Spine Exam and Treatment Flashcards
pain from OA/Occiput-C1 can cause a headache where?
over orbit
pain from C2-3 can cause a headache where?
lateral head, inner ear
pain from C6 can cause a headache where
global HA
pain from T4 can cause what kind of headache
“head in a vice”
the C1 transverse process is located where
just medial and inferior to mastoid process
how do you performa left upper quadrant test
chin out > sidebend left > rotate left
how to use cervical stabilizer
-place under occiput
-palpate SCM and ant scalenes
-start at 20-22 mmHg
-slight nod to incrs 2mmHg
-hold 2 sec
-increase 4 mmHg
-repeat until 30 mmHg or until failure
-repeat at highest level with a goal of 10x10 sec
pts should be able to hold the deep flexor and neck extensor endurance tests for about ___ seconds
30
PA glides are for _____ symptoms while UPA glides are for _____ symptoms
- central and bilateral
- unilateral
PA glides can help with _____ while UPA help with ________
extension
rotation
transverse glides are usually performed _____ the side of pain and can help to what?
towards
centralize the symptoms
what are the 3 criteria for a positive neural tension test
- reproduce comparable sign
- can be sensitized
- different than contralateral side
muscle energy techniques should be performed for _____ reps with a ____ second hold
3-5 reps for 3-5 seconds hold
OA MET improves _____ while AA improves _______
flexion
rotation
how to perform OA MET
- bring pt to barrier of OA flexion
- have them gently (submax) look up at you
- hold 3-5 secs
- engage new barrier
How to perform AA MET
- bring pt to barrier of AA rotation
- block isometric (submax) contralateral rotation
- hold 3-5 seconds
- engage new barrier
how to perform left firstt rib MET
-pt is in sitting with L arm propped on your leg
-PT palpates first rib
-have pt L SB, L rotate
-block isometric R SB
-reassess
-stretch scalenes
T or F: if a pt comes in with a lateral shift, that needs to be corrected first
T
how do you correct a lateral shift? how can pt do this at home
pull pt’s iliac crest towards you with your hands and push lumbar spine away with your shoulder
*pt can perform against a wall at home
how is a lateral shift named
based on direction of shoulders
are pts typically shifted towards or away from pain
away
how to perform lumbar quadrant test
have pt reach to the back of their knee and overpress
how to perform lumbar quadrant flexion test
have pt bend forward and reach toward back of leg and overpress
with passive accessories, always clear ____ levels above/below
2
how to perform slump test
- pt seated, have them slump over bringing chin to chest
- extend knee
- DF (if not too much)
can sensitive by releasing the neck of DF
SLR for tibial nerve
SLR + ankle DF and eversion
SLR for superficial peroneal nerve
SLR + ankle PF and inversion
SLR for sural nerve
SLR + ankle DF and inversion
neural tension test for lateral femoral cutaneous nerve
pt in sidelying
adduct hip, knee flexion, hip extension
neural tension test for obturator nerve
pt in sidelying
abduct hip, knee flexion, hip extension
neural tension test for saphenous nerve
pt in prone
extend hip, extend knee, ankle DF and inversion
Pts should be able to hold the sorenson test, prone isometric chest raise, and supine isometric chest raise for about _____ seconds
30
T or F: prone isometric chest raise is strongly supported by literature
T
instability catch sign
- in standing pt bends forward as much as possible and then returns to standing
- posititive test is an inability to return to a full erect position (Gower’s sign)
laslett’s cluster number one
-sacral thrust
-thigh thrust
-distraction
-compression (sidelying)
*need 2 out of 4
laslett’s cluster number two
-distraction
-thigh thrust
-Gaenslen’s
-compression
-sacral thrust
need 3 out of 5
fortin finger sign test
-The patient points to their area of pain which lies inferomedial to the PSIS
-Pt consistently points to same area at least twice
Grade 1 lumbar rotation mobilization
-PT behind pt with hands on pts hips
-knees flexed to 45
-pt’s hand on table
-gently rock
Grade 2 lumbar rotation mobilization
-PT behind pt with hands on pts hips
-knees flexed to 45
-pt’s hands on ribs
-gently rock
Grade 3 lumbar rotation mobilization
-PT behind pt with hands on shoulder and hip
-knees flexed to 60
-start by rocking hip and follow with shoulder
-3:1 pelvic to shoulder movement
Grade 4 lumbar rotation mobilization
-PT facing pt with arms hooked on ribs and ischium
-palpation with proximal thumb and distal fingers
MET to treat an anterior pelvic rotation
-pt supine
-flex, add, IR to barrier
-pt pushes leg out against PT
-can assist at IT
MET to treat a posterior pelvic rotation
-pt prone
-abduct hip then extend to barrier
-pt attempts to flex
-can assist at PSIS
What is a cue you can give a pt while teaching TA activation?
-have them palpate just inside ASIS to feel for activation
-make sure they are breathing
How can you progress TA activation exercise?
-perform in quadraped, add unstable surface, functional activity
-co-contraction with lumbar multifidus
*progress lumbar multifidus activation in same way
How can you teach a pt to activate lumbar multifidus?
-anterior pelvic tilt—“think about arching your back”
-can put pillow under stomach if needed
How to use a lumbar stabilizer?
-pt in supine hooklying
-stabilizer under lumbar spine with base at S2
-inflate to 40 mmHg
-activate TA and LM
-maintain reading during supine exercises
What level should be the fulcrum for lumbar flexion/extension?
L3-4
T or F: if your pt has spondylolisthesis you should be cautious with extension exercises
T
*also spinal stenosis, post laminectomy, foraminal compression, significant posterior disc bulge, and SIJ
If a pt has a posterior annulus tear or posterior ligament sprain you should be cautious with ____________ exercises
flexion
*also SIJ and pre-disc conditions
You should be cautious with rotation exercises if your pt has…(3)
-disc herniation
-pre disc conditions
-instabilities
You should be cautious with lateral flexion exercises if your pt has…(2)
-iliolumbar ligament sprain
-ipsilateral flexion compromise
the pain cycle
initial insult > irritation > pain (muscle guarding) > localized edema > localized inflammation > fibrous reaction > functional disability
