M2: Lumbar Objective 2 Flashcards
What is the favored sitting position?
Lumbopelvic sitting
What does lumbopelvic sitting look like?
- anterior pelvic rotation
- lumbar lordosis
- thoracic relaxation
Does not involve end-range positions in T/L spine
What does lumbopelvic sitting result in?
activation of local stabilizing muscles without high compressive loads of ES
Lumbopelvic sittin - effect on head position
Relatively neutral head/neck alignment
What is the procedure for assessing the effect of sitting posture correction on spinal sx?
- Observe unsupported sitting posture
- PT manually assists anterior rotation of the pelvis
- PT manually repositions the scapulae as needed
- Pt is asked to actively maintain position
- Assess sx for changes
What should initial unsupported sitting posture look like?
- flat feet
- knees and hips flexed 80˚
Posture assessment: When the PT manually assists anterior rotation of pelvis, this results in:
(Lumbar, sternum, scapulae, head)
- normal low lumbar lordosis
- slight sternal lift or depression to restore normal thoracic kyphosis
- scapulae sitting flush on thoracic wall
- gentle occipital lift away from cervical extension to adjust head-on-neck posture
Correction of sitting posture » sx may
- decrease
- increase
- remain the same
Pts with spinal pain (speed and step length)
- slower gait
- shorter, asymmetrical step length
What do LBP pts do to walk faster?
- increase cadence rather than stride length
- done to limit motion about the spine and hips in order to modify axial loading during walking
What factors may affect gait strategies in LBP pts?
- intensity of pain
- level of disability
- distribution of pain
- fear related to physical activity
Which of these accounts for more variance of walking ability with LBP pts?
- level of perceived disability
- pain intensity
level of perceived disability
What is a very strong predictor of gait velocity in LBP pts?
Fear related to physical activity
How to progressively assess standing balance
- EO on firm, level surface, then EC
- EO on dynamic surface, then EC
- Add tandem, single-leg on varying surfaces EO/EC
Standing balance assessment: under 45
Should be able to complete these tests
Standing balance assessment: under 60
Should be able to maintain all conditions up to 30 seconds
Why is balance important to assess with LBP pts?
Balance impairments have been demonstrated in individuals with LBP and neck pain
Steps of AROM testing
- Test uninvolved side
- Explain and ask for response to movement
- Establish baseline sx at rest and prior to movement
- Assess pain/sx response
- Assess quality by observing from all sides as needed
- Assess quantity of movement grossly
What are we trying to do with testing?
Trying to reproduce the pt’s sx
Assessment of pain/sx response: things to remember
- note pain rating
- note behavior of sx
- re-establish sx baseline to prevent cumulative effect
What are you looking for with AROM testing with respect to quality of movement?
- smoothness, ease of movement
- control
- deviations from normal (aberrant or substitutions)
- intervertebral movement
Assessing quantity of movement grossly
- normal
- hypomobile
- hypermobile
(Gravity/bubble inclinometer)
If AROM is normal, what should you do?
- apply overpressure
- assess end-feel
- assess effect on sx
If AROM with OP is normal and sx haven’t been reproduced, what should you do?
Try
- repeated movements
- sustained movements
- combined movements
