Podcast
Questions and Answers
What is the primary purpose of FABER and FADIR tests?
What is the primary purpose of FABER and FADIR tests?
- To assess muscle strength
- To improve balance and coordination
- To increase joint mobility
- To assess for reproduction of symptoms and/or deficits (correct)
Passive Accessory Intervertebral Joint Movement (PAIVM) is BEST described as movement that:
Passive Accessory Intervertebral Joint Movement (PAIVM) is BEST described as movement that:
- cannot be actively performed by the patient but is needed for movement (correct)
- is assessed using imaging techniques only
- can be actively performed by the patient
- is only performed by the patient during exercise
Passive Physiological Intervertebral Movements (PPIVM) involve:
Passive Physiological Intervertebral Movements (PPIVM) involve:
- actively resisting movements performed by the therapist
- passively performing movements that could be performed actively (correct)
- assessing joint structures through surgical procedures
- movements that are beyond the patient's normal active range
When assessing the quality of movement during PAIVM and PPIVM, which of the following characteristics are evaluated?
When assessing the quality of movement during PAIVM and PPIVM, which of the following characteristics are evaluated?
During Central Posterior-Anterior (CPA) and Unilateral PA glides, the patient should be positioned in:
During Central Posterior-Anterior (CPA) and Unilateral PA glides, the patient should be positioned in:
What is the primary purpose of the lumbopelvic examination?
What is the primary purpose of the lumbopelvic examination?
What does MOI stand for in the context of a subjective exam?
What does MOI stand for in the context of a subjective exam?
Which of the following is an outcome measure used in lumbopelvic examination?
Which of the following is an outcome measure used in lumbopelvic examination?
What does the Patient Specific Functional Scale (PSFS) primarily assess?
What does the Patient Specific Functional Scale (PSFS) primarily assess?
What does a higher score on the Fear Avoidance Beliefs Questionnaire (FABQ) indicate?
What does a higher score on the Fear Avoidance Beliefs Questionnaire (FABQ) indicate?
What is the range of the Numeric Pain Rating Scale (NPRS)?
What is the range of the Numeric Pain Rating Scale (NPRS)?
The physical exam should reproduce the patient's familiar symptoms to:
The physical exam should reproduce the patient's familiar symptoms to:
What is the MCID for the PSFS?
What is the MCID for the PSFS?
What instruction is typically given to a patient when assessing lumbar flexion ROM?
What instruction is typically given to a patient when assessing lumbar flexion ROM?
For lumbar extension ROM, what positioning of the arms is typically recommended for the patient?
For lumbar extension ROM, what positioning of the arms is typically recommended for the patient?
During the assessment of lumbar rotation ROM, where is the patient typically positioned?
During the assessment of lumbar rotation ROM, where is the patient typically positioned?
In repeated motions assessment, what is the typical number of repetitions performed in one direction?
In repeated motions assessment, what is the typical number of repetitions performed in one direction?
What is the primary purpose of testing dermatomes in a lower extremity exam?
What is the primary purpose of testing dermatomes in a lower extremity exam?
Which dermatome is associated with the medial malleolus?
Which dermatome is associated with the medial malleolus?
What is the duration for which moderate force is typically applied and held during myotome testing?
What is the duration for which moderate force is typically applied and held during myotome testing?
Which motion is assessed when testing the L2 myotome?
Which motion is assessed when testing the L2 myotome?
Flashcards
Lumbopelvic Mobility Assessment
Lumbopelvic Mobility Assessment
Evaluating the movement and flexibility of the lumbar and pelvic region.
Oswestry Disability Index (ODI)
Oswestry Disability Index (ODI)
A questionnaire assessing the degree of disability due to back pain, scored 1-5.
Minimum Clinically Important Difference (MCID)
Minimum Clinically Important Difference (MCID)
The smallest change in a score that reflects meaningful improvement.
Patient Specific Functional Scale (PSFS)
Patient Specific Functional Scale (PSFS)
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Fear Avoidance Beliefs Questionnaire (FABQ)
Fear Avoidance Beliefs Questionnaire (FABQ)
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Numeric Pain Rating Scale (NPRS)
Numeric Pain Rating Scale (NPRS)
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Hypothetico-Deductive Reasoning
Hypothetico-Deductive Reasoning
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Working Hypothesis
Working Hypothesis
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Lumbar Flexion
Lumbar Flexion
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Lumbar Extension
Lumbar Extension
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Lumbar Lateral Flexion
Lumbar Lateral Flexion
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Lumbar Rotation
Lumbar Rotation
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Dermatomes
Dermatomes
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Myotomes
Myotomes
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Repeated Motions
Repeated Motions
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Hip Screen
Hip Screen
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FABER Test
FABER Test
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FADIR Test
FADIR Test
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Passive Accessory Intervertebral Movement (PAIVM)
Passive Accessory Intervertebral Movement (PAIVM)
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Qualitative Assessment of Movement
Qualitative Assessment of Movement
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Central Posterior-Anterior (CPA) Glides
Central Posterior-Anterior (CPA) Glides
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Study Notes
Lumbopelvic Examination
- Adam Squires, PT, DPT, Cert SMT, Cert DN, Board Certified Specialist in Orthopedic PT presented the material
- Objectives: understand and demonstrate ability to assess lumbopelvic mobility, strength, and joint assessment
Subjective Exam Outcome Measures
- Where is the pain? (body chart)
- Initial hypothesis
- What makes it worse?
- What is it?
- How much does it take?
- What makes it better?
- What is it?
- How much does it take?
- History (MOI, timeframe)
- Working Hypothesis
Outcome Measures
- Oswestry Disability Index (ODI)
- Patient Specific Functional Scale (PSFS)
- Fear Avoidance Beliefs Questionnaire (FABQ)
- Numeric Pain Rating Scale (NPRS)
Oswestry Disability Index
- 10 questions related to activities limited by back pain
- Each question scored 1-5
- Total out of 50
- Multiply by 2 to get percentage
- Minimum Clinically Important Difference (MCID): 6-10 point change (12-20% change)
- 50% reduction considered "successful" treatment
Patient Specific Functional Scale
- Patient chooses 3-5 activities with difficulty
- Rated on scale 0-10
- 0: unable to perform activity
- 10: able to perform activity at same level as before injury
- Average of ratings
- Patient-valued activities
- Minimum Detectable Change (MCID) - 1.5 points
- Minimum Detectable Change (MDC) - 2.5 points
Fear Avoidance Beliefs Questionnaire
- Focuses on beliefs about activity and work contributing to low back pain
- 16 questions
- 0-6 = completely disagree to completely agree (higher scores = increased fear avoidance behaviors)
- Physical Activity Subscale
- Work Subscale
- Minimum Clinically Important Difference (MCID): 25%
Numeric Pain Rating Scale
- 0-10 scale
- 0 = no pain
- 10 = worst pain imaginable
- Minimum Clinically Important Difference (MCID) and Minimum Detectable Change (MCD) – both 2 points
Physical Exam
- Purpose: confirm/refute working hypothesis, hypothetic-deductive reasoning, diagnosis/prognosis, reproduce patient's symptoms (if reproduce, generally reducible, if not, screen for referral), identify impairments/functional limitations and targets for intervention
Overview
- Lumbar ROM (Range of Motion): overpressure, repeated motions
- Dermatomes: Test light touch from L2-S2, compare bilaterally, indicative of nerve root pathology
- Myotomes: L2 through S2, stabilize proximally, apply moderate force and hold for 5 seconds, assess for weakness, indicative of nerve root/other motor neuron pathology
- Hip Screen: ROM (flexion, IR, ER, extension), FABER, FADIR, assess for reproduction of symptoms/deficits
- Joint accessory motion assessment
Lumbor ROM
- Flexion: "Tuck chin to chest, slide hands down legs"
- Extension: "Cross arms and lean back as far as you can"
- Lateral Flexion: "Slide hand down side of leg"
- Rotation (seated): "Turn and look behind you as far as possible"
Repeated Motions
- 5-10 repetitions in one direction
- Centralization vs. Peripheralization
LE Dermatomes
- L2: anteromedial mid-thigh
- L3: medial epicondyle of knee
- L4: medial malleolus
- L5: dorsal 3rd MTP
- S1: lateral heel
- S2: midline popliteal fossa
LE Myotomes
- Stabilize proximally
- Apply moderate force, hold for 5 seconds
- Assess weakness
- Indicative of nerve root or other motor neuron pathology, upper vs lower motor neuron lesions
Myotomes
- L2: hip flexion
- L3: knee extension
- L4: ankle dorsiflexion
- L5: great toe extension
- S1: ankle plantarflexion
- S2: knee flexion
Hip Screen
- Hip ROM (flexion, IR, ER, extension)
- FABER
- FADIR
- Assess for reproduction of symptoms/deficits
Joint Assessments
- Passive Accessory Intervertebral Joint Movement (PAIVM): cannot be actively performed, needed for movement, reproduction of symptoms, quality of movement (normal, hypomobile, hypermobile), Posterior-Anterior (PA) glides (central and unilateral),
- Passive Physiological Intervertebral Movements (PPIVM): passively perform movements actively performed, reproduction of symptoms and quality of movement,
- Joint Assessment (Central PA, Unilateral PA glides): Patient prone, broad contact, nose over area, slowly sink into tissue, assess for pain provocation and resistance, be systematic
Joint Accessory Motion
- Lumbar CPA: hypothenar eminence ("dummy" hand)
- Lumbar UPA: "dummy" or stacked thumbs
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Description
This lesson covers lumbopelvic examination techniques, including assessment of mobility, strength, and joint function. It also discusses subjective exam outcome measures, such as pain location, aggravating and relieving factors, and patient history. Standardized outcome measures like the Oswestry Disability Index are also examined.
