Lumbosacral Examination and Intervention

Question 1

Herniated Disk pattern

Answer 1

• Insidious onset
• Unilateral to symmetrical
• Worse with flexion activities
• Variable symptoms
• Periods of no pain
• Mornings and evenings worse
• Low back and buttock symptoms

Question 2

Lumbar Radiculopathy pattern

Answer 2

• Back pain initially before leg pain
• Pain/parasthesia presents suddenly
• Symptoms intermmittent or constant
• Varies dependent on activity and position
• Pt reports weakness or difficulty with gait
• Pain in low back and radicular pattern down LE

Question 3

Adherent Nerve Root pattern

Answer 3

• Episode of back pain months ago or surgury
• Leg symptoms never completely went away
• Sitting not and issue and walking makes it feel better
• Reports episodes of burning and aching or parasthesias
• Unable to bend forward due to sharp pain in LE
• Pain in low back and leg

Question 4

Stenosis pattern

Answer 4

• Chronic back pain
• Intermittent sx in back “Stiffness”
• complains of one or both legs cramping with walking
• Sitting always relieves symptoms
• Standing tall or extending spine aggravates leg pain
• low back and bilateral leg pain

Question 5

Spondylosis Pattern

Answer 5

Symmetrical or asymmetrical back pain
Localized pain
Episodic; usually time b/w episodes decreases
May not c/o functional limitations until tissue is engaged

Question 6

Spondylolysis Pattern

Answer 6

Localized back pain; usually asymmetrical
May have been due to trauma or excessive repetitive force
Most cases insidious
OK with stationary tasks like sitting and standing
Extending or side-bending towards painful side an issue
Pain localized in low back

Question 7

Spondylolesthesis Pattern

Answer 7

General back ache to intense stabbing pain or catching
Flexion activities ok compared to extension
Transitioning in and out of positions painful
May c/o feeling weak, difficult to stand up

Question 8

SI subjective exam

Answer 8

More likely to be traumatic
Fortin sign = pt points toward PSIS
Pt may report difference in fit of pants or that they feel uneven when they sit

Question 9

Red Flags

Answer 9

Failure to improve with conservative care >30 days
Cancer
Cauda Equina syndrome
Infection
Spinal Compression fx
Abdominal Aortic Aneurysm

Question 10

Shift named for…

Answer 10

Position of the shoulders relative to the pelvis

Question 11

Stenotic posture

Answer 11

Flexed at the hip and reduced lordosis

Question 12

Derangements will deviate…

Answer 12

Away from the painful side

Question 13

Adherent nerve roots will deviate…

Answer 13

Towards the painful side

Question 14

Stenosis marked limitation in…

Answer 14

Extension

Question 15

Spondylolysthesis will always be better….

Answer 15

Towards endrange

Question 16

Flexion ROM

Answer 16

80°

Question 17

Extension ROM

Answer 17

25°

Question 18

Side-bending ROM

Answer 18

35°

Question 19

Rotation (Thoracolumbar)

Answer 19

45°

Question 20

Acute Kyphotic deformity

Answer 20

Testing starts prone over pillows to accomodate deformity

Question 21

Flexion PROM End feel

Answer 21

Firm

Question 22

Extension PROM End feel

Answer 22

Firm or hard

Question 23

Side-bending/rotation PROM end feel

Answer 23

Firm or hard

Question 24

Grading of PROM

Answer 24

Hypo/Hyper/Normal

Question 25

Hicks CPR on stabilization

Answer 25

3 of 4 variable present: - Younger than 40 y/o - Greater general flexibility (SLR >91°) - Instability catch or aberrant movement during flex/ext - Positive findings on the prone instability test

Question 26

Symptoms below the buttock?

Answer 26

Do a neuro screen

Question 27

Neuro Exam

Answer 27

LLNT (SLR, slump) Myotomes Dermatomes MSRs/DTRs

Question 28

SLR/Slump 3 criteria for being positive

Answer 28

Reproduce comparable sign Asymmetrical findings Sensitizing movements change symptoms

Question 29

Tests for intermmittent claudication of nerve

Answer 29

``` Bicycle test (Patients with PVD will get ischemic pain) Stoop test ```

Question 30

Test cluster for SIJ provocation

Answer 30

``` Iliac compression Iliac Gapping Thigh Thrust Pelvic Torsion Left Pelvic Torsion Right ```

Question 31

Clinical Reasoning in patients with Lumbopelvic pain

Answer 31

Use repeated movements in conjunction with the 5 pain provocation tests

Question 32

Diagnosis vs classification

Answer 32

Try to classify, diagnosis isnt necessarily possible

Question 33

Low back pain classifications

Answer 33

1) Manipulation 2) Specific Exercises 3) Stabilization 4) Traction

Question 34

CPR for success with manipulation

Answer 34

4 or more present: - Recent onset - Low FABQ (35)

Question 35

Stabilization training

Answer 35

Specific exercise approach more effective in patients with chronic spondylolysis or spondylolysthesis

Question 36

Directional Preference return to function phase

Answer 36

Once pt centralized, after 72 hours w/o symptoms you start repeated FIL After FIL, flip over and do prone ext w/ a sag Continue if no pain

Question 37

Anterior rotated SI

Answer 37

Needs posterior rotation

Question 38

Posterior rotated SI

Answer 38

Needs anterior rotation

Question 39

Sliders used

Answer 39

In acute conditions 5-6 active repetitions or 1-2 sets 30-60 seconds passively

Question 40

Tensions used

Answer 40

Sub-acute to chronic

Question 41

Femoral nerve testing

Answer 41

Prone or side-lying

Question 42

Sciatic nerve testing

Answer 42

Supine | Bias nerve for sural, tibial, and fibular