic
- phasic
Tonic muscles are prone to:
- tightness
- shortness
Phasic muscles are prone to
- weakness
- inhibition
Where do muscle imbalances often occur?
- lumbopelvic hip region
- neck-shoulder region
Upper crossed syndrome: Which muscles are stiff?
- upper traps
- levator
- pec major
- SCM
Upper crossed syndrome: Which muscles are weakened?
- deep neck flexors
- lower traps
- serratus anterior (scap stabilizers!)
What are typical deviations of upper crossed syndrome?
- FHP
- increased thoracic kyphosis
- anterior translation of C-spine
- protracted/elevated scapulae
Upper crossed syndrome may affect (movement)
All movements of c-spine and upper extremity
Lower crossed syndrome: Which muscles are stiff?
- hip flexors
- erector spinae
Lower crossed syndrome: Which muscles are weakened?
- glutes
- abs
Lower crossed syndrome: typical deviations
- anterior pelvic tilt
- increased hip flexion
- increased lumbar lordosis
What are the 3 major postures we discussed that describe the entire spine?
- Kyphotic-lordotic
- Flat back
- Swayback
Which posture is similar to upper and lower crossed syndromes?
Kyphotic-lordotic
kyphotic-lordotic posture: stiffness
- neck extensors
- hip flexors
- lumbar ES
kyphotic-lordotic posture: weakness
- neck flexors
- upper back ES
- EO
kyphotic-lordotic posture: hamstrings?
May or may not be weak
kyphotic-lordotic posture: facets
Facets are more closed down throughout entire spine
Flat back posture: What does this look like?
- reduced/absent lumbar lordosis
- posterior pelvic tilt
- hip extension
- slight ankle PF
- slight C-spine extension
- upper thoracic flexion
- straight lower thoracic spine
Flat back posture: weak muscles
- hip flexors
- lumbar paraspinals
Flat back posture: stiff muscles
Hamstrings
Swayback posture: c-spine/head
- head forward
- C-spine extended
Swayback posture: upper trunk
- increased flexion and posterior displacement of upper trunk
- flexion of upper spine
Swayback posture: pelvis/hips
- posterior pelvic tilt
- Hyperextension at hips with anterior pelvic displacement
- hanging on hip ligaments
Swayback posture: knees/ankles
- knees hyperextended
- ankles neutral
Swayback posture: facets
more low back facet involvement than upper back
Swayback posture: center of gravity/mass
- upper body mostly behind line of gravity
- center of mass is moved forward to keep balance
