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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.
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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
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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
-
passive testing tests what?
noncontractile structures (ligs, jt capsules, surrounding soft tissue... not muscle)
-
PPIVM
PAIVM
- passive physiological inter vertebral movement
- passive accessory inter vertebral movement
-
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
-
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
-
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
-
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
-
sidebending PPIVM testing in prone
- abd one leg
- lock that femur into your hip and do pure abd
-
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)
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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
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