Week 1- LQ Screening Examination

Question 1

Why do we perform a screening exam?

Answer 1

Allows us to progress and refine a hypothesis to guide making a primary plan of care

Question 2

Describe the progression of the LQ screening examination

Answer 2

• Standing: observation and posture
• Standing: functional observation/clearing
• Standing functional myotomal assessment
• Standing Clearing Tests: Lumbar
• Seated Clearing Tests: Thoracic
• Seated Clearing Tests: Hip
• Seated: Neuromotor Sensory Screening Exam
• Myotomes
• Dermatomes
• LQ Reflexes
• LQ reflexes (upper motor neuron signs)
• Supine clearing tests: Straight leg raise
• Prone clearing: lumbar spring testing

Question 3

Standing: observation and posture

Answer 3

Look for gross abnormalities, not subtle differences

Question 4

Standing: functional observation/clearing

Answer 4

• Squat
• Step up
• Step down

Question 5

Standing functional myotomal assessment

Answer 5

• Step up: L3-L4
• Heel walking: L4-L5
• Toe walking: L5-S1

Question 6

Standing Clearing Tests: Lumbar

Answer 6

• Region specific
• Flexion
• Extension
• Quadrant motion (ext., rot, side bending)
• Used with or without overpressure

Question 7

Seated Clearing Tests: Thoracic

Answer 7

• Block legs

- Rotate R/L upper back

Question 8

Seated Clearing Tests: Hip

Answer 8

• FABER (flexion, abduction, & external rotation)

- F/ADD (flexion, adduction)

Question 9

What patients require a neuromotor sensory screening exam?

Answer 9

• Those w/ lumbar/LQ pain
• Symptoms go below gluteal fold
• LQ symptoms of questionable origin

Question 10

LQ Myotomes

Answer 10

• L2-3: Hip flexors
• L3-4: Knee extensors
• L4: Ankle dorsiflexors
• L5: Hallux extension
• S1: Ankle plantar flexors

Question 11

What is a positive finding with myotomes?

Answer 11

Significant weakness or diminished resistance relative to opposite side

Question 12

LQ Dermatomes

Answer 12

• L1: Inguinal area
• L2: Anterior mid-thigh
• L3: Medial knee
• L4: Medial malleolus
• L5: Distal medial dorsum of foot
• S1: Lateral border of foot
• S2: Medial/posterior calcaneus

Question 13

What is a positive finding with dermatomes?

Answer 13

Significantly diminished sensation relative to opposite side

Question 14

LQ Reflexes

Answer 14

• L2-L4: Patellar

- S1-S2: Achilles

Question 15

What is a positive finding with LQ reflexes?

Answer 15

• Diminished/absent reflexes correlated w/ derm/myotome nerve root pathology
• Hyperactive may mean upper motor neuron pathology

Question 16

How to grade reflexes

Answer 16

• 4+: Very brisk response; associated w/ clonus
• 3+: Brisk response; possibly hypeerreflexive
• 2+: Normal, average response
• 1+: Low, normal response
• 0: No response
• 1+(R): Absent response; present with reinforcement
• 0(R): No response, even with reinforcement

Question 17

LQ Reflexes: Upper Motor Neuron Signs

Answer 17

Babinski

• Normal response: Toes curl
• Babinski present: hallux extends, toes fan out

Question 18

Supine clearing tests: Straight leg raise

Answer 18

• Looks at adverse neurodynamic mobility of sciatic nerve and its branches

Question 19

What does it mean if the straight leg test brings on symptoms below 45 degrees?

Answer 19

Lumbar radiculopathy

Question 20

What does it mean if the straight leg test brings on symptoms above 45 degrees?

Answer 20

Adverse neurodynamics- nerves running into lower quarter are sensitized, but not from herniated disc

Question 21

Prone clearing: lumbar spring testing

Answer 21

• CPA: central posterior to anterior
• UPA: unilateral posterior to anterior
• Looking to reproduce symptoms