[MDDR] Lower Back Assessment

Question 1

The movement examination of the lower back consists of?

Answer 1

Individual movements and repeated movements

Question 2

What would you see in the movement examination for the ‘reducible disc’ diagnostic category?

Answer 2

Centralisation or directional preference (DP)

Question 3

What would you see in the movement examination for the ‘Tissue Dysfunction’ diagnostic category?

Answer 3

• Restricted ROM
• Pain reproduced at the end of the available ROM
• No significant change in site or intensity of pain
• No significant change in ROM

Question 4

What would you see in the movement examination for the ‘Movement Control Impairment’ diagnostic category? Ft

Answer 4

• Painful arc without centralisation or DP
• Deviation from plane of movement
• Use of hands to return from FIS
• Moves through range that causes pain despite pain

Question 5

What would you see in the movement examination for the ‘Postural Syndrome’ diagnostic category? AC

Answer 5

• Full and painless ROM in all directions

- No aberrant movement patterns

Question 6

What would see in the movement examination for the ‘Category Indeterminate’ diagnostic category?

Answer 6

• Fear of movement
• Splinting, guarding
• Sudden onset of acute pain early in ROM
• Pain limits movement

Question 7

What should the neurological examination include?

Answer 7

Motor testing
Sensory testing
Reflex testing
Neurodynamic testing

Question 8

If LBP is of a chemical nature, what factors/symptoms would you expect?

Answer 8

• Pain easily aggravated by activity
• Pain not readily eased by rest or change of position
• Typically constant pain
• Pain & stiffness that lasts >60 minutes after waking

Question 9

If you suspect the pain is of chemical nature, what should you do?

Answer 9

Reconsider red flags or inflammatory conditions (i.e. Reiters, Ank) or consider post-traumatic inflammation even

Question 10

What conditions with particular relevance to the lumbar spine should been screened for medical referral?

Answer 10

Cauda Equina Syndrome
Cancer
Infection
Fracture

Question 11

How many repetitions is suggested for the reacted movement examination?

Answer 11

5-20 reps

Question 12

What must you ensure during repeated movements?

Answer 12

That the patient is progressively going further into the ROM so they reach EROM

Question 13

The physical examination in order should include?

Answer 13

• Observation & Postural Analysis
• Individual Movements
• Repeated Movements
• Palpation
• Passive Movements (PPIVMs & PAVIMs)
• Functional tests (i.e. stairs, in/out chair, hop)
• Special Tests (i.e. prone instability test, SIJ pain provacation tests)

Question 14

What are the 5 diagnostic categories for lower back pain

Answer 14

Reducible Disc
Tissue Dysfunction
Movement Control Impairment
Postural Syndrome
Category Indeterminate

Question 15

Physiological & Accessory movements are assessed during the manual examination.

What are the lumbar spine PPIVM’s?

Answer 15

1) Flexion
2) Extension
3) Side-Flexion

These are side-lying tests

Question 16

Physiological & Accessory movements are assessed during the manual examination.

What are the lumbar spine PAIVM’s?

Answer 16

1) Spring Test
2) Caudal/Cranial Glides
3) Rotation

These are prone lying tests

Question 17

Briefly, therapists perform PPIVM’s and PAVIM’s to determine:

Answer 17

1) The ROM of the segment
2) The stiffness of the motion segment
3) Does the movement reproduce the patients pain

Question 18

A neurological exam should be performed on any patient that complains of or exhibits:

Answer 18

• Altered sensation (paraesthesia, numbness, hypersensitivity, tremor)
• Referred pain below the buttock crease or distal to the shoulder
• Weakness, heaviness, clumsiness (tripping over things)
• Muscle atrophy