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Flashcards in Spine Deck (46):

How to determine flexion vs extension

Pt lies prone
1. Palpate transverse process
2. If asymmetry WORSENS in extension, the segment is FLEXED and vice versa.
3. If asymmetry IMPROVES in extension, the segment is EXTENDED and vice versa.
4. No change = NEUTRAL

If unclear, test in flexion.


Standing flexion test

Pt standing w/ ft shoulder width apart
Eyes at level of PSIS
Thumbs under PSISs
Rest fingers on iliac crests or glutes
Bend forward, follow PSIS movement


Positive standing flexion test?

One PSIS moves superiorly during last 10 deg of forward bending
Pos = side of IS dysfunction


Cause of false positive standing flexion test

Contralateral tight hamstrings


How do you determine if the ASIS is inferior or superior?

Have the patient lay supine
Use your palms to locate the ASIS
Hook your thumbs under each ASIS and compare which one is superior
The side of the positive standing flexion test is the concern


How do you determine the height of the pubic ramus?

1 Explain what you're doing to the patient
2. Patient supine, place palms on the abdomen move caudally until the superior aspect of the pubic rami is contacted. Place index fingers superior on each rami. Look straight down at your fingers to compare heights.


How do you determine leg length discrepancies?

1. Patient lies supine.
2. Position stands at end of table.
3. palpate the most interior aspects of each medial malleolus with the thumbs. Determine if one leg is shorter.
The medial malleolus follows the ASIS.


How do you determine the PSIS height?

1. Patient lies prone.
2. Use palms to locate the PSIS.
3. Hook your thumbs horizontally to under each PSIS and compare which one is superior.
floor. The side of the positive spending flexion test is the side of concern.


How to determine the height of the ischial tuberosity

1. Patient prone.
2. A place of palms into the gluteal fold slightly medially


Fryette type I mechanics characteristics

1. Neutral
2. Thoracic or lumbar spine
3. Sidebending and rotation in opposite directions
4. Treat the apex of the group


Fryette type II mechanics characteristics

1. Non-neutral
2. Thoracic or lumbar spine
3. Single vertebral unit
4. Sidebending and rotation in the same direction


Muscle Energy for NSLRR L2-4

1. Physician stands on the side opposite to the rotational component (on the left)
2. Patient places L hand over R shoulder
3. Phys weaves L arm under pt's L arm and places L hand over pt's L hand (to control R shoulder
4. Phys places R thumb at apex of R convexity & applies anteromedial force vector
5. Maintain neutral spine
6. Side bend trunk to R, rotate upper trunk L until movement is felt under R thumb.
7. Pt performs isometric contraction attempting to sit up 3-5 s
8. Pt releases, phy takes up slack until restrictive barrier reached
9. Repeat up to 3 times
10. Goal: Improvement in motion


Muscle Energy for FRLSL Lumbar spine

1. Pt seated, phys seated or standing behind pt.
2. L hand monitors the inferior interspinous region and the transverse processes of vertibra.
3. Bring upper trunk into extension, right side bending and right rotation.
4. Pt rotates left, bends left, bends forward against resistance


ME for Lumbar ERSR

1. Pt seated, phys stands in front
2. Pt's L hand placed on R shoulder
3. Phys L axilla on pt's L shoulder
4. Phys R hand monitors dysfunctional Vertebra transverse processes and inferior interspinous region.
5. Isometric contraction.


CS for L1 R anterior TP

Physician stands at same side of TP
1. Flex hips + lumbar spine to L1
2. Rotate pelvis toward tender side (trunk away)
3. Sidebend toward TP (feet toward)


CS for L2 R anterior TP

Physician stands at opposite side of TP
1. Flex hips + lumbar spine to L2
2. Rotate pelvis away from tender side (trunk towards)
3. Sidebend away from TP (feet away)


CS for L3-4 R anterior TPs

Phys stands at opposite side of TP
1. Flex hips + lumbar spine to L3 or 4
2. Rotate pelvis away from TP (trunk towards)
3. Sidebend away from TP (feet away)


CS for L5 R anterior TP

Phys at same side of TP
1. Flex hips + L spine to L5
2. Rotate pelvis toward TP (Trunk away)
3. Sidebend away from TP (move feet away)


CS for Posterior Lumbar TPs

Phys at same side of TP
1. Grasp ipsilateral IC and lift from table


CS for Piriformis

Patient prone
1. Flex + abduct ipsilateral hip
2. Add internal/external rotation prn


CS for iliacus

Pt supine
1. Bilateral hip flexion w/ ankles crossed & knees flexed


CS for Lat trochanter TP

Monitor TP while abducting hip


ME for anterior innominate rotation

Pt supine
Phy stands on contralateral side
1. Flex knee & hip
2. Ext rotatte hip & abduct leg
3. Phy hand on ischial tuberosity w/ pt knee in phy axilla
4. Extend hip & knee against phys
5. 3-5 reps
6. Reassess


ME for posterior innominate rotation

Pt supine
Phy stands ipisilateral side
1. Bring pt's SI joint to edge of table
2. Phy hand on opposite ASIS
3. Phy other hand on knee hanging off table
4. Pt lift knee against phy push towards floor
5. Take up slack between contractions
6. Repeat 3-5 reps
7. Reassess


ME for superior or inferior pubic shear

Pt supine
1. Knees flexed
2. Pt abducts both knees, 3-5 reps
3. Phys arm between knees, Pt adducts knees, 3-5 reps


SI joint BLT
Useful for rotation, flare or shear

Phy sits ipsilateral to SI dysfxn
1. Post hand contacts post sacrum, close to SI joint
2. Post hand proximal fingers contact medial PSIS
3. Other hand on ASIS
4. Post hand exerts anterior force on sacral sulcus to disengage SI joint
5. Move innominate to balance sacroiliac ligaments
6. Hold BLT until release felt, reassess


What does a positive seated flexion test look like? (+SeFT)

PSIS on dysfxn side moves more superiorly during last 10 degrees of forward bending.
Ischial tuberosities must stay on table!


How to test the sacral base

Lumbosacral spring test:
1. patient prone
2. Heel of hand on lumbosacral joint
3. Apply short anterior force assessing motion or "spring"


Pos lumbosacral spring test consists of:

Restricted lumbosacral motion, i.e. no spring

Cause: backward sacral torsion, bilateral sacral extension, unilateral sacral extension


Neg lumbosacral spring test indicates:

forward sacral torsion, bilateral sacral flexion, unilateral sacral flexion


Pos ILA spring test

Poor spring at ILA (resists anterior motion)

Cause: sacral flexions, forward torsions


Neg ILA spring test

Good ILA spring

Cause: sacral extensions, backward torsions


Sphinx test use

Test range of motion of the sacral base
Start prone, test depth of sacral sulci
Pt moves up on elbows, recheck sacral sulci depths and ILAs


Pos sphinx test characteristics

Asymmetry between sulci (and ILAs) worsen.

Causes: Backward torsions, unilateral extensions


Neg sphinx test characteristics

Asymmetry between sulci (and ILAs) improves

Causes: Forward torsions, unilateral flexion


Sacral torsion characteristics

Anterior (deep) sulcus on one side
Posterior (shallow) ILA on the OPPOSITE side


Unilateral sacral flexion/extension characteristics

Anterior (deep) sulcus on one side
Posterior (shallow) ILA on the SAME side


Bilateral sacral flexion (flex-in-in) characteristics

Sulci b/l deep
ILAs b/l shallow
ILA spring test (+)
Lumbosacral test (-)


Bilateral sacral flexion tx

Pt prone
1. Abduct both legs 15 deg (loose packs SI joints)
2. Internally rotate both legs (allows posterior sacral motion)
3. Heel of hand presses anterior-superior, encourage INhalation and resists EXhalation
4. Repeat 3-5 cycles & retest


Bilateral sacral extension (Ex-Ex-Ex) characteristicss

(-) SeFT
ILAs bilaterally deep
(+) Lumbosacral test
(-) ILA spring test

tx: legs in external rotation, encourage EXhalation


Bilateral sacral extension characteristics

Pt prone
1. Abduct both legs 15 deg
2. Externally rotate both legs
3. Pt up to elbows (prone prop position)
4. Heel of hand on sacral base
5. Encourage EXhalation, resist INhalation
6. Repeat 3-5 cycles, retest


MFR for prone lumbosacral release

Left- thoracic hand moves right, lumbar hand moves left
Right- vice versa

side bending (clock/counterclock),
Right- thoracic hand clock, lumbar counter
Left- vice versa

flex/extend (superior/inferior)
Flex: hands move together
Extend: hands move apart

Neutral: no difference in either hand


MFR prone lumbosacral release TX

Hold all tissues in plane of ease (indirect) or restriction (direct) until release is palpated
Utilize respiratory assist


Sacral rock

Find area of greatest sacral restriction, gently spring against the barrier in each direction alternately. Repeat in a general rocking motion.
Add respiratory assist.


Prone traction

Tx of: sacral dysfunction


Viscerosomatic reflexes

Heart: T1-5
Lungs: T2-7
Esophagus: T2-8
Stomach & duodenum: T5-9
Small intestine - ascending colon: T9-11
Transverse colon - rectum: T8-L2
Vasomotor Lower extremities: T10-L2
Kidneys + upper ureter: T10-L1
Lower ureter: L1-2
Bladder: T11-L2
Testes/Ovaries: T10-11
uterus & cervix: T10-L2
Penis/anterior vaginal wall + clitoris: T11-L2
Prostate: L1-2