Week 1: Mon 1.11.16 lab exam, standing and sitting

Question 1

Baseline data (as stated by the book) to collect prior to formal observation/exam (6)

Answer 1

• height
• weight
• pulse
• respiration
• BP
• baseline symptoms

Question 2

The observation portion of the exam begins in the waiting room. What are some things we should be observing? (8)

Answer 2

• facial expression
• postural characteristics
• general fitness and well being
• quality of movement
• rising from waiting room chair
• sitting
• walking
• willingness to move

Question 3

True or False: All functional movements that are aggravating factors should be tested.

Answer 3

False

Due to potential for cumulative stresses that may make the patient’s symptoms worse.

Question 4

True or False: Functional movements are often provocative measures and indicators of motor control strategies.

Answer 4

True

Question 5

What functional activity did we analyze in lab that you may use in the clinic with LBP?

Answer 5

Squatting

Question 6

Answer 6

Daniel Arsham

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Question 7

Why are squats an important functional activity?

Answer 7

They mimic sit-to-stand from a chair

Question 8

Things to watch for when a person performs a squat

Answer 8

• Knees centered over foot without too much varus or valgus or rotational movement during squat
• spinal curves should not change throughout squat
• pelvis starts squat in neutral, anteriorly tilts while squatting
• trunk should stay over base of support

**Alterations from above positions ⇒probably altered motor control

Question 9

How do people with LBP tend to walk?

If you tell them to walk fast, what do they tend to do?

How does this compare to people without LBP?

Answer 9

Gait: Slow with shorter assymmetrical steps

Increase their cadence to walk faster

Healthy people increase stride length to walk faster

Question 10

A strong predictor of gait velocity is ________

Answer 10

fear avoidance

Question 11

What test did we do in lab for gait observation?

Answer 11

10 meter walk test

Question 12

Something we should assess when we have patients with LBP and difficulty walking

Answer 12

motor control of the lumbopelvic hip complex

Question 13

Patients with LBP often have impaired balance. In standing they may demonstrate _______ _______ and they may keep their center of force significantly ________.

Answer 13

postural sway

posterior

Question 14

Why do the heel and toe walk test during an objective exam?

Answer 14

They are quick functional tests for L5-S1 myotomes and L4-L5 myotomes

Question 15

Aside from toe walk test, what is another option for testing S1?

Answer 15

manually muscle test gastroc complex in standing

Question 16

List of things a clinician will be looking at/for when observing posture (5)

Answer 16

focusing on lumbo pelvic and lower extremity reagions for:

• scoliosis
• lordosis
• kyphosis
• lateral shift
• patterns suggesting muscle imbalance

Question 17

Why does the clinician place herself at eye level with the patient’s pelvis?

Answer 17

To assess posture by checking the symmetry of the bony landmarks of the pelvis.

Question 18

If there is assymmetry in the bony landmarks- ASIS, PSIS, iliac crests, what could it mean? (2)

Answer 18

• leg length discrepency
• pelvic girdle asymmetry

Question 19

Examining lordosis part of the objective exam for posture. Why is it important?

Answer 19

• Need to know if lumbaar lordosis is increased, decreased, or normal
• Are there any other deviations observed with the lordosis such as lordosis kyphosis posture or a lateral shift

Question 20

Another term for lateral shift

Answer 20

sciatic scoliosis

(but it occurs in people with or without leg pain)

Question 21

In which direction is it most common to see a lateral shift?

Answer 21

Contralateral- away from the pain

Question 22

What MDT category would a lateral shift typically fall under?

Answer 22

mechanical derrangement

Question 23

General guidelines/steps for performing lateral shift correction in standing

Answer 23

• therapist stands on the same side as the shift
• establish resting symptoms
• side-gliding movement is performed in an oscillatory manner
• monitor symptoms for centralization or peripheralization (don’t continue if peripheralization- can be tried in unload position)
• move into over-correction position, past midline
• ask patient to bend backwards while assessing symptoms
• can progress to repeated extension in this position.
• stop if shift cannot be corrected after 1-2 days

Question 24

How do you name a lateral shift?

Answer 24

• It is always named Bobby. jk!
• named by the direction that the upper thoracic and shoulders are pointed toward.
• Example of Right Lateral shift below

Question 25

What systems does the patient rely on during balance testing with eyes open on a foam mat?

Answer 25

visual and vestibular

Question 26

What systems does the patient rely on during balance testing with eyes closed on a foam mat?

Answer 26

Just vestibular vision is gone and somatosensory is altered

Question 27

What are you checking as you measure AROM? (4)

Answer 27

* quality of movement * quantity of movement * pt. willingness to move * symptomatic response

Question 28

Where do inclimomters go when measuring flexion? How do you determine just lumbar flexion?

Answer 28

T12- measures lumbopelvic motion S2- just hip motion T12-S2 = lumbar flexion

Question 29

Measuring lumbar flexion with one inclinometer- where does it go?

Answer 29

T12

Question 30

Measuring lumbar extension with one inclinometer- where does it go?

Answer 30

T12 ## Footnote can also use the same double inclinometer method as used in finding lumbar flexion

Question 31

Something to ensure patients do not do when measuring lumbar flexion and extension

Answer 31

Don't let them bend their knees

Question 32

4 points to remember when performing the manual lateral shift correction in standing

Answer 32

1. progressive worsening pain or peripheralizing pain that refer or radiates distally into LE indicates shift correction should be stopped and repeated in non-weight bearing position 2. sign and symptoms of radiculopathy or CES (?) are reasons to abandon the process 3. if shift cannot be corrected across midline after 1 or 2 days, the condition is likely irreversible (not the sentiment of an optimist) 4. nausea or faintness indicates trial of an alternative management procedure. \*\*\*CES = cauda equina syndrome

Question 33

What does MDT stand for? What is that?

Answer 33

mechanical diagnosis and treatment (the technical name for McKenzie method stuff)