Lumbopelvic Examination and Outcome Measures

Lumbopelvic Examination

• Examines lumbopelvic mobility, strength, and joint assessment.
• The presenter is Adam Squires, PT, DPT, Cert SMT, Cert DN, a Board Certified Specialist in Orthopedic Physical Therapy.
• The objectives are to understand and demonstrate ability to assess lumbopelvic mobility, strength, and joint assessment.

Subjective Exam Outcome Measures

• Includes questions like "Where is the pain?" (documented on a body chart) and "What makes it worse/better?".
• Includes a history (MOI, timeframe, etc).
• Includes determining a working hypothesis.

Outcome Measures

• Oswestry Disability Index (ODI): 10 questions related to activities limited by back pain, each scored 1-5. Total score out of 50, multiplied by 2 to get a percentage. Minimum Clinically Important Difference (MCID) is 6-10 points change (12-20% change) and 50% reduction is considered a successful outcome in most research.
• Patient Specific Functional Scale (PSFS): Patient selects 3-5 activities, rates difficulty on a 0-10 scale (0-unable, 10-as before). Includes average of ratings, patient valued activities, Minimum Detectable Change (MCID) - 1.5 points and Minimum Detectable Change - 2.5 points.
• Fear Avoidance Beliefs Questionnaire (FABQ): Focuses on beliefs about activity and work contributing to low back pain. Uses 16 questions, 0-6 being "completely disagree" and higher scores indicating increased fear avoidance behaviors. Includes Physical Activity and Work subscales. MCID = 25%.
• Numeric Pain Rating Scale (NPRS): Measures pain on a 0-10 scale (0 = no pain, 10 = worst pain imaginable). Minimum Clinically Important Difference (MCID) and clinically important difference are both 2 points.

Physical Exam

• Lumbar ROM:
  • Flexion: "Tuck chin to chest, slide hands down your legs as far as you can."
  • Extension: "Cross your arms and lean back as far as you can."
  • Lateral Flexion: "Slide your hand down the side of your leg as far as you can."
  • Rotation: "Patient seated, Turn and look behind you as far as possible."
• Repeated Motions: 5-10 repetitions of motion in one direction are assessed, observing centralization versus peripheralization.
• Dermatomes: Light touch sensation is tested from L2-S2, comparing bilaterally, to assess for nerve root pathology.
  • Specific dermatome locations are L2=Anteromedial mid-thigh, L3=Medial epicondyle of knee, L4=Medial malleolus, L5=Dorsal 3rd MTP, S1=Lateral heel, S2=Midline popliteal fossa.
• Myotomes: L2-S2 are assessed; the examiner stabilizes proximally, applies moderate force, and holds for 5 seconds to assess for weakness. This is indicative of nerve root or motor neuron pathology (upper vs. lower motor neuron lesions).
  • Specific myotome actions for each area are L2=Hip flexion, L3=Knee extension, L4=Ankle dorsiflexion, L5=Great toe extension, S1=Ankle plantarflexion, S2=Knee flexion.
• Hip Screen: Assesses hip ROM (flexion, IR, ER, extension); and uses specific tests such as FABER and FADIR to assess for reproduction of symptoms and/or deficits.
• Joint Assessment:
  • Passive Accessory Intervertebral Joint Movement (PAIVM): tests cannot be actively performed but are still needed for movement. Assesses quality of movement (normal, hypomobile, hypermobile). Tests include (CPA & UPA glides).
  • Passive Physiological Intervertebral Movements (PPIVM): intervertebral movements that could be performed actively. Observing reproduction of symptoms and quality of movement.
  • Specific techniques like central posterior-anterior (PA) and unilateral PA glides are tested for assess of pain provocation and resistance. Patient should be in prone position, and with broad contact. Using the nose over area for area assessment, slowly sinking into the tissue without poking. Be consistent. The hypothenar eminence or "dummy" hand is used for testing. "Dummy" or stacked thumbs for UPA.