Week 1: Mon 1.11.16 lab exam, standing and sitting Flashcards
Baseline data (as stated by the book) to collect prior to formal observation/exam (6)
- height
- weight
- pulse
- respiration
- BP
- baseline symptoms
The observation portion of the exam begins in the waiting room. What are some things we should be observing? (8)
- facial expression
- postural characteristics
- general fitness and well being
- quality of movement
- rising from waiting room chair
- sitting
- walking
- willingness to move
True or False: All functional movements that are aggravating factors should be tested.
False
Due to potential for cumulative stresses that may make the patient’s symptoms worse.
True or False: Functional movements are often provocative measures and indicators of motor control strategies.
True
What functional activity did we analyze in lab that you may use in the clinic with LBP?
Squatting
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Why are squats an important functional activity?
They mimic sit-to-stand from a chair
Things to watch for when a person performs a squat
- Knees centered over foot without too much varus or valgus or rotational movement during squat
- spinal curves should not change throughout squat
- pelvis starts squat in neutral, anteriorly tilts while squatting
- trunk should stay over base of support
**Alterations from above positions ⇒probably altered motor control
How do people with LBP tend to walk?
If you tell them to walk fast, what do they tend to do?
How does this compare to people without LBP?
Gait: Slow with shorter assymmetrical steps
Increase their cadence to walk faster
Healthy people increase stride length to walk faster
A strong predictor of gait velocity is ________
fear avoidance
What test did we do in lab for gait observation?
10 meter walk test
Something we should assess when we have patients with LBP and difficulty walking
motor control of the lumbopelvic hip complex
Patients with LBP often have impaired balance. In standing they may demonstrate _______ _______ and they may keep their center of force significantly ________.
postural sway
posterior
Why do the heel and toe walk test during an objective exam?
They are quick functional tests for L5-S1 myotomes and L4-L5 myotomes
Aside from toe walk test, what is another option for testing S1?
manually muscle test gastroc complex in standing
List of things a clinician will be looking at/for when observing posture (5)
focusing on lumbo pelvic and lower extremity reagions for:
- scoliosis
- lordosis
- kyphosis
- lateral shift
- patterns suggesting muscle imbalance
Why does the clinician place herself at eye level with the patient’s pelvis?
To assess posture by checking the symmetry of the bony landmarks of the pelvis.
If there is assymmetry in the bony landmarks- ASIS, PSIS, iliac crests, what could it mean? (2)
- leg length discrepency
- pelvic girdle asymmetry
Examining lordosis part of the objective exam for posture. Why is it important?
- Need to know if lumbaar lordosis is increased, decreased, or normal
- Are there any other deviations observed with the lordosis such as lordosis kyphosis posture or a lateral shift
Another term for lateral shift
sciatic scoliosis
(but it occurs in people with or without leg pain)
In which direction is it most common to see a lateral shift?
Contralateral- away from the pain
What MDT category would a lateral shift typically fall under?
mechanical derrangement
General guidelines/steps for performing lateral shift correction in standing
- therapist stands on the same side as the shift
- establish resting symptoms
- side-gliding movement is performed in an oscillatory manner
- monitor symptoms for centralization or peripheralization (don’t continue if peripheralization- can be tried in unload position)
- move into over-correction position, past midline
- ask patient to bend backwards while assessing symptoms
- can progress to repeated extension in this position.
- stop if shift cannot be corrected after 1-2 days
How do you name a lateral shift?
- It is always named Bobby. jk!
- named by the direction that the upper thoracic and shoulders are pointed toward.
- Example of Right Lateral shift below
What systems does the patient rely on during balance testing with eyes open on a foam mat?
visual and vestibular
What systems does the patient rely on during balance testing with eyes closed on a foam mat?
Just vestibular
vision is gone and somatosensory is altered
What are you checking as you measure AROM? (4)
- quality of movement
- quantity of movement
- pt. willingness to move
- symptomatic response
Where do inclimomters go when measuring flexion? How do you determine just lumbar flexion?
T12- measures lumbopelvic motion
S2- just hip motion
T12-S2 = lumbar flexion
Measuring lumbar flexion with one inclinometer- where does it go?
T12
Measuring lumbar extension with one inclinometer- where does it go?
T12
can also use the same double inclinometer method as used in finding lumbar flexion
Something to ensure patients do not do when measuring lumbar flexion and extension
Don’t let them bend their knees
4 points to remember when performing the manual lateral shift correction in standing
- progressive worsening pain or peripheralizing pain that refer or radiates distally into LE indicates shift correction should be stopped and repeated in non-weight bearing position
- sign and symptoms of radiculopathy or CES (?) are reasons to abandon the process
- if shift cannot be corrected across midline after 1 or 2 days, the condition is likely irreversible (not the sentiment of an optimist)
- nausea or faintness indicates trial of an alternative management procedure.
***CES = cauda equina syndrome
What does MDT stand for?
What is that?
mechanical diagnosis and treatment
(the technical name for McKenzie method stuff)
