M2: Lumbar Objective 2

Question 1

What is the favored sitting position?

Answer 1

Lumbopelvic sitting

Question 2

What does lumbopelvic sitting look like?

Answer 2

• anterior pelvic rotation
• lumbar lordosis
• thoracic relaxation

Does not involve end-range positions in T/L spine

Question 3

What does lumbopelvic sitting result in?

Answer 3

activation of local stabilizing muscles without high compressive loads of ES

Question 4

Lumbopelvic sittin - effect on head position

Answer 4

Relatively neutral head/neck alignment

Question 5

What is the procedure for assessing the effect of sitting posture correction on spinal sx?

Answer 5

1. Observe unsupported sitting posture
2. PT manually assists anterior rotation of the pelvis
3. PT manually repositions the scapulae as needed
4. Pt is asked to actively maintain position
5. Assess sx for changes

Question 6

What should initial unsupported sitting posture look like?

Answer 6

• flat feet

- knees and hips flexed 80˚

Question 7

Posture assessment: When the PT manually assists anterior rotation of pelvis, this results in:

(Lumbar, sternum, scapulae, head)

Answer 7

• normal low lumbar lordosis
• slight sternal lift or depression to restore normal thoracic kyphosis
• scapulae sitting flush on thoracic wall
• gentle occipital lift away from cervical extension to adjust head-on-neck posture

Question 8

Correction of sitting posture » sx may

Answer 8

• decrease
• increase
• remain the same

Question 9

Pts with spinal pain (speed and step length)

Answer 9

• slower gait

- shorter, asymmetrical step length

Question 10

What do LBP pts do to walk faster?

Answer 10

• increase cadence rather than stride length

- done to limit motion about the spine and hips in order to modify axial loading during walking

Question 11

What factors may affect gait strategies in LBP pts?

Answer 11

• intensity of pain
• level of disability
• distribution of pain
• fear related to physical activity

Question 12

Which of these accounts for more variance of walking ability with LBP pts?

• level of perceived disability
• pain intensity

Answer 12

level of perceived disability

Question 13

What is a very strong predictor of gait velocity in LBP pts?

Answer 13

Fear related to physical activity

Question 14

How to progressively assess standing balance

Answer 14

• EO on firm, level surface, then EC
• EO on dynamic surface, then EC
• Add tandem, single-leg on varying surfaces EO/EC

Question 15

Standing balance assessment: under 45

Answer 15

Should be able to complete these tests

Question 16

Standing balance assessment: under 60

Answer 16

Should be able to maintain all conditions up to 30 seconds

Question 17

Why is balance important to assess with LBP pts?

Answer 17

Balance impairments have been demonstrated in individuals with LBP and neck pain

Question 18

Steps of AROM testing

Answer 18

1. Test uninvolved side
2. Explain and ask for response to movement
3. Establish baseline sx at rest and prior to movement
4. Assess pain/sx response
5. Assess quality by observing from all sides as needed
6. Assess quantity of movement grossly

Question 19

What are we trying to do with testing?

Answer 19

Trying to reproduce the pt’s sx

Question 20

Assessment of pain/sx response: things to remember

Answer 20

• note pain rating
• note behavior of sx
• re-establish sx baseline to prevent cumulative effect

Question 21

What are you looking for with AROM testing with respect to quality of movement?

Answer 21

• smoothness, ease of movement
• control
• deviations from normal (aberrant or substitutions)
• intervertebral movement

Question 22

Assessing quantity of movement grossly

Answer 22

• normal
• hypomobile
• hypermobile

(Gravity/bubble inclinometer)

Question 23

If AROM is normal, what should you do?

Answer 23

• apply overpressure
• assess end-feel
• assess effect on sx

Question 24

If AROM with OP is normal and sx haven’t been reproduced, what should you do?

Answer 24

Try

• repeated movements
• sustained movements
• combined movements