Week 8 Lumbar Orthopedic Tests

Question 1

Besides using the lumbar orthopedic tests in conjunction with chiropractic static and motion palpation to locate the pain generating areas (e.g., lumbar vs pelvis) and the possible type of lesion (e.g., facet, disc), these tests may be most useful in simply identifying _______________ and ____________

Answer 1

• what loads will be beneficial (“therapeutic bias”)

- which loads to avoid (activity modifications).

Question 2

What are a variety of directions to test the lumbar spine (and how are they tested )?

Answer 2

• flexion: supine flexion (knees to chest)
• extension: prone extension (with overpressure)
• Rotation: Farfan torsion
• kemps

Question 3

What are activity modifications for flexion sensitivity?

Answer 3

• avoid sustained flexion postures
• teach hip hinge (combined with neutral pelvis and abdominal bracing)
• break up sitting with micro breaks (every 20, 30 or at least 50 minutes)
• Bruegers position (arching the lumbar spine)
• extension exercises (prone pressing up on elbows or standing extending back)

Question 4

What part of the day is the back most susceptible to injury? What activities should they modify during this time?

Answer 4

The first two hours

• need to abdominal brace and up hinge out of bed
• need to put hand with straight arm on counter to reduce flexion load
• hip hinge to get into car

Question 5

What is the possible diagnosis with a flexion test results AND LOCAL PAIN AGGRAVATED

Answer 5

SPRAIN
DISC DERANGEMENT
SUBLUXATION

Question 6

What is the possible diagnosis with a flexion test results AND LOCAL PAIN IS RELIEVED?

Answer 6

PERHAPS A FACET SYNDROME

ANTERIOR DERANGED DSIC

Question 7

What is the possible diagnosis with a flexion test results AND LEG SYMPTOMS AGGRAVATED?

Answer 7

DISC DERANGEMENT OR HERNIATION

Question 8

What is the possible diagnosis with a flexion test results AND LEG SYMPTOMS CENTRALIZE WITH REPETITIVE/SUSTAINED LOAD?

Answer 8

SPINAL CANA STENOSIS

ANTERIOR DERANGED DISC (RARE)

Question 9

What are activity modifications for extension sensitivity ?

Answer 9

• Walk at a faster rate with larger arm swing
• Stand with foot on step/support
• Lean over counter
• Posterior pelvic tilt
• Use step stools/ladders for reaching

Question 10

Whaat is farfan torsion positive for?

Answer 10

Facets
Alternating rings of annular. Fibers
Muscles

Question 11

What are activity modifications for rotation load sensitivity?

Answer 11

• don’t vacuum or vacuum in the other hand to promote the opposite rotation
• use two hands to vacuum

Question 12

What is the possible diagnosis with prone extension test results and LBP AGGRAVATED BY RESISTED EXTENSION

Answer 12

EXTENSOR STRAIN

Question 13

What is the possible diagnosis with prone extension test results and LBP AGGRAVATED BY PASSIVE OVERPRESSURE

Answer 13

LUMBAR JOINT

• FACET
• DISC DERANGEMENT
• SPRAIN
• SPONDYLOLISTHESIS

Question 14

What is the possible diagnosis with prone extension test results and LBP WITH HYPERMOBILITY?

Answer 14

SEGMENTAL INSTABILITY

Question 15

What is the possible diagnosis with prone extension test results and LEG SYMPTOMS AGGRAVATED IN PATIENTS OVER 55 (SUSTAINED)

Answer 15

SPINAL STENOSIS
OSTEOPHYTE ROOT COMPRESSION
ANY AGE: SPONDYLOLISTHESIS, STRUCTURAL INSTABILITY

Question 16

What is the possible diagnosis with prone extension test results and LEG SYMPTOMS CENTRALIZE WITH REPETITION

Answer 16

DISC LESION (DERANGED OR HERNIATED)