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2013-09-15 16:53:09

lumbar testing
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  1. 6 elements to standing lumbar testing (basic, just looking at rough quality, range, willingness to move, symptoms, changes, etc)
    • 1) PT holds ASISes from behind as pt rolls forward (PT is low, squatting or on a stool)
    • 2) pt's hands on butt, head extended, arch back (PT in same low pos) (can be done prone, pushing up on elbows)
    • 3) PT reaches to pt's opp hip and pt tilts to that side (PT is standing on the side pt is tilting away from)
    • 4) repeat to opposite side
    • 5) pt's arms crossed in front horiz like Dream of Genie, PT stabilizing hips, pt rotate to side
    • 6) repeat to other side

    If it's all good, repeat with VERY gentle over pressure.
  2. If a herniated disc is causing discomfort and the symptom is in L leg, what does it tell you if the pt leans to the L for comfort or to the R?
    • to L (towards pain) --- the protrusion is medial to the nerve root
    • to R (away from pain) --- protrusion is lat to nerve root
  3. resisted lumbar testing
    • Provide the resistance in the neutral pos. Tell the pt to "hold" as you slowly increase pressure then slowly release.
    • Pt is seated.
    • 1) flexion
    • 2) extension
    • 3) bilat side bending (hug around the shoulder pt's leaning towards)
    • 4) rotation (Genie arms) PT w a hand on each shoulder
  4. passive testing tests what?
    noncontractile structures (ligs, jt capsules, surrounding soft tissue... not muscle)
  5. PPIVM
    • passive physiological inter vertebral movement
    • passive accessory inter vertebral movement
  6. forward bending PPIVM -- how?
    • pt sidelying
    • hips and knees at 90 (or knees tucked in more, into a "small bundle")
    • PT palpate interspace L5-S1
    • table height set so that when PT is in a squat, the pt's lower knee is in the hip crease, upper knee above ASIS
    • cradle calves on one forearm
    • keep calves parallel to ground
    • swing legs slightly to sense opening/closing at interspace (thru jt's full ROM)
    • move to sup interspace
    • can do holding only 1 leg, but you'll have to move more
  7. back bending PPIVM testing
    • same grip on 2 or 1 legs like in flexion
    • 1) drive hips posteriorly, compressing the hip
    • or
    • 2) do hip extension, but she says this isn't as good (maybe bc it involves more joints?)
    • palpate to feel the closing of each joint
  8. prone back bend PPIVM
    • can only do if the pt can truly just use arms, not back muscles, to push back into extension
    • pt slowly rises as PT palpates joints
  9. side bending PPIVM in side lying
    • push sup on IT to feel the side band (can palpate on interspace L or R of the vert)
    • pull on iliac crest to feel opposite side bend
    • or
    • hips and knees at 90
    • put pt's knees on your hip and lower them for side bending, raise them for contralat bendign
  10. sidebending PPIVM testing in prone
    • abd one leg
    • lock that femur into your hip and do pure abd
  11. prone rotation PPIVM testing
    • grab ASIS across from PT w one hand, using other to palpate as you lean back to pull on hip and create rotation
    • or,
    • lift calves, bending knees to 90, hold distant ankle (can hug against shoulder) and roll legs to R for L bend, to L for R bend  (don't do this if RF is so tight it causes ant pelvic tilt in this pos)

    (remember, the rotation is named for the upper segment)
  12. PAIVM spring test, PA
    • purpose: sense overall relative mobility of all motion segments
    • use pisiform area, or space btwn the thenars
    • expect > mobility as you get higher bc the more caudal facets are more frontal plane
    • place pressure on bilat TPs
    • put non-pressing hand's middle and index fingers over TPs