When is LQS used?
1) sx's are assoc w insidious onset, 2) radicular signs, 3) sensation altered, 4) SC signs, 5) psychogenic sx's, 6) not clear where examiner should start
observation and inspection
assess pt. from posterior, anterior, and lateral position to look for deviations from "normal"
pelvic tilt vs. lumbar spine position
are not related; resting position of the pelvis is not related to amount of lordosis person has
Does excessive lordosis cause low back pain?
no, it is unrelated
lateral deviation of shoulders relative to the pelvis; thought to be due to disc disease; shift is non-structural compensation for pain
structural bony deformity of the spine; can be "c" or "s" curve
forward bending test
test for scoliosis pt's with a rib hump (on side of convexity) & indicates a bony deformity
most reliable L-spine AROM tests
tape measure & inclinometer (single)
How is trunk rotation tested?
while pt. is sitting; in order to control pelvis
designed for testing nerve involvement, max resisted isometric testing is key, can use > 1 repetition for suspected + tests
great toe extensor
ankle plantar flexors or evertors
causes of muscle weakness
1) muscle injury 2) pain 3) peripheral nerve injury 4) nerve root lesion 5) CNS lesion 6) tendon pathology eg. avulsion 7) psychologic overlay
only conducted when pt. reports altered sensation; 1st light touch then 2nd sharp dull discrimination
1(1+) diminished, 2(2+) normal, 3(3+) exaggerated, 4(4+) clonus
most meaningful DTR grades
0 and 4+
which nerve root does not have a test?
which pulses do you palpate in LE?
dorsalis pedis and posterior tibial
+ SLR test
only + for nerve root irritation when sx's are reproduced/increased below the knee
SLR test is most positive at what arc?
20-40 degrees; tension applied to sciatic roots at this angle
femoral nerve traction test
pt. lies prone, flex knee, extend hip, + test elicits sx's in L2-4 distribution
flex L-spine, flex head with overpressure, extend knee with SLR and ankle DF, pt. extends c-spine
is the gapping test reliable and valid?
there is some evidence that series of +SIJ provocation tests indicate presence of SIJ syndrome
is the slump test reliable?
no reliability or evidence
PT crosses hands and pushes laterally on pt's ASIS bilaterally, which compresses posterior SIJ and gaps anteriorly
pt. is positioned sidelying and PT applies longitudinal force through ASIS
pt. lies supine, and PT places pt's test leg so foot rests on top of opposite knee (figure four), PT pulls knee to table, and if knee only comes to 45 deg. instead of parallel with opposite leg, indicates + test
sx's of vascular claudication
skin changes, hair loss, decreased pulses in LE, possible numbness from knee down