Module 15: Advanced Paediatric Spinal Flashcards
What are the 10 steps for motion palpation of the Lumbopelvic spine?
The 10 steps?
1. L5 flexion and Ext
2. Si flexion
3. SI extension
4. L5 rotation
5. L5 LF
6. SI internal and external Rotation
7. S2-4 Flexion
8. Connective Tissue
9. Neurology
10. Compensation patterns
The Lumbar Spine
1. L1-4 Flexion and Extension
2. L1-4 Rotation
3. L1-4 Lateral flexion
Step 1
L5 assessment part 1
Identify kinesiopathology at L5/S1 in flexion and extension (X-axis).
Interpretation
Loss of flexion: L5 or anterior sacrum
Loss of extension: Posterior sacrum
Normal: Check innominates, pubis, sacral segments, lower extremities, upper cervical & cranial
Step 2
SI joint assessment part 1
Examine the sacroiliac joints in extension
Interpretation
When L5/S1 flexion is lost:
Examine the sacroiliac joints in extension
Interpretation
When L5/S1 flexion is lost:
SI extension will be normal when L5 is subluxated. Proceed to step 4 to quantify the Y & Z-axis vectors.
SI extension will be impaired on the side of the anterior sacrum. Extension will be impaired at both SI’s when the sacrum is base anterior
Step 3
SI joint assessment part 2
Examine the sacroiliac joints in flexion (X- axis)
Interpretation
When L5/S1 extension is lost:
SI flexion will be impaired on the side of the posterior sacrum.
Flexion will be impaired at both SI’s when the sacrum is base posterior
Step 4
L5 assessment part 2
Define L5/S1 vectors in Y-axis rotation when there is loss of flexion at L5/S1 and normal SI movement
Interpretation
Impaired movement with right pelvic rotation implies a spinous right fixation and with left pelvic rotation a spinous left fixation
Step 5
L5 assessment part 3
Define L5/S1 vectors in Z-axis rotation when there is loss of flexion at L5/S1 and normal SI movement
Interpretation
Impaired movement to either side implies an open wedge between L5 and S1 on that side
Step 6
SI joint assessment part 3
Define SI rotation when there is loss of flexion or extension with normal L5/S1 movement
Interpretation
Impaired internal rotation implies an external fixation (Ex) and impaired external rotation implies an internal rotation fixation (In)
Step 7
Sacral segment assessment
Examine the individual sacral motion segments starting at S1/S2 and moving to S4/S5
Interpretation
Impaired movement in flexion implies posteriority of the lower component of the motion segment being examined.
Step 8 Coccyx assessment
Examine the individual coccyx motion segments
Interpretation
Impaired movement in flexion implies posteriority of the lower component of the motion segment being examined.
Step 9
Connective tissue response
Examine the point specific connective tissue and muscle locations related to the vectors of kinesiopathology identified in steps 1-7.
Pain is indicated by an involuntary extensor response, spontaneous pupillary constriction, facial wincing, crying or a change in the pitch of the cry.
Step 10
Neurology and Compensation patterns
Elicit the muscle stretch reflexes at L4 and S1 in addition to the perianal reflex and the cremasteric reflex in boys
Identify the compensation pattern associated with the subluxation vectors
Summarise the Pelvic Assessment in your mind and on paper
Anterior sacrum
What are the six main postural and spinal motion compensation responses when an anterior sacrum subluxation is present?
- Increased lumbar & cervical lordosis
- Craned neck posture
- Loss of lateral flexion at the upper cervical complex, often bilaterally
- Loss of rotation at the upper cervical complex, often bilaterally
- Hypermobility at C0/C1 along the long axis of the occipital condyles, invariably bilateral
- Contralateral hamstring hypertonicity
Posterior sacrum
What are the five main postural and spinal motion compensation responses when a posterior sacrum subluxation is present?
- Decreased lumbar & cervical lordosis
- Craned neck posture
- Loss of lateral flexion at the upper cervical complex, often bilaterally
- Loss of rotation at the upper cervical complex, often bilaterally
- Hypermobility at C0/C1 along the long axis of the occipital condyles, invariably bilateral
L5 Subluxation
What are the three main postural and spinal motion compensation responses when a L5 subluxation is present?
- Decreased lumbar & cervical lordosis
- Decreased A-P &/or P-A glide in the hip on the side of the open wedge
- Hypermobility at L4/L5 in flexion
Anterior innominate (AS?)
What are the four main postural and spinal motion compensation responses when an anterior innominate subluxation is present?
- Decreased lumbar & cervical lordosis
- Low iliac crest ipsilaterally
- Elevated gluteal bulk ipsilaterally
- Elevated SI “dimple” ipsilaterally
Posterior innominate
What are the six main postural and spinal motion compensation responses when a posterior innominate subluxation is present?
- Increased lumbar & cervical lordosis
What are the six main postural and spinal motion compensation responses when a posterior innominate subluxation is present? - Elevated iliac crest ipsilaterally
- Low gluteal bulk ipsilaterally
- Low SI “dimple” ipsilaterally
- Involuntary knee flexion ipsilaterally
- Decreased A-P glide in ipsilaterally hip joint
- Short leg same side as PI prone unless anatomical short leg opposite
Pubis
What are the main postural and spinal motion compensation responses when an inferior pubic ramus subluxation is present?
What are the main postural and spinal motion compensation responses when a superior pubic ramus subluxation is present?
- Inferior pubic ramus produces the same compensation pattern as the anterior innominate subluxation
- Superior pubic ramus produces the same compensation pattern as the posterior innominate subluxation
Mid lumbar subluxations
- In an infant or child, what is the best clinical indicator of a subluxation affecting L3 or L4?
- When motion palpating the lumbar spine in infants, toddlers and pre-schoolers is it easier to palpate hypo or hyper mobility?
- Where is the hypermobility found?
- In an infant or child, what is the best clinical indicator of a subluxation affecting L3 or L4?
- Presence of a crossed adductor response after 6 months of age. Usually ipsilateral to the lumbar subluxation
- When motion palpating the lumbar spine in infants, toddlers and pre-schoolers is it easier to palpate hypo or hyper mobility?
- Hypermobility
- Where is the hypermobility found?
- At the level above the subluxation
- What are the six main steps involved in the assessment and correction of each subluxation?
- Define the vectors of kinesiopathology
- Define the associated hypermobility
- Define the neurology of the VSC
- Define the connective tissue pain patterns
- Provide the adjustment
- Confirm the correction of the hypomobility, hypermobility and neurology