Lumbar Spine Practical

Question 1

purpose of PAVIM

Answer 1

segmental mobility assessment
pain provocation assessment - more reliability for pain provocation

Question 2

purpose of transverse PAVIM

Answer 2

treatment

Question 3

how to conduct lumbar side flexion PPVIM

Answer 3

Patient in side flexion/sidelying
PT in front facing patient
using left hand to rest on back and stabilise vertebrae from formarm to elbow
moving hand grasp patients uppermost innominate under ischial tuberosity
bring patient into hip flexion
compare opposite side

Question 4

describe rotation PPIVM

Answer 4

Side lying with his and knees flexed
physio - forearm resting on back, other hand holds hip fingers spread over ilium/greater trochanter
movement - stabilise thorax and pelvis rotated away from therapist. palpate relative movement of distal spinous process in relation to proximal one.

Question 5

describe flexion/extension PPIVMS

Answer 5

Patient position - side lying, hips and knees flexed
physio position - in front facing patient
moving hand grasps back of flexed knees posteriroly and hips will grasp knees anteriorly
palpating hand - feel space gap in flexio and narrow in extension
movement - flex hips by rocking the patients knees towards patients chest to flex and extend lumbar spine

Question 6

normal response to SLR NDT

Answer 6

ROM 50-120 degree hip flexion
posterior thigh, knee calf pulling
relieved by neck extension

Question 7

abnormal response to SLR NDT

Answer 7

eproduces leg pain +/- LBP
Asymmetrical ROM
Different to expected normal response.

Question 8

What sensitising manoeuvres can be used for SLT NDT

Answer 8

Hip Add
Hip MR
Passive neck flexion
Opposite SLR (B/L)
Ankle DF
PF/Inv

Question 9

the sensitising manoeuvre add what type of stress on what tissue

Answer 9

longitudinal stress on neural tissue - sciatic nerve

Question 10

when would SLR NDT be indicated

Answer 10

if patient presents with spinal or leg pain
used to highlight disc pathology in isolation
tests sciatic nerve - L4-S1

Question 11

Purpose of Passive neck flexion NDT

Answer 11

loads connective and conductive tissue of spinal cord
stresses cervical, thoracic and lumbosacral nerve root and cervical meningeal structures

Question 12

red flag in passive neck flexion NDT

Answer 12

foot P&Ns or numbness

Question 13

abnormal response to passive neck flexion NDT

Answer 13

Symptoms reproduced e.g. pain, neurological symptoms etc.

Question 14

What is a desensitising manoeuvre for passive neck flexion NDT

Answer 14

Hip and knee flexion

Question 15

What is a sensitising manoeuvre for passive neck flexion NDT

Answer 15

SLR
Cervical sideflexion
Upper limb BPPT

Question 16

Purpose of prone knee bend NDT and how is it conducted

Answer 16

patient in prone
hold foot and passively flex knee till heel reaches buttock
stabilis elower back
test femoral nerve L2-L4

Question 17

Purpose of adding sensitising manoeuvres to prone knee bend in NDT

Answer 17

delineate neuropathodynamics from quads, psoas muscle tightness

Question 18

when would it be indicated to conduct a prone knee bend NDT

Answer 18

lumbar pain
anterior hip pain
thigh and knee symptoms

Question 19

normal response to PKB NDT

Answer 19

Heel reaches buttock and patient feels stretching sensation in anterior thigh.

Question 20

Abnormal response to PKB NDT

Answer 20

Reproduces symptoms or is asymmetrical

Question 21

Sensitising manoeuvres for PKB NDT

Answer 21

Hip Extension
Hip Adduction
Slump (cervical and trunk flexion) in side lying
Hip rotation
Ankle DF / Ever
Bilateral PKB

Question 22

Purpose of slump test NDT

Answer 22

provides indication of longitudinal mobility of nerve tissue in caudad and cephalad directions

Question 23

indications for slump test

Answer 23

Spinal symptoms
Lumbar or thoracic radiculopathy
Sciatic tract symptoms
Provocative activities that indicate that slump may be aggravating e.g. pain aggravated by kicking, dance (leg kick) or driving (bucket seat).

Question 24

contraindications for slump test

Answer 24

Irritable disorder
Unstable disc pathology
Recent progressing neuro changes
Cord or Cauda equine symptoms.

Question 25

method of slump test

Answer 25

pt - sits plinth thighs fully support arms behind back
flex trunk
flex cervical spine
knee extension - on asymptomatic side
ankle dorsiflexion
repeat on symptomatic leg
if symptomatic - extend neck
then rest and add B/L knee extension and ankle DF

Question 26

Normal response to slump test

Answer 26

Trunk flexion – nil
Add cervical flexion – 50% normals report pain in T8/9 region – why?
Add knee extension – discomfort & pulling in posterior knee / thigh / hams and symmetrical restriction – most people can’t fully extend knee.
Add DF – intensifies above
Release neck – decreases all symptoms and increases knee extension possible.

Question 27

abnormal response to slump test

Answer 27

Reproduces patient’s symptoms
Asymmetry
Symptoms moved by other movement of distant body parts.

Question 28

when are central PAVIM PAs indicated as a treatment

Answer 28

Indicated when pain or muscle reactivity is provoked on exam, but performed short of both of

Question 29

when are unilateral PAVIM PA indicated as a treatment

Answer 29

Very effective when muscle reactivity or pain is provoked on exam and in treatment, angle can be varied as indicated by response to technique or whether IVF is to be opened

Question 30

when would transverse PAVIM be indicated as a treatment

Answer 30

More likely to produce improvement in symptoms if done from painless side, pushing spinous process towards painful side. This opens joint / IVF on painful side. In lower lumbar spine, not as useful as rotation or PAs, due to difficulty accessing

Question 31

when is rotation PPIVM indicated as a treatment

Answer 31

Very useful technique in treating low back pain –
* Most valuable when pain is unilateral or with central pain with unilateral signs

Question 32

how is the patient and therapist positioning for grade III rotation PPIVM

Answer 32

patient - Lying on side, with uppermost (left) leg flexed with foot hooked behind lower knee. Lower leg extended.
therapist - To apply rotation, therapist stands behind patient again and stabilises thorax at anterior aspect of left shoulder, while producing rotation via pelvis.

Question 33

how is the patient and therapist positioning for grade IV rotation PPIVM

Answer 33

patient -Same as for Grade III except left leg is now allowed to drop over edge of bed. Stabilising pressure can alternately be provided through patient’s left hand on abdomen – this reduces strain on thoracic spine during technique
therapist -Same as for Grade III except different amplitude.