Artho-kinematics
A patient demonstrates restricted left lumbar facet mobility at L3/L4.
Which combination of movements would MOST likely be limited?
Left rotation and right side bending
A 41-year-old female presents with localized right-sided low back pain following a sudden twisting movement 8 days ago.
Examination reveals:
- Pain remains above the knee
- Lumbar flexion and right side bending are limited
- Hypomobility at L3/L4 and L4/L5
- Negative SLR and normal neurological examination
- FABQ work score: 12
- Right hip internal rotation: 42°
Which diagnosis is MOST likely?
B. Lumbar mobility deficits
A patient experiences pain that travels from the lower back down into the leg.
Question: What is the term for pain that travels along a nerve root?
Radicular pain.
During a Straight Leg Raise (SLR) test, what additional movement can the therapist perform to increase neural tension and confirm nerve involvement?
Passive cervical flexion (neck flexion).
What factors outweigh physical factors predicting long-term disability?
What is Psychosocial factors?
Waddell- “ fear of pain and what we do about it may be more disabling than the pain itself”
A patient presents with hypomobility of the right L4/L5 facet joint, specifically limiting its ability to gap.
Which combination of lumbar movements would MOST likely be restricted?
Right rotation and left side bending.
A 43-year-old male presents with acute low back pain after lifting and twisting while moving furniture.
Examination reveals:
Right low back pain radiating into the lateral calf
Right great toe extension strength 3+/5
Positive SLR at 35°
Lumbar flexion and extension both reproduce calf pain
Repeated extension does not centralize symptoms
Lumbar distraction relieves leg pain
SI provocation tests are negative
Which diagnosis is MOST likely?
Lumbar radiculopathy secondary to disc herniation that does not centralize
A patient presents with weakness in the L5 myotome, specifically great toe extension. Which lumbar disc level is MOST likely herniated?
L4/L5 disc (compressing the L5 nerve root).
Which SI joint provocation test is considered the most sensitive (SNOUT), meaning a negative result helps rule OUT SI joint pain?
Posterior Shear (Thigh Thrust) Test.
Band like pain (tumor or cord compression)
Heavy legs, Gait Disturbance
Increased lying flat, at night, with marked interruption of sleep (tumor, infection)
Escalating, agonizing pain
A patient demonstrates limited lumbar left side bending at L4/L5.
Based on lumbar facet arthrokinematics, which additional impairment would MOST likely be present?
Restricted left facet downslide
what ideal treatment for central canal stenosis?
unweighted treadmill
A patient presents with low back pain suspected to involve ligamentous or annular disc weakness. Which movement combination is MOST likely to reproduce the patient’s symptoms?
B. Flexion and rotation
Which SI joint displacement would indicate the need for a posterior torsion manipulation in side lying?
Anterior innominate rotation (anterior torsion).
Where does a spinal tumor MOST commonly come from? (3)
from the lung, breast, and Prostate
A patient has a restricted right lumbar facet at L4/L5. During active lumbar flexion and extension, which movement deviations would MOST likely occur?
Flexion deviates right; extension deviates left.
36-year-old female presents with persistent low back pain following a minor fall 5 months ago.
Examination reveals:
- Pain extends throughout the lumbar spine, buttocks, and both thighs
- Light touch produces significant pain
- CSI score: 62
- FABQ score: 40
- Symptoms fluctuate unpredictably
- No consistent mechanical pattern
- Neurological findings N/A
Chronic low back pain with generalized pain (central sensitization)
A patient presents with weakness in ankle dorsiflexion and diminished sensation along the medial calf. Which lumbar level is MOST likely affected by lateral foraminal stenosis?
L4/L5 foraminal stenosis (compressing the exiting L4 nerve root).
A patient reports pain near the PSIS that worsens during single-leg weight bearing. Which special test would be MOST appropriate to assess functional sacroiliac joint instability?
Active Straight Leg Raise (ASLR) Test.
CSI central sensitization index: What are the scoring ranges?
0-29 Subclinical
30-39 Mild
40-49 Moderate
50-59 Severe
60-100 Extreme
If the R side facets is tight in the lumbar spine what is limited?
R rotation + L SB is limited AND FB R + BB L deviation occurs
List the 5 components of the clinical prediction rule for LUMBAR MOBILITY DEFICITS/ ICF: LBP with Mobility Deficits
Fear-Avoidance Beliefs Questionnaire work score <19 points.
Duration of current episode <16 days.
No symptoms extending distal to the knee.
At least 1 hypomobile lumbar spine segment.
At least 1 hip with >35° of internal rotation range of motion.
A patient reports low back pain that radiates into both calves after walking for 5 minutes. Symptoms resolve when sitting or leaning forward.
What is the clinical term used to describe this symptom pattern?
Neurogenic claudication.
What special test should be used for LUMBAR SPINAL STENOSIS (FLEXION SYNDROME)/ ICF: LBP with Related Lower Extremity Pain?
2-stage treadmill test
1) Higher FABQ Scores are an indication to
BONUS POINTS
2) What does a score of below 19 mean?
3) What does a score over 34 mean?
use and active exercise-based approach in which feared activities are gradually introduced in a controlled environment to assist the patient in overcoming their fears of activity
2) Predict a patient who will respond to a more curative approach, including manipulation (positive prognosis)
3) is a yellow flag for someone that has fear avoidance