Assessment of the Spine

Question 1

Assessment of posture

Answer 1

1. Pt needs to be undressed, shoes off
2. Look at frontal and sagittal planes
3. Look in standing and sitting

Question 2

Scoliosis

Answer 2

• Curvature of spine
• Can occur in all 3 planes - frontal plane most commonly seen
• *Name curve by convexity
• Causes: Idiopathic (75-85%), trauma, DJD, osteoporosis, leg length difference
• Structural (irreversible) vs. Nonstructural (reversible)

Screen with forward flexion

Cobb angle measures degrees of curve

Question 3

Scoliosis Signs and Symptoms

Answer 3

Signs:

• Range of motion deficit
• Cosmetic covering (e.g. long hair)

Symptoms

• Pain
• Decreased cardiopulmonary function (if T-spine curve is greater than 65 degrees)
• Neurological sxs associated with spinal stenosis

Question 4

Scoliosis Treatment

Answer 4

PT:

• Exercises to improve spinal mobility, strengthen, and decrease pain
• Stretch concave side
• Strengthen convex side
• Exercise by itself doesn’t stop progression of curve

Surgery:

• For curves > 50 to 60 degrees
• Spinal fusion, with or without Harrington rod instrumentation
• -> Hypermobility at spinal segments where rods end

Question 5

Osteokinematics of lumbar motion - Flexion

Answer 5

• Pure flexion and extension - gliding motion of facet joints
• L1-5 favor flexion (12-15 degrees per segment)
• Flexion increases as we move down lumbar region
• -> Most flexion at L4/5 and L5/S1

Question 6

Osteokinematics of lumbar motion - Side bending, rotation

Answer 6

• Limited side bending (5-8 degrees per segment)

- Limited rotation ( Least rotation at L4/5, L5/S1

Question 7

Total Lumbar motion

Answer 7

Flexion: 40-60 degrees
Extension: 20 degrees
Side bending: 15-20 degrees
Rotation: 3-18 degrees

Question 8

Role of quadrant tests

Answer 8

Combined gross motions – if straight plane motions don’t elicit pt’s sxs

Question 9

Repeated motion testing

Answer 9

• Used frequently

- Assess for changes in pain (intensity and location) and AROM

Question 10

Palpation for reproduction of sxs

Answer 10

Maitland approach for exam and asessment

• Looking for comparable sign/ asterisk’s sign
• Graded mobilization (I- IV)
• Perform at spinous process, articular pillar

Assess for:

• Pain
• Limited motion

Question 11

Prone instability test

Answer 11

• Test historically was used alone
• Concerns about metrics
• Now used as component of clinical prediction rules for manipulation
• Used when hypermobility of segment/s suspected

Test:

• Pt prone at edge of plinth, feet on ground
• PA glide, identify painful segment (Grade II-III)
• Pt lifts feet of ground
• Pressure at same level
• If pain less/ abolished –> Positive test

Question 12

Quantification of muscle function

Answer 12

Tests are reliable
Allow for quantification of progression
Four tests used: Flexor, extensor, and side endurance tests

Question 13

Flexor endurance test

Answer 13

• Hold body ~45 degrees

- Healthy: 2.5 minutes

Question 14

Extensor endurance test

Answer 14

• Prone, ASIS at end of plinth

- Healthy: 3 minutes

Question 15

Side bridge endurance tests

Answer 15

• Repeated on each side

- Healthy: 1.5 minutes