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KIN 446 Exam 1
Terms in this set (71)
Innervates anterior and medial muscles of the thigh, medial leg, and foot
Posterior branches form the femoral nerve
Anterior branches form the obturator nerv
Innervates buttocks, posterior femur muscles, and the entire lower leg
Sciatic nerve in three distinct sections (L4-S3) (biggest nerve in the body)
Provide respiration and movement associated with the scapula UE and LE
Close to the spinal cord and directly influence its motion
Intrinsic muscles help stabilize the spine while the extrinsic muscles are performing are performing activities. Basis for lumbar stabilization exercises.
Intervertebral disk lesions
Loss of water, decreased protein, and altering of chemical structure
extrusion of the nucleus pulposus through the annulus fibrosus
Narrowing of the spinal canal or intervertebral foramen
Common in ≥50 year olds
Typical Degenerative Process with aging (Wear & Tear on the body; arthritis, degenerative disc disease
Pain during walking prolonged standing
Radiating pain-the nerve is impinged in one spot and it radiates down the entire nerve
Joint play test (joint stability tests)
Facet joint pathology (joints get stuck for degenerate)
Spondylitic defects (Mini fractures or congenital weaknesses; young females)
Defect in the pars interarticularis
"Collared Scotty dog"
Localized low back pain restricts extension
Can be a progression of spondylolysis
Seperation of vertebra
"Decapitated Scotty dog"
Ilium rotates and subluxates on the sacrum
Mobility at SI joint is 2 mm or less
Injury or degeneration of pubic symphysis
Tight hamstrings (posterior tilt)
Tight hip flexors (anterior tilt)
Signs and symptoms
Pain over SI joint
Compression or distraction of pelvis duplicates symptoms
flaccidity of the muscles
Upper and lower quarter screen
Deep tendon reflexes
Core stability exercises
Biomechanical Education/ Conservation Techniques
Past medical history
History of back injuries or surgeries
Changes in activity
Mental health status
History of the present conditions
Location of the pain and referred or radicular symptoms
Onset of the pain
Severity of the pain (0/10 scale)
Consistency of the pain-Constant pain, Intermittent pain
Bowel or bladder control
Disability associated with low back pain-Sleeping pattern
Inspection of observation of gait, General movement and posture
Inspection of S or C curvature
Inspection of thoracic spine
Inspection of breathing patterns, bilateral comparison of skin folds, shape of the chest
Inspection of lumbar spine
Inspection of lordotic curve, standing posture, and erector muscle tone
Disc collapse of gets smaller in the front in thoracic and cervical spine
1. Spinous process
2. Supraspinous ligaments
3. Costovertebral junction
5. Paravertebral muscles
6. Scapular muscles
Palpation of the thoracic spine
1. spinous process
2. step-off deformity
3. paravertebral muscles
Palpation of the lumbar spine
1. Median sacral crests
2. Iliac crests
3. Posterior superior iliac spine (PSIS)
5. Ischial tuberosity ?
6. Greater trochanter
7. Sciatic nerve ?
8. Pubic symphysis ?
Palpation of the sacrum and pelvis
Posterior from the jugular notch of the sternum
Even with the medial border of the scapular spine
Even with the inferior angle of the scapula
In normal body posterior to umbilicus
Level with iliac crests
Typically demarcated by dimples
Level of posterior superior iliac spine
Joint and muscle function assessment
Active range of motion (AROM)-Flexion and extension, Lateral bending, Rotation
Manual muscle tests (MMT)
Passive range of motion (PROM)-Flexion, Extension, Rotation
Ask patient to raise involved leg. If uninvolved leg does not push down in the other hand the test is positive for malingering.
Adams Forward Bend Test
Therapist observes back for scoliosis while standing. Then asks the patient to bend over at waist. If see a muscular hump on one side the test is positive for structural scoliosis. If the hump does not appear and scoliosis appears to go away the test is positive for functional scoliosis.
Beevor's sign of thoracic nerve inhibitor
Place patient is hook-lying position.
Patient performs partial sit-up.
If umbilicus moves in any particular direction the test is positive for possible nerve root condition T5-T12 which innervates abdominal muscles. If the umbilicus does not move in any direction the test is negative as all muscles are working.
The therapist gently presses downward on the spinous processes. There should be a slight spring action. If the process nearly disappears this is hypermobility and if there is no movement, this is hypomobility of the spine. Positive test either way. If there is slight spring the test is negative.
Straight leg raise test
Well or cross straight leg raise
General tests for nerve root impingement
The patient is in supine. The therapist gently raises the leg straight into the air. If patient complains of pain before 70 degrees the test is positive for possible sciatic nerve irritation. Pain may be in low back and buttocks radiating down the posterior of the leg. If pain begins before 30 degrees the test is highly positive. NO complaints of symptoms means a negative test.
Well SLR test
Place patient in supine position. Raise the uninvolved leg. If the patient complains of pain on the involved side the test is positive for a large space occupying lesion (herniated disc). (Sciatic nerve irritation)
Place the patient sitting at the end of the table. Patient Flexes thoracic spine and shoulders forward, then flex neck, then extend knee, then dorsiflex the ankle. If pain begins, have the patient relieve the last movement (i.e. slightly relieve the knee extension and neck flexion) then have the patient extend the knee again to see if pain returns without the neck flexed. Pain at anytime during this test makes it a positive test for either sciatic nerve or other spinal root irritation or irritation of the dural lining of the spinal cord.
Place the patient in either a standing or sitting position. If older patient or suspect balance problems sitting would be better. Have the patient extend the spine then side bend and rotate toward the involved side. Therapist applies pressure downward on the shoulders. If patient complains of pain on involved side the test is positive for nerve root compression on that side. Less likely but could indicate SI problem or facet joint pain.
Femoral Nerve test
Place the patient in a prone position. The therapist passively flexes the knee then passively extends the hip while stabilizing the body just above the hip. Complaints of pain in the anterolateral thigh is a positive test for femoral nerve irritation (L2,3,4).
Place the patient in a supine position and flex the hip to 90 degrees with the knee also flexed. Gently extend the knee. Also place thumb over sciatic/tibial nerve area behind the knee. If complaints of pain occur when the knee is extended relieve the pain by flexing about 20 degrees to see if the pain stops. This is a positive test for sciatic nerve irritation.
Sacroiliac compression and distractions test
Place patient on the side with the painful side upward. Place hands over ASIS and press downward. Pain in the SI area is a positive test for SI pathology.
Place patient supine. Place hands over each ASIS and press downward. Pain in the SI region is a positive sign for SI pathology.
Place the patient in a supine position with the involved leg crossing over the other (flexed, abducted, externally rotated and extended). Place one hand on the knee and the other over the opposite ASIS. Press down on both simultaneously. If complaints of pain result the test is positive for SI joint or hip joint pathology.
Can affect respiration
Pathologies (Cancer, gall bladder, and gastroesophageal conditions) can refer pain to what?
Pathologies that can be
mistaken as low back
pain can be kidney
infection, CA or other
located just above the
pelvis and lateral to what?.
ilium, pubic and ischial on each side
called the Y Ligament or the Ligament of Bigelow. Supposed to be the strongest ligament in the body, prevents hyperextension & helps with maintenance of pelvic posture.
site where iliotibial band meets the tibia.
muscles that serve primarily to control hip internal rotation during gait.
nerve that controls motor functions such as leg flexion at the hip and leg extension at the knee
nerve that control motor functions such as adduction of the thigh
abnormally decreased angle of hip
abnormally increased angle of hip
Increased angle above normal, which is 20 degrees; based on head of femur
Decrease angle below 15, which is normal; based on head of femur
Sartorius muscle (anterior)
Adductor longus (lateral)
between the ASIS and the pubic tubercles.
snapping hip syndrome
When the hip is flexed adducted, and bearing weight, the tensor fascia lata which attaches into the iliotibial ban, can ride anteriorly over the greater trochanter and make an audible and palpable snap. Called what?
located midway between the greater trochanter and the ischial tuberosity. When the hip is extended the nerve is covered by the gluteus maximus. When the hip is flexed moves away from the nerve. If tenderness results with palpation between these two landmarks this may indicate a herniated lumbar disc or piriformis tightness pressuring the nerve. Difficult to palpate the nerve under fatty soft tissue.
Slipped capital femoral epiphysis
Displacement of the femoral head relative to the femoral neck
Femoral head remains in acetabulum
Femoral neck displaces anteriorly
More frequent in adolescents that are over weight
Limitation in internal rotation
Gait pattern with involved extremity externally rotated
MOI: Fall onto flexed knee with hip abducted
Sciatic nerve passes under or through the piriformis
Tighteness spasm or hypertrophy
Pressure on the sciatic nerve
Piriformis syndrome test
Patient in supine position. Tester flexes the leg to 90 degrees and then carefully applies pressure moving the knee toward the opposite shoulder. Pain in the buttock & sciatica areas = + test.
Precautions for hip arthroplasty
1. No hip flexion beyond 90 degrees.
2. No adduction past the midline.
3. No internal rotation past the midline.
Goal = preventing dislocation.
Anterior lateral approach
In general, the patient should avoid:
Combined hip external rotation and flexion
Hip adduction past the midline of the body
Hip internal rotation beyond neutral
Posterior lateral approach
In general, the individual should avoid:
Hip flexion greater than 90 degrees
Hip adduction past the midline of the body
Hip internal rotation past neutral
The patient should avoid:
Hyperextension of the hip
Extreme hip external rotation
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