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What is the kind of history that a pt presenting with Lsp problems?
- - pain, stiffness, weakness, instability?
- - status- getting better or worse
- - body chart- area of pain, paraesthesia, areas above/ below, clear areas
- a tick= area is fine
- x = area of pins and needles and numbness
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What qu do u ask the pt about their history?
- - 24hr behaviour- am stiffness, day, evening- night, sleep position
- - aggravating factors- sitting, sit to stand, standing, walking, bending, prolonged bending, lifting- cough, sneze (valsalva manoeuvres)
- - easing factors- rest, movt, position
- - irritability- mechanical/ inflam- howeasy to aggravate/relieve
- - how long can you stand for before you get your pain
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What are the special qu that must be asked of a pt with Lsp problems?
- - cauda equina- since back pain, do you have trouble controlling your bladder/ bowel? Or saddle pareasthesia/ anaesthesia
- - spinal cord- bilateral limb pareasthesia- glove/ sock distribution, unsteadiness on feet (ataxia)
- - general health
- - if an recent unexplained weight loss
- - medication
- - long term medication- steriods/ anticoagulants
- - recent x-rays
- - past illness, surgery, Ca
- - red flad- you may need to link between what they tell you and mechanical problems
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What past history will you ask your Lsp pt of?
- - of this episode
- - previous episode- how long to get better- baseline for realistic goals
- - trauma
- - surgery
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What yellow flags or psychosocial qu/ things do we need to find out about a pt with Lsp?
- - occupation
- - work status- do they feel supported
- - home- sport, hobbies
- - concerns about return to work, return to activites
- - pts perspective on their condition- what they think is going on
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Conduct a physical examination on ur Lsp pt.
- obs- posture, scoliosis, pelvic shift, wasting
- functional movt- sit- stand, walk, standingon one leg
- Observe- quality, rhythm, range, pain behaviour, spasm
- -standing on one leg u can get ur pt into ipsilateral compression
- - ridgid in mm spasm- crease formation where they use, dip at L4/5- step
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Conduct Lsp active movts with your patient
- flex
- ext
- LF
- Rot (sitting)- test in sitting- stabilise pelvis
- OP- stabilise pelvis and OP, OP when reproducing P
- Quadrant- closing-ext and side flexion
- - opening- flex and SF
- repeate movts to see if there is a response with P
- Sustained movts
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Conduct a neurological examination of a pt with Lsp problems
- - is essential as a precaution pain, PN and numbness
- - sensation
- - power (s1 in standing)
- - reflexes
- -babinski
- - clonus
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What are the neurodynamic tests for the Lsp?
- sensitivity of nervous system to mechanical stressors
- - SLR
- - passive neck flexion
- - prone knee bend PKB
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Perform the SLR neurodynamic test
- - +/-sensiting manoeuvres (DF, IR, NF)
- - hold heel in your hand
- - lock knee in ext
- - do a few so the pt gets use to and relaxes their mm
- - If PF eases it is neuro
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Conduct the neurodynamic test passive neck flexion?
- pt supine legs in ext
- start with a small head nod
- progress to excess neck flexion
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Conduct a PKB neurodynamic test on your lumbar spine pt
- - pt prone
- - knees bent together and relax
- - lift head up into ext
- - wind up the femoral nerve
- 'their pain'
- Standardise
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Palpate the area of a Lsp pt
- - soft tissue- feel for heat and mm spasm
- -PAVIMS
- - central PA
- - Unilateral PA- both sides
- - transverse- push spinour process across- this increases unilateral flexion
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Conduct the PPIVMS on ur pt with Lsp problems
- Pt sidelying
- You are feeling for what level the lack of movt where you need to treat
- - flex
- - ext
- - LF
- - Rot
- Supports pts legs on yours move pt into flex
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What are the basic treatment for a pt with Lsp problems
- PAIVMS:
- - Central- to increase extension
- - unilateral- increase ext and lateral flex same side
- - transverse- open other side and increase rot to the same side
- - rotation
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How can you treat a pt using a rot technique
- Grades 1- 4
- 1- knees bent and together- to fel L5 need to be in more flex
- pt hand on be small rot movements and rock down the femur, hands over the greater trochanter
- 2- sameas above but arm on side rokin opposites
- 3- bottomr leg nearly in ext and top leg still flex. Arm still on ribs and rock top
- 4- pull bottomw shoulder out so pt is nearly flat on back
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lateral flex treatment
- 1-4
- - used to close with restriction
- - push up thelateral side- one small, two large
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Lsp treatment- distraction
- longitudinal caudad
- Single leg
- Bilateral
- Pt supine- knees flex position, get on bed as well and pull down
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