Ortho 2 (special tests/glides): Lx Spine 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 - prone instability test
Pt: lays only half way up the bed, with the hips flexed, the trunk muscles relaxed & the feet resting on the floor
Pht: will do a PA over the most symptomatic SP If provocation of pain is reported….
Lx spine - active straight leg raise (basic scan)
Normal = optimal Lx-Sx functional load transfer
- Leg raised = effortless bilaterally
- Lx-Sx region = stable (no movt)
- Need good activation of IU & OU ms
Abnormal
- One leg: feels heavier to lift
- Lx-Sx region: unstable (movt in ext, flex, rotation, SF of spine)
Grading system (active leg lifting)
0= not difficult at all
1= minimally difficult
2 = somewhat difficult
3= fairly difficult
4= very difficult
5= unable to do
Optimal ASLR = the only joint moving is the hip & “it is not difficult at all”
Lx spine - ASLR testing inner unit muscle stimulation (3)
Lx spine - ASLR testing outer unit muscle stimulation - anterior sling
(+)ve test if applying compression(s) or activating sling(s) which:
- Makes it easier to lift the leg (affected)
- More stable Lx-Sx spine (Good sensitivity & specificity with pt SI pain post-portum)
Meaning:
- When test results are (+)ve, the assumption is that a lack of motor control exists for dynamic stabilization of the pelvic
- Load transfer (stability of the Lx-Sx spine) can be helped via the ms that were (+)ve on Ax
Lx spine - ASLR testing outer unit muscle stimulation - posterior sling
(+)ve test if applying compression(s) or activating sling(s) which:
- Makes it easier to lift the leg (affected)
- More stable Lx-Sx spine (Good sensitivity & specificity with pt SI pain post-portum)
Meaning:
- When test results are (+)ve, the assumption is that a lack of motor control exists for dynamic stabilization of the pelvic
- Load transfer (stability of the Lx-Sx spine) can be helped via the ms that were (+)ve on Ax
Lx spine - assess transferse abdominal ms
Pt: spine in neutral position
Pht: palpate IU ms
Ax IU ms activation (tension) without any OU ms contraction
Ask pt to breathe in & on the breath out gently activate IU ms using one of the strategies (identify the best strategy for your pt), Then breathe normally
Normal:
Able to activate IU ms alone
Deep, slow tension of IU ms
No substitution from OU ms contraction (No Lx or pelvic movts, No fast contraction)
With IU ms activation should be able to breathe normally
Activation -10x10sec (Ax how many reps pt can do)
Abnormal: Substitution strategies
OU ms contraction (causing post rot of pelvis, Lx spine flex/ext)
Bulging of abdomen (= Internal oblique ms contraction)
Depression rib cage (= rectus abdo ms contraction)
Hold breath
Not able to hold 10sec, 10x
**exercises slides 19/20
Lx spine - assess the multifidus ms
Pt: spine in neutral position
Pht: palpate IU ms
Ax IU ms activation (tension) without any OU ms contraction
Ask pt to breathe in & on the breath out gently activate IU ms using one of the strategies (identify the best strategy for your pt), Then breathe normally
Normal:
Able to activate IU ms alone
Deep, slow tension of IU ms
No substitution from OU ms contraction (No Lx or pelvic movts, No fast contraction)
With IU ms activation should be able to breathe normally
Activation -10x10sec (Ax how many reps pt can do)
Abnormal: Substitution strategies
OU ms contraction (causing post rot of pelvis, Lx spine flex/ext)
Ant rotation of pelvis, gripping of buttock ms (= OU ms contraction)
Hold breath
Not able to hold 10sec, 10x
Lx Spine - assess the pelvic floor ms
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 - femoral nerve sheath mobility
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 - supine TrA test
Lx spine - prone TrA test
Lx Spine - Anterior oblique sling Ax
Lx spine - prone hip extension
Ax the strength, control & firing pattern of the lumbopelvic stabilizers & hip extensor ms
- Pt in prone with a pillow under the pelvis (for neutral position of the spine)
- Pt is asked to lift a straight leg 8-10 inches off the table
Lx spine - posterior oblique sling - LAT DORSI ms strength
Lx spine sling Ax - Hip Abduction neuromuscular control test
Lx spine sling Ax - Glut medius Isometric (brake) strength test
Lx spine sling Ax - Glut medius ms strength – Trendelenburg test
