Lumbopelvic Examination Techniques
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Questions and Answers

During lumbar rotation ROM assessment, what is the recommended patient position?

  • Seated (correct)
  • Standing
  • Supine
  • Prone
  • Which instruction is most appropriate for assessing lumbar extension ROM?

  • "Tuck your chin to your chest and reach for your toes."
  • "Cross your arms and lean back as far as you can." (correct)
  • "Slide your hand down the side of your leg as far as you can."
  • "Turn and look behind you as far as possible."
  • Repeated motions during lumbar assessment are primarily used to observe what clinical phenomenon?

  • Muscle strength imbalances
  • Centralization vs. Peripheralization (correct)
  • Joint hypermobility
  • Ligamentous laxity
  • To assess the L4 dermatome, where should light touch sensation be tested?

    <p>Medial malleolus (C)</p> Signup and view all the answers

    Weakness in ankle plantarflexion is indicative of potential pathology at which myotome level?

    <p>S1 (B)</p> Signup and view all the answers

    When performing myotome testing, what is the recommended duration to hold the applied resistance?

    <p>5 seconds (A)</p> Signup and view all the answers

    Which of the following is NOT a component of a standard hip screen as part of a lumbar assessment?

    <p>Hip Extension (C)</p> Signup and view all the answers

    What is the primary purpose of assessing for reproduction of symptoms during hip and joint screening?

    <p>To confirm the presence and location of the patient's reported issue. (B)</p> Signup and view all the answers

    Testing light touch sensation bilaterally for dermatomes is crucial to:

    <p>Compare sensory responses and detect nerve root pathology (B)</p> Signup and view all the answers

    Which of the following best describes Passive Accessory Intervertebral Joint Movement (PAIVM)?

    <p>Movements that cannot be actively performed by the patient but are necessary for normal joint function. (C)</p> Signup and view all the answers

    Regarding the 'quality of movement' assessment within PAIVM and PPIVM, what is a key consideration?

    <p>It includes subjective evaluation of whether the movement feels normal, hypomobile, or hypermobile. (D)</p> Signup and view all the answers

    When performing Central Posterior-Anterior (CPA) glides, what is the recommended body position for the patient?

    <p>Prone with the area to be assessed exposed. (D)</p> Signup and view all the answers

    During Central PA and Unilateral PA glides, what technique is emphasized for applying pressure?

    <p>Employing a broad contact and slowly sinking into the tissue with lower body weight. (C)</p> Signup and view all the answers

    During a lumbopelvic subjective examination, which of the following is crucial for formulating an initial hypothesis?

    <p>Identifying aggravating and easing factors of pain. (C)</p> Signup and view all the answers

    Which outcome measure directly quantifies activity limitations related to back pain through a percentage score?

    <p>Oswestry Disability Index (ODI) (B)</p> Signup and view all the answers

    According to the information provided, what change in Oswestry Disability Index (ODI) score is considered the Minimum Clinically Important Difference (MCID)?

    <p>A 6-10 point change (C)</p> Signup and view all the answers

    On the Patient Specific Functional Scale (PSFS), what does a score of '0' indicate?

    <p>The patient is unable to perform the activity. (C)</p> Signup and view all the answers

    The Fear Avoidance Beliefs Questionnaire (FABQ) is designed to assess the impact of beliefs on which aspect of low back pain?

    <p>Physical activity and work participation. (C)</p> Signup and view all the answers

    What does a score of '10' represent on the Numeric Pain Rating Scale (NPRS)?

    <p>Worst pain imaginable. (C)</p> Signup and view all the answers

    The physical examination in lumbopelvic assessment primarily serves to:

    <p>Confirm or refute the working hypothesis developed from the subjective exam. (D)</p> Signup and view all the answers

    If a patient's reported symptoms are reproducible during a physical examination, this generally suggests that the symptoms are:

    <p>Potentially reducible with physical therapy intervention. (A)</p> Signup and view all the answers

    Flashcards

    Passive Accessory Intervertebral Joint Movement (PAIVM)

    These are movements that cannot be actively performed by the patient, but are still necessary for normal joint movement. They are assessed passively by a clinician.

    Passive Physiological Intervertebral Movements (PPIVM)

    These movements can be performed actively by the patient but are assessed passively by the clinician. They involve the natural range of motion of the joint.

    PA Glide

    A technique used to assess the movement of a joint by applying pressure to it in a specific direction. It involves gliding the joint surface in a posterior-anterior direction.

    Unilateral PA Glide

    A PA glide applied to one side of the joint, while the other side remains stable. It is used to assess the movement of individual vertebral segments.

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    Systematic approach to PA glides

    When assessing a joint using PA glides, it is important to be systematic and consistent in your application. This ensures that you are fairly and reliably evaluating the joint's movement.

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    Lumbar Flexion

    A bending movement of the spine forward, bringing the chest towards the thighs. It is typically measured by having the patient 'tuck chin to chest, slide hands down their legs as far as you can.'

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    Lumbar Extension

    The ability of the spine to move backward, extending the back. It can be assessed by 'crossing your arms and leaning back as far as you can.'

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    Lumbar Lateral Flexion

    The ability of the spine to bend sideways, moving the trunk to the left or right. Measured by 'sliding hand down the side of your leg as far as you can.'

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    Lumbar Rotation

    The ability of the spine to rotate, turning the torso from the right to the left. It can be measured by having the patient seated and 'turning and looking behind them as far as possible.'

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    Repeated Motions

    A series of repeated movements in one direction, assessing how pain responds. Centralization refers to pain moving closer to the center of the body, while peripheralization describes pain spreading further out.

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    Dermatomes

    Areas of skin innervated by a specific nerve root. Testing light touch sensation from L2-S2 bilaterally helps identify nerve root pathologies.

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    Myotomes

    Groups of muscles innervated by a specific nerve root. Assessing muscle strength from L2-S2 helps determine nerve root involvement, differentiating between upper and lower motor neuron lesions.

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    Hip Screen

    An assessment of hip range of motion (ROM) including flexion, internal rotation (IR), and external rotation (ER). This helps identify potential limitations arising from the hip joint affecting the lumbar spine.

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    Oswestry Disability Index (ODI)

    A standardized questionnaire that measures how much a patient's back pain limits their ability to perform daily activities.

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    Fear Avoidance Beliefs Questionnaire (FABQ)

    This questionnaire assesses a patient's fear of movement and physical activity in relation to their back pain.

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    Numeric Pain Rating Scale (NPRS)

    A pain scale where patients rate their pain from 0 (no pain) to 10 (worst imaginable pain).

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    Patient Specific Functional Scale (PSFS)

    A questionnaire based on activities that are important to the patient, allowing them to rate their ability to perform them.

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    Minimum Clinically Important Difference (MCID)

    The smallest change in an outcome measure that is considered meaningful for a patient.

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    Hypothetico-Deductive Reasoning (Clinical Reasoning)

    A process of using a hypothesis to guide the examination and then confirming or refuting that hypothesis based on the findings.

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    Impairments and Functional Limitations

    The process of identifying physical limitations and problems that are preventing a patient from reaching their goals.

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    Purpose of the Physical Examination

    The goal of a physical examination is to confirm or refute the initial hypothesis about the patient's condition and to identify impairments and functional limitations.

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    Study Notes

    Lumbopelvic Examination

    • Examination focuses on lumbopelvic mobility, strength, and joint assessment.
    • Presenter is Adam Squires PT, DPT, Cert SMT, Cert DN, board certified specialist in orthopedic physical therapy.
    • Institution is Idaho State University.

    Objectives

    • Students should understand and demonstrate the ability to assess lumbopelvic mobility.
    • Students should understand and demonstrate the ability to assess lumbopelvic strength.
    • Students should understand and demonstrate the ability to assess lumbopelvic joint assessment

    Subjective Exam Outcome Measures

    • Location of pain (body chart)
    • Initial hypothesis
    • Factors worsening pain
    • Factors improving pain
    • Description of pain
    • How long does each activity cause pain?
    • Medical history (MOI, timeframe)
    • Develop 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 (ODI)

    • 10 questions related to activities limited by back pain.
    • Each question scored 1-5.
    • Total scored out of 50.
    • Percentage calculated by multiplying total score by 2.
    • Minimum Clinically Important Difference (MCID) is 6-10 point change (12-20% change).
    • 50% reduction in score is considered "successful" treatment in most research.

    Patient Specific Functional Scale (PSFS)

    • Patient chooses 3-5 activities they have difficulty doing.
    • Activities are rated on a scale of 0-10 (0 = unable to perform, 10 = able to perform at the same level as before the injury/problem).
    • Average of the ratings is calculated.
    • Activities are patient-valued.
    • Minimum Detectable Change (MCID) is 1.5 points.
    • Minimum Detectable Change is 2.5 points.

    Fear Avoidance Beliefs Questionnaire (FABQ)

    • Focuses on how beliefs about activity and work contribute to low back pain.
    • 16 questions range from "completely disagree" to "completely agree."
    • Higher scores indicate increased fear avoidance behaviors.
    • Subscales include: Physical Activity and Work.
    • Minimum Clinically Important Difference (MCID) is 25%.

    Numeric Pain Rating Scale (NPRS)

    • Scale of 0-10.
    • 0 = no pain, 10 = worst pain imaginable.
    • Minimum Clinically Important Difference (MCID) and Minimum Detectable Change (MCD) are both 2 points.

    Physical Examination

    • Aims to confirm/refute working hypotheses regarding the patient's condition.
    • Uses hypothetico-deductive reasoning for diagnosis and prognosis.
    • Reproduces patient's symptoms to confirm if they are reproducible (generally reducible).
    • If symptoms are not reproducible, the examiner should screen for referral.
    • Identifies impairments and functional limitations to guide interventions.

    Overview

    • Lumbar range of motion (ROM): Includes flexion, extension, lateral flexion, and rotation.
    • Lumbar overpressure and repeated motions should be noted.
    • Spinal dermatomes, myotomes, and hip screens are key assessments.
    • Active and passive accessory movements (PAIVM/PPIVM) and glides are part of the joint assessment process.

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    Related Documents

    Lumbopelvic Exam PDF

    Description

    This quiz focuses on the examination of lumbopelvic mobility, strength, and joint assessments. Students will explore various subjective measures and outcome tools necessary for a comprehensive evaluation of lumbopelvic function. Enhance your understanding of orthopedic physical therapy with this insightful assessment.

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