Lumbopelvic special tests
What special tests can you perform to assess for lumbar radiculopathy?
LQ neuro exam, slump test, SLR, UPAs, Quadrant
What are some treatments you can provice to improve mobility?
UPAs/CPAs
Neutral gap manipulation
Therapeutic exercise: Cobra, repeated extension (improve lumbar extension), quadruped (improve flexion), open book exercise (to improve rotation), hip flexor stretch
What are the precautions of a Lumbar Disectomy?
No bending, no lifting > 10 lbs, no twisting for 6 months post op (NO BLT)
Consider waiting 12 weeks or more to lift >10 lbs
What is the cluster of tests called for SIJ sprain? How many have to be (+) to rule in SIJ sprain? What are the tests?
Cluster of Laslett- if more than 2 tests provoke familiar symptoms, SIJ is likely the source of pain
SIJ compression
SIJ distraction
Thigh thrust
Sacral thrust
A 25 yr old patient presents with pain in their low back and numbness and tingling down the back of their right leg. The pain is often brought on when trying to sit for extended periods of time. What pathology might you suspect?
A. Lumbar Radiculopathy
B. Spinal Stenosis
C. Lumbar Facet Syndrome
D. SIJ sprain
A. Lumbar Radiculopathy
What special tests can you use to assess for lumbar disc pathology?
LQ neuro exam, SLR, Slump test, wells SLR, Prone knee bend, repeated movements, CPAs
What are some treatments to improve movement coordination deficits and muscle power deficits?
STM of the paraspinals and QL
Therapeutic exercise: abdominal performance, abdominal stabilization exercises, BKFO, planks, bridges, clamshells, quadruped (to correct excessive extension/flexion), hip hinge with stick
What are the precautions after a lumbar fusion?
No bending, lifting, twisting for 6 weeks post op (NO BLT)
Lifting >10kg restricted for 12 weeks
Proper wound care
What is an example of an orange flag?
Psychiatric symptoms: clinical depression, personality disorders, PTSD, psychosis
A 70 year old patient presents with low back pain with radiating pain down their left leg. Patient finds relief when they are bent over in a more flexed position. What pathology might you suspect?
A. Lumbar Radiculopathy
B. Lumbar Disc Disorder
C. Lumbar Degenerative Joint Disease
D. Lumbar Spinal Stenosis
D. Lumbar Spinal Stenosis
What special tests/exam pieces can you use to assess for lumbar instability/coordination deficits?
Abdominal performance, bent knee fall out, prone instability test, + Gowers sign
Thomas test to look at muscle length
What are some treatments to improve related lower extremity pain?
Lateral shift correction: start in prone (with pillow), progress to standing (with therapist, against a wall, freestanding)
Centralization: start in prone (with/without pillow, on elbows), progress to standing (repeated extension)
What are the phases/time frames of rehabilitation after a Lumbar Disectomy?
Phase 1: Protected motion (1-3 weeks)
Phase 2: Progressive loading/strengthening (3-6 weeks)
Phase 3: Functional: sensorimotor (7-12 weeks)
A patient reports low back pain after playing in a soccer game recently. They state when they bend over to put on their shoes it feels like their back is catching and they hear a clunk sound. What pathology might you suspect?
A. Lumbar Disc disorder
B. Lumbar Instability
C. Lumbar Facet Syndrome
D. Lumbar strain/sprain
B. Lumbar Instability
What special tests/exam components can you use to assess for Lumbar muscle strain?
What are some treatments to improve radiating pain?
UPAs, SLR sliders and tensioners, slump (sciatic nerve) flossing
What are the phases/time frames for healing for Lumbar Fusion?
Phase 1: protected motion (0-2 weeks)
Phase 2: Progressive loading/strengthening (3-6 weeks)
Phase 3: Functional: sensorimotor training (8-16 weeks)
Phase 4: Sport specific
A patient reports low back pain that is worse with sitting positions and sometimes the pain goes into their left leg. Looking at their posture they are leaning to their right side. What pathology might you suspect?
A. Lumbar disc disorder
B. Lumbar Radiculopathy
C. Lumbar Spinal Stenosis
D. Lumbar DJD
A. Lumbar disc disorder
What special tests/exam components can you use to assess for Lumbar Facet Dysfunction?
Lumbar CPA, UPA, Quadrant test
What are some treatments to improve SIJ pain?
Isometric mobilization anterior or posterior innominate
Therapuetic exercise: self isometric mobilization, hip abduction/adduction strengthening, teach log roll for rolling out of bed
Why is having the patient heel walk and toe walk helpful during the exam? What nerve roots is toe walking and heel walking testing?
It can help look at DF and PF strength along with coordination which can help you decide if you need to do a full neuro exam
Toe walking: S1
Heel walking: L4/5
A patient reports that have right low back pain. They recently slipped but caught themselves before they fell and now are having trouble standing up straight and bending to their right side when they get dressed. What pathology might we suspect?
A. Fracture of Lumbar Vertebrae
B. Lumbar Facet Syndrome
C. Spinal Stenosis
D. Lumbar sprain/strain
B. Lumbar Facet Syndrome