Podcast
Questions and Answers
What is the highest score a patient can record on the Numeric Pain Rating Scale (NPRS)?
What is the highest score a patient can record on the Numeric Pain Rating Scale (NPRS)?
During a lumbar extension Range of Motion (ROM) assessment, what instruction should be given to the patient?
During a lumbar extension Range of Motion (ROM) assessment, what instruction should be given to the patient?
Which dermatome is assessed by testing light touch sensation at the medial malleolus?
Which dermatome is assessed by testing light touch sensation at the medial malleolus?
Testing great toe extension for strength assesses the integrity of which myotome?
Testing great toe extension for strength assesses the integrity of which myotome?
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What is indicated when a patient's pain moves away from the spine during repeated motions?
What is indicated when a patient's pain moves away from the spine during repeated motions?
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In Passive Accessory Intervertebral Joint Movement (PAIVM) assessment, what type of glide is performed with the patient in a prone position?
In Passive Accessory Intervertebral Joint Movement (PAIVM) assessment, what type of glide is performed with the patient in a prone position?
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What does the Minimum Clinically Important Difference (MCID) primarily help to determine in patient care?
What does the Minimum Clinically Important Difference (MCID) primarily help to determine in patient care?
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What is the MOST important initial aim when performing a lumbopelvic examination?
What is the MOST important initial aim when performing a lumbopelvic examination?
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Which element is considered MOST crucial during the subjective examination of a patient with lumbopelvic pain?
Which element is considered MOST crucial during the subjective examination of a patient with lumbopelvic pain?
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Why is utilizing a body chart significant in the subjective assessment of a patient with lumbopelvic pain?
Why is utilizing a body chart significant in the subjective assessment of a patient with lumbopelvic pain?
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When exploring aggravating and alleviating factors during a subjective examination, what key information is MOST important to ascertain?
When exploring aggravating and alleviating factors during a subjective examination, what key information is MOST important to ascertain?
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In the context of a lumbopelvic subjective examination, why is gathering information about the mechanism of injury (MOI) crucial?
In the context of a lumbopelvic subjective examination, why is gathering information about the mechanism of injury (MOI) crucial?
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For the Oswestry Disability Index (ODI), what does a higher score indicate about a patient's condition?
For the Oswestry Disability Index (ODI), what does a higher score indicate about a patient's condition?
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When using the Patient Specific Functional Scale (PSFS), a change from 4 to 6 in a patient's rating for a chosen activity would indicate:
When using the Patient Specific Functional Scale (PSFS), a change from 4 to 6 in a patient's rating for a chosen activity would indicate:
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In the Fear Avoidance Beliefs Questionnaire (FABQ), a higher score on the physical activity subscale suggests:
In the Fear Avoidance Beliefs Questionnaire (FABQ), a higher score on the physical activity subscale suggests:
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Study Notes
Lumbopelvic Examination
- Primary Goal: Assess lumbopelvic mobility, strength, and joint integrity to understand pain and dysfunction, develop a working hypothesis, identify impairments, reproduce symptoms, and confirm/refute the hypothesis.
- Examination Framework: Subjective questioning and objective testing using hypothetico-deductive reasoning.
Subjective Examination
- Crucial for Patient Experience: Gathers information about the patient's experience.
- Pain Location: Pinpointing affected areas using a body chart.
- Pain Aggravating/Alleviating Factors: Identify activities, positions, and intensities that worsen or improve symptoms.
- History: Mechanism of injury (MOI), symptom duration, and other relevant history.
- Working Hypothesis: Initial hypothesis about the cause of pain.
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Outcome Measures: Quantify pain, disability, fear avoidance.
- Oswestry Disability Index (ODI): 10-question survey (scored 0-50, then x2). MCID: 6-10 points. Successful treatment: 50% reduction.
- Patient-Specific Functional Scale (PSFS): Rates 3-5 difficult activities (0-10 scale). MCID: 1.5 points; MDC: 2.5 points. Higher number = better function.
- Fear-Avoidance Beliefs Questionnaire (FABQ): Measures fear and avoidance related to physical activity and work (higher scores indicate more fear). MCID: 25%.
- Numeric Pain Rating Scale (NPRS): 0-10 scale. MCID and MDC: 2 points.
Physical Examination
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Confirm/Refute Hypothesis, Identify Impairments:
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Lumbar Range of Motion (ROM):
- Flexion: Chin to chest, hands down legs.
- Extension: Arms crossed, lean back.
- Lateral Flexion: Hand down leg.
- Rotation: Turn and look behind.
- Overpressure: Gentle force at end of range.
- Repeated Motions: 5-10 repetitions, observe pain centralization (towards spine) or peripheralization (away from spine). This helps with directional preference.
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Lower Extremity (LE) Dermatomes: Assesses light touch sensation (L2-S2), comparing bilaterally for nerve root issues.
- Dermatome Examples: L2 (anteromedial mid-thigh), L3 (medial epicondyle of knee).
- Dermatome Examples: L4 (medial malleolus), L5 (dorsal 3rd MTP).
- Dermatome Examples: S1 (lateral heel), S2 (midline popliteal fossa).
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LE Myotomes: Assesses muscle strength (L2-S2), holding for 5 seconds with moderate force while stabilizing, look for weakness and upper/lower motor neuron pathology.
- Myotome Examples: L2 (hip flexion), L3 (knee extension).
- Myotome Examples: L4 (ankle dorsiflexion), L5 (great toe extension).
- Myotome Examples: S1 (ankle plantarflexion), S2 (knee flexion).
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Hip Screen: Assess hip ROM (flexion, internal/external rotation, extension), FABER, and FADIR to assess for symptom reproduction or deficits.
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Joint Accessory Motion Assessment:
- Passive Accessory Intervertebral Joint Movement (PAIVM): CPA & UPA glides (patient prone).
- Passive Physiological Intervertebral Movement (PPIVM): Passively moving the joint through active motions. Emphasize broad contact and "sinking" into tissue.
Key Concepts
- Hypothetico-Deductive Reasoning: Forming a hypothesis and testing it objectively.
- Reproducible Symptoms: The ability to reproduce patient pain is generally a good sign it is reducible.
- Centralization vs. Peripheralization: Pain movement (towards or away from spine) guides treatment.
- MCID (Minimum Clinically Important Difference): Smallest beneficial change in an outcome measure.
- MDC (Minimum Detectable Change): Smallest measurable difference in a test.
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Description
Test your knowledge on the lumbopelvic examination process, focusing on assessment techniques, subjective questioning, and identification of pain features. This quiz covers important aspects such as pain location, aggravating factors, and initial working hypotheses. Enhance your understanding of evaluating lumbopelvic mobility and dysfunction.
