Musculoskeletal LQ Week 1 - Lumbopelvic Pathologies, and Physical Exam

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Questions and Answers

What is the primary goal of taking a patient history during a physical examination?

  • To establish a working diagnosis (correct)
  • To perform diagnostic imaging
  • To prepare a treatment plan before assessment
  • To eliminate all subjective accounts of pain

Which approach should be taken first when conducting a patient history?

  • Active listening techniques
  • Open-ended questions (correct)
  • Closed-ended questions
  • Direct probing for specifics

How should a clinician progress through the stages of questioning during the patient history?

  • Focus solely on active listening without any questioning
  • Use only a mix of open and closed questions throughout
  • Start with close-ended, then use open-ended, and finish with clarifying questions
  • Begin with open-ended, proceed to clarifying, and end with close-ended questions (correct)

What is a working diagnosis, as described in the context of patient history?

<p>A rough draft diagnosis to guide further assessment (C)</p> Signup and view all the answers

What technique is essential after open-ended questions in the patient history-taking process?

<p>Active listening and clarifying questions (A)</p> Signup and view all the answers

When assessing gait deviations in the lumbopelvic region, what is a key observation to make?

<p>The patient's ability to maintain a neutral pelvic tilt (D)</p> Signup and view all the answers

During the functional neurological screen, which specific movement assesses the integrity of the L4-L5 myotome?

<p>Heel walk (C)</p> Signup and view all the answers

What is the primary purpose of the upper motor neuron testing components, such as the Babinski and Clonus tests during a neurological examination?

<p>To detect signs of central nervous system dysfunction (D)</p> Signup and view all the answers

During the 'Functional Testing – Depending on Symptom Irritability and Ability Level' section, the assessment of a patient's lumbar spine positioning during functional movements focuses on which of the following?

<p>The patient's preferred strategy for moving, such as hip-dominant versus quadriceps-dominant (D)</p> Signup and view all the answers

The neurological examination is integrated into the comprehensive lumbar physical examination to achieve which objective?

<p>To rule out any neurological involvement in the patient's symptoms (B)</p> Signup and view all the answers

Which functional movement is described as evaluating the patient's ability to control their lumbar spine positioning, particularly focusing on anterior pelvic tilt and lumbar lordosis?

<p>SL squat (D)</p> Signup and view all the answers

The 'Quadrant Test' is a component of which aspect of the lumbar physical examination?

<p>Range of Motion and Joint Mobility Assessment (B)</p> Signup and view all the answers

During the active range of motion (AROM) assessment, the clinician includes 'overpressure' if pain-free. What is the primary reason for applying overpressure in this scenario?

<p>To provoke the patient's symptoms if they are latent (D)</p> Signup and view all the answers

Which factor is NOT considered when assessing a patient's symptom behavior?

<p>Social media presence (B)</p> Signup and view all the answers

What type of symptom onset suggests a clear, identifiable cause?

<p>Sudden/traumatic (D)</p> Signup and view all the answers

Which of the following is least likely to be part of a patient's medical history review?

<p>Favorite sports teams (A)</p> Signup and view all the answers

What is indicated by the presence of hypomobility during joint assessment?

<p>Difficulty in moving the joint (C)</p> Signup and view all the answers

Which method should be utilized to first assess a joint's mobility?

<p>Active range of motion (C)</p> Signup and view all the answers

Which symptom duration and severity may indicate high irritability?

<p>Persistent severe pain lasting over 24 hours (D)</p> Signup and view all the answers

What does an empty end-feel during passive range of motion signify?

<p>Acute inflammation or fracture (C)</p> Signup and view all the answers

In the context of joint mobility testing, what is the primary goal of passive accessory movements?

<p>To normalize physiological movement (D)</p> Signup and view all the answers

What should be important to consider when assessing a high irritability joint?

<p>Start with gentle assessments (A)</p> Signup and view all the answers

Which statement about assessing contralateral sides is true?

<p>Helps establish a baseline for comparison (A)</p> Signup and view all the answers

What is the primary concern when reviewing a patient's social history during assessment?

<p>Identify potential environmental barriers (C)</p> Signup and view all the answers

During joint assessment, which sequence is recommended for assessing mobility?

<p>Active range, passive physiological, then passive accessory (A)</p> Signup and view all the answers

Which of the following would most likely indicate the need for a limited physical examination?

<p>High irritability (A)</p> Signup and view all the answers

What is the purpose of recognizing a patient's irritability level during assessment?

<p>To customize the intervention approach (A)</p> Signup and view all the answers

Which of the following is NOT a symptom of pelvic pain related to female urogenital conditions?

<p>Fatigue or loss of energy (A)</p> Signup and view all the answers

What psychological factor may lead to increased rates of disability in patients with low back pain?

<p>Pain-related fear (C)</p> Signup and view all the answers

Which condition is associated with a forward displacement of one vertebral body over another?

<p>Spondylolisthesis (D)</p> Signup and view all the answers

Which screening instrument is recommended for identifying signs of depression?

<p>PHQ-2 Screening Instrument (C)</p> Signup and view all the answers

Which symptom is common in both prostate issues and pelvic inflammatory disease?

<p>Pain during sexual activity (B)</p> Signup and view all the answers

What is a common immediate management technique for facet joint pain?

<p>Unilateral posterior-to-anterior joint mobilization (B)</p> Signup and view all the answers

Which sign is indicative of Major Depressive Disorder?

<p>Markedly diminished interest in activities (D)</p> Signup and view all the answers

What factors can exacerbate symptoms of facet joint pain?

<p>Extension movements (D)</p> Signup and view all the answers

In what situation is referral to a mental health professional indicated?

<p>When a patient answers positively to both PHQ-2 questions (A)</p> Signup and view all the answers

Which condition describes degenerative changes in the spine commonly due to aging?

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

What does the 'severity' component of the S.I.N.S.S. assessment primarily evaluate?

<p>The intensity of a patient's pain and its impact on daily activities (D)</p> Signup and view all the answers

In the context of symptom irritability, which description defines a 'maximal' level of irritability?

<p>Symptoms require a long time to ease after minimal activity (D)</p> Signup and view all the answers

What is the primary goal of Grade 1 mobilization in joint treatment?

<p>Decrease pain (D)</p> Signup and view all the answers

Which category indicates a condition that has persisted for more than six weeks?

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

When should Grade 4 mobilization techniques be applied?

<p>When a stiff joint is not painful (A)</p> Signup and view all the answers

What is typically included in the physical examination plan based on patient history?

<p>Deciding which tests to conduct during the examination (D)</p> Signup and view all the answers

What defines the Minimal Clinically Important Difference (MCID)?

<p>The minimum change perceived as beneficial by patients (B)</p> Signup and view all the answers

Which of the following best describes the 'nature' of symptoms in the S.I.N.S.S. assessment?

<p>The specific type and characteristics of pain (B)</p> Signup and view all the answers

Which stage indicates that a patient has experienced symptoms for less than three weeks?

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

Which tool assesses a patient's functional ability to complete specific activities?

<p>Patient Specific Functional Scale (D)</p> Signup and view all the answers

In the assessment of stability, what does 'waxing and waning' mean?

<p>Symptoms become worse and then better over time (D)</p> Signup and view all the answers

What does the Osteopatic Disability Index (ODI) score indicate?

<p>Degree of physical function impairment (D)</p> Signup and view all the answers

Which of the following describes a characteristic of the Muscle Energy Technique (MET)?

<p>Voluntary muscle contractions against counterforce (D)</p> Signup and view all the answers

What is the primary goal of conducting a patient history during a visit?

<p>Develop rapport and form hypotheses regarding symptoms (D)</p> Signup and view all the answers

Which of the following best describes a 'moderate' stage of irritability?

<p>A moderate level of activity can be tolerated with symptoms returning at baseline after rest (B)</p> Signup and view all the answers

In the context of joint treatment, what does 'muscle guarding' refer to?

<p>Involuntary muscle contraction and pain (D)</p> Signup and view all the answers

How should a provider fill out the body chart in the symptom location assessment?

<p>Use tick marks for areas without symptoms and shade areas with pain descriptors (C)</p> Signup and view all the answers

Which Maitland mobilization grade is applied to improve mobility with large amplitude into resistance?

<p>Grade 3 (B)</p> Signup and view all the answers

What aspect does the 'stage' component of S.I.N.S.S. address?

<p>The timeframe of the presenting condition (B)</p> Signup and view all the answers

What does the Orebro Musculoskeletal Pain Screening Questionnaire focus on?

<p>Identifying psychosocial 'yellow-flags' (D)</p> Signup and view all the answers

In a scenario where a patient shows consistent lower back pain with recent exacerbation, which category does this represent?

<p>Acute on chronic (C)</p> Signup and view all the answers

What is a primary characteristic of the Roland-Morris Disability Questionnaire?

<p>Scores out of 24 items (A)</p> Signup and view all the answers

What should the initial greeting in a patient history session aim to achieve?

<p>Establish comfort and rapport with the patient (B)</p> Signup and view all the answers

During assessment, what does a hypermobile segment indicate?

<p>Increased range of motion beyond the expected limit (B)</p> Signup and view all the answers

Which of the following describes the symptom assessment process using the body chart?

<p>The patient first provides information, which the provider then verifies (D)</p> Signup and view all the answers

Which screening tool is designed to identify subgroups of patients with low back pain?

<p>STarT Back Screening Tool (B)</p> Signup and view all the answers

What does a chronic stage suggest about a patient's symptoms?

<p>Symptoms are more than six weeks old and have potentially persistent implications (C)</p> Signup and view all the answers

What is the main purpose of using mobilization with movement (MWM)?

<p>To apply an accessory glide and active movement concurrently (B)</p> Signup and view all the answers

What is the primary purpose of assessing a patient's living environment during evaluation?

<p>To identify potential ergonomic issues (A)</p> Signup and view all the answers

Which factors should be prioritized during a physical examination according to the S.I.N.S.S model?

<p>Severity and irritability of symptoms (A)</p> Signup and view all the answers

In the context of medical screening, what distinguishes red flags from yellow flags?

<p>Red flags signal high risk of serious disorders; yellow flags reflect psychological concerns. (A)</p> Signup and view all the answers

What initial action should a clinician take if a patient presents with concerning features during a screening?

<p>Consider further investigation or referral straight away. (A)</p> Signup and view all the answers

Which statement accurately reflects the importance of listening to the patient during the subjective examination?

<p>Patients’ narratives provide vital insights into their concerns and treatment needs. (A)</p> Signup and view all the answers

How should a clinician address a patient's symptoms that are difficult to reproduce during a physical examination?

<p>Use overpressure or sustained movements to explore symptoms. (A)</p> Signup and view all the answers

What is the first step in the clinical decision-making process regarding patient concerns?

<p>Determine the level of concern based on evidence. (B)</p> Signup and view all the answers

What should be considered if a patient presents without any red or yellow flags?

<p>Proceed with classification and treatment by the physical therapist. (B)</p> Signup and view all the answers

What role do yellow flags play in the screening process?

<p>They highlight unhelpful beliefs and anxieties about pain that may require additional support. (A)</p> Signup and view all the answers

What aspect of a patient's occupation might influence their treatment plan?

<p>Their ergonomic setup and activity level (A)</p> Signup and view all the answers

Which tool is more effective for predicting 'work' outcomes?

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

What does a higher score on the FABQ-W indicate?

<p>Higher levels of fear-avoidance beliefs (A)</p> Signup and view all the answers

Which cutoff score on the FABQ-W suggests a patient's likelihood of returning to work?

<blockquote> <p>29 (C)</p> </blockquote> Signup and view all the answers

The Pain Catastrophizing Scale (PCS) assesses which aspect related to pain?

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

What does a TSK score greater than 37 indicate?

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

When should self-reporting information from patients be used?

<p>To guide physical examination and interventions (B)</p> Signup and view all the answers

Which of the following is NOT a category to consider while assessing patient history?

<p>Cognitive assessment (C)</p> Signup and view all the answers

What type of mechanism of injury is associated with a specific incident?

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

What signifies a patient with unilateral localized low back pain?

<p>Facet joint pain (A)</p> Signup and view all the answers

Which instrument assesses fear of movement?

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

Which patient history factor is crucial in making clinical judgments for establishing prognosis?

<p>Previous Test/Treatment (A)</p> Signup and view all the answers

What do 'aggravating and easing factors' refer to in symptom assessment?

<p>Factors influencing symptom behavior (C)</p> Signup and view all the answers

What could prior episodes of pain indicate?

<p>Higher risk of chronic pain (A)</p> Signup and view all the answers

What is the purpose of using the movement or activity that reproduces symptoms?

<p>As a functional reassessment sign (D)</p> Signup and view all the answers

What T-score range is indicative of osteopenia?

<p>-2.5 to -1 (A)</p> Signup and view all the answers

Which of the following is the most common cause of sacroiliac joint pain?

<p>Injury from high impact (A)</p> Signup and view all the answers

How many stages are there in the progression of a disc herniation?

<p>4 stages (B)</p> Signup and view all the answers

What is the most common type of disc herniation?

<p>Posterolateral (D)</p> Signup and view all the answers

What does a normal T-score range from?

<p>+1 to -1 (D)</p> Signup and view all the answers

Which symptom is NOT typically associated with sacroiliac joint pain?

<p>Prolonged relief while lying down (C)</p> Signup and view all the answers

Which is a common characteristic of degenerative disc disease?

<p>Thickening of the ligamentous flavum (C)</p> Signup and view all the answers

At what age range is intervertebral disc herniation most commonly observed?

<p>25-45 years (B)</p> Signup and view all the answers

What is a consequence of the annulus fibrosis being disrupted during an extrusion stage of disc herniation?

<p>Nucleus pulposus moves into the epidural space (B)</p> Signup and view all the answers

What percentage of symptomatic disc herniations regress spontaneously over time?

<p>63% (C)</p> Signup and view all the answers

What is the most common cause of spondylolysis?

<p>Chronic strain leading to stress fracture (C)</p> Signup and view all the answers

At which lumbar levels is spondylolysis most commonly found?

<p>L4-L5 and L5-S1 (B)</p> Signup and view all the answers

What type of spondylolisthesis is often associated with adolescents engaged in athletics?

<p>Isthmic (D)</p> Signup and view all the answers

Which clinical presentation is characteristic of isthmic spondylolisthesis?

<p>Low back pain with radiating pain into the extremities (C)</p> Signup and view all the answers

What grading indicates a 50% forward displacement of one vertebra over another in spondylolisthesis?

<p>Grade 2 (B)</p> Signup and view all the answers

Which imaging technique is primarily used to diagnose scoliosis?

<p>Lateral view radiographs (D)</p> Signup and view all the answers

What is the primary management strategy for symptomatic Grade I and II spondylolisthesis?

<p>Non-operative therapy including modifications and exercise (D)</p> Signup and view all the answers

What is the risk factor associated with the progression of spondylolisthesis?

<p>Female gender (D)</p> Signup and view all the answers

What is a characteristic of structural scoliosis type?

<p>Inflexible curvature of the spine (A)</p> Signup and view all the answers

Which of the following factors does NOT contribute to primary osteoporosis?

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

At what degree of curvature does surgical fixation become a treatment option for scoliosis?

<p>Greater than or equal to 50 degrees (A)</p> Signup and view all the answers

What defines lumbar spinal stenosis?

<p>A narrowing or constriction of the spinal canal. (C)</p> Signup and view all the answers

Which symptom is typically associated with lumbar radiculopathy?

<p>Weakness in a specific myotome. (C)</p> Signup and view all the answers

Which type of scoliosis is most commonly idiopathic?

<p>Adolescent scoliosis (A)</p> Signup and view all the answers

What is a common symptom associated with osteoporosis?

<p>Fractures with minimal trauma (B)</p> Signup and view all the answers

Which of the following is a key clinical presentation of lumbar spinal stenosis?

<p>Unilateral or bilateral lower extremity pain. (A)</p> Signup and view all the answers

What is a method used to assess skeletal maturity in scoliosis patients?

<p>Cobb method (D)</p> Signup and view all the answers

What is the recommended initial management for mild to moderate lumbar spinal stenosis?

<p>Analgesic medications and flexibility exercises. (D)</p> Signup and view all the answers

What mechanism of injury is most common for a lumbar muscle strain?

<p>Flexion and rotation under load. (D)</p> Signup and view all the answers

What is a common characteristic of the pain associated with lumbar muscle strain?

<p>Localized ache primarily in the low back. (D)</p> Signup and view all the answers

When may neurological signs be absent in lumbar radiculopathy?

<p>In cases of disc injury or ligamentous sprains. (D)</p> Signup and view all the answers

What is a crucial aspect to assess during functional testing?

<p>Ability to perform daily activities without pain. (C)</p> Signup and view all the answers

What may indicate a hypomobile sacroiliac joint during the Marcher’s test?

<p>Failure of the PSIS to move relative to S2. (A)</p> Signup and view all the answers

What role does posture assessment play during the evaluation?

<p>Identification of potential misalignments or abnormalities. (D)</p> Signup and view all the answers

In which situation should surgical options be considered for a patient with lumbar spinal stenosis?

<p>When there is cauda equina syndrome present. (A)</p> Signup and view all the answers

What does increased mechanosensitivity in nerve roots indicate during lumbar radiculopathy?

<p>A heightened inflammatory response. (D)</p> Signup and view all the answers

What type of sensation do patients with lumbar spinal stenosis commonly report?

<p>Numbness and pins/needles. (A)</p> Signup and view all the answers

What should be assessed as part of the vital assessment upon initial evaluation?

<p>Blood pressure, heart rate, and respiratory rate. (D)</p> Signup and view all the answers

For a patient with a history of cancer and unexplained weight loss presenting with low back pain, what is the most appropriate initial investigation?

<p>Magnetic resonance imaging (MRI) of the lumbar spine (D)</p> Signup and view all the answers

What is the most appropriate referral pathway for a patient presenting with severe, progressive neurological deficit affecting both legs, saddle anesthesia, and bladder dysfunction?

<p>Emergency referral for MRI and surgical opinion (C)</p> Signup and view all the answers

What is the most appropriate imaging modality for initial assessment of a patient with suspected abdominal aortic aneurysm?

<p>Ultrasound of the aorta (B)</p> Signup and view all the answers

Which clinical feature is considered a red flag for spinal malignancy?

<p>Unremitting night pain (D)</p> Signup and view all the answers

What is the most common site of metastases in the spine?

<p>Lumbar spine (C)</p> Signup and view all the answers

Which of the following is NOT a clinical feature suggestive of spinal infection?

<p>Unremitting night pain (D)</p> Signup and view all the answers

What is the most appropriate referral pathway for a patient with suspected ankylosing spondylitis?

<p>Referral to a rheumatologist (D)</p> Signup and view all the answers

Which of the following clinical features are suggestive of Ankylosing Spondylitis? (Select all that apply)

<p>Improvement of symptoms with exercise but not with rest (C), Awaken during the second half of the night due to back pain (D)</p> Signup and view all the answers

Which of the following is NOT a risk factor for abdominal aortic aneurysm?

<p>Female sex (A)</p> Signup and view all the answers

Which of the following is a typical feature of Cauda Equina Syndrome?

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

What is the point prevalence of spinal fractures causing low back pain?

<p>0.7%-4.5% (A)</p> Signup and view all the answers

What is the most appropriate initial imaging for a patient with suspected spinal fracture in a patient over the age of 16 with blunt trauma?

<p>CT thoracic and lumbar spine (B)</p> Signup and view all the answers

What is the most appropriate referral pathway for a patient with low back pain, fever, and chills?

<p>Emergency referral for MRI and blood tests (D)</p> Signup and view all the answers

Which of the following conditions is characterized by a prevalence of 0.2-0.5%?

<p>Ankylosing Spondylitis (A)</p> Signup and view all the answers

Which of the following is a clinical feature associated with Ankylosing Spondylitis?

<p>Morning stiffness lasting greater than 30 minutes (A)</p> Signup and view all the answers

Which of the following is a red flag for a referred pain pathology related to the digestive system?

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

The Innominate Rotation Test assesses for which of the following?

<p>Rotation of the pelvis around its vertical axis (D)</p> Signup and view all the answers

During the Limb Length Test - Long Sitting Test, what does a change from a short to a long leg length indicate?

<p>Posterior innominate rotation (B)</p> Signup and view all the answers

The "Sign of Buttock" test is used to identify potential pathology in which area?

<p>The buttock, behind the hip joint (D)</p> Signup and view all the answers

During the Prone Instability Test, what does a decrease in symptoms when applying CPA while the legs are raised off the floor indicate?

<p>The patient has a spinal instability issue (C)</p> Signup and view all the answers

In the Passive Lumbar Extension Test, how is the patient positioned?

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

What specific joint is assessed during the Quadrant Test?

<p>Facet joint (A)</p> Signup and view all the answers

Which structure is NOT palpated during the palpation section of the examination?

<p>Anterior Superior Iliac Spine (C)</p> Signup and view all the answers

What is the PRIMARY objective of the "Hip AROM with Overpressure" test?

<p>Determine if hip mobility is contributing to the patient's symptoms (A)</p> Signup and view all the answers

During the Thomas Test, what does a limitation in hip extension indicate?

<p>Tightness in the hip flexor muscles (C)</p> Signup and view all the answers

During the 90/90 Straight Leg Raising Test, what is considered a positive result?

<p>The patient can extend their knee beyond 20 degrees with a straight leg (C)</p> Signup and view all the answers

Which of the following is NOT a special test mentioned in the context of "Clearing the Hip"?

<p>SLR (Straight Leg Raise) (C)</p> Signup and view all the answers

During the palpation section of the examination, which bony landmark would a clinician palpate to help identify the L4 spinous process?

<p>L4 transverse process (A)</p> Signup and view all the answers

Which of the following statements BEST describes the function of the "Hip AROM with Overpressure" test?

<p>To identify if the hip joint is the source of the patient's pain. (C)</p> Signup and view all the answers

What is the PRIMARY objective of "Clearing the Hip" during a lumbar physical examination?

<p>To rule out the hip as the source of the patient's symptoms. (D)</p> Signup and view all the answers

What is the PRIMARY purpose of the "Thomas Test"?

<p>To assess the flexibility of the hip flexor muscles. (B)</p> Signup and view all the answers

What is the purpose of "special lumbar tests" in the context of this document?

<p>To differentiate between different types of lumbar pain. (D)</p> Signup and view all the answers

During an Active Range of Motion – Lateral Flexion assessment, how should the clinician apply overpressure?

<p>Place one arm across the patient's chest, the other on the pelvis, and apply overpressure. (B)</p> Signup and view all the answers

Which of these is NOT an assessment tool used to assess lumbar joint mobility?

<p>Straight Leg Raise Test (C)</p> Signup and view all the answers

What is a positive finding in the Slump Test?

<p>Pain reproduction in the back or leg that changes with a sensitizing maneuver. (C)</p> Signup and view all the answers

When assessing neurodynamics, what is the primary purpose of using a sensitizing maneuver after symptom provocation?

<p>To confirm a positive test by ensuring the response is neurologically mediated. (C)</p> Signup and view all the answers

What is the primary purpose of conducting a Thigh Thrust Test during sacroiliac joint assessment?

<p>To reproduce pain, suggesting a possible SI joint dysfunction. (C)</p> Signup and view all the answers

Which of these is NOT a component of the Sacroiliac Joint Pain: Test Item Cluster?

<p>Active Straight Leg Raise Test (C)</p> Signup and view all the answers

Which muscle group is assessed using resisted isometric movements in sitting?

<p>Lower abdominal muscles (A)</p> Signup and view all the answers

What is the primary focus of the Repeated End Range Testing in Weightbearing assessment?

<p>To determine the effectiveness of a treatment plan by monitoring symptom response. (A)</p> Signup and view all the answers

Which of these is a positive finding in the Prone Knee Bend Test?

<p>Pain reproduction that worsens with neck flexion. (A)</p> Signup and view all the answers

Which of these is a key consideration when performing a Straight Leg Raise Test?

<p>Add only one component at a time and reassess symptom response after each addition. (A)</p> Signup and view all the answers

During a Crossed Straight Leg Raise Test, how should the clinician stabilize the knee?

<p>Place one arm on the tibia and the other on the heel. (D)</p> Signup and view all the answers

What are two key questions to be answered and documented for each joint during a Lumbar Segmental Accessory Assessment?

<p>Change in symptoms and perceived segmental mobility. (A)</p> Signup and view all the answers

What is the primary purpose of a comprehensive lumbar physical examination?

<p>To evaluate the patient's symptoms and determine the contributing factors for their condition. (D)</p> Signup and view all the answers

Which of the following is NOT a specific area of focus when considering motion quality?

<p>Pain threshold (D)</p> Signup and view all the answers

Which of these is a key consideration when applying overpressure during an Active Range of Motion assessment?

<p>Increase pressure gradually and monitor the patient's response. (B)</p> Signup and view all the answers

Which of these is an example of an aberrant motion during active range of motion assessment?

<p>A sudden 'catch' or feeling of instability during the movement. (A)</p> Signup and view all the answers

Flashcards

Patient History

The process of gathering detailed information from a patient about their health and concerns.

Open-ended questions

Questions that allow patients to express their thoughts freely, encouraging detailed responses.

Active listening

Engaging fully in the patient's narrative, showing understanding and empathy.

Closed-ended questions

Questions that can be answered with a simple 'yes' or 'no', used later in the history-taking.

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Working diagnosis

A preliminary diagnosis based on the initial assessment of the patient’s history.

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Symptom History

Documentation of the onset and duration of patient symptoms.

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Mechanism of Injury

The way an injury occurs: sudden, overuse, or insidious.

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Irritability

How easily a symptom is aggravated or eased.

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Aggravating Factors

Specific activities or positions that worsen symptoms.

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Easing Factors

Things that relieve or improve symptoms.

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24-Hour Day Pattern

Symptom variation throughout the day—morning, afternoon, night.

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Social Determinants of Health

Conditions in which people are born and live affecting health outcomes.

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Past Medical History

Records of previous illnesses, surgeries, and treatments.

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Joint Assessment

Evaluation of joint function to identify issues like hypomobility or pain.

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Active Range of Motion (AROM)

The extent of movement a patient can perform independently at a joint.

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Passive Range of Motion (PROM)

Movement of a joint through its range without patient effort.

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End-Feel Assessment

Evaluation of joint resistance at the limit of motion.

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Joint Hypomobility

Decreased movement in a joint, often causing pain.

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Joint Hypermobility

Increased movement in a joint, potentially leading to instability.

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Barrier Concept

The resistance felt in a joint during movement testing.

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S.I.N.S.S

A systematic strategy for assessing patient symptoms: Severity, Irritability, Nature, Stage, Stability.

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Severity

Refers to the intensity of a patient's pain and its impact on daily activities.

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Nature

The type and characteristics of pain symptoms experienced by the patient.

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Stage

Assessment of the timeframe of symptoms: Acute, Subacute, Chronic.

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Stability

Progression of symptoms over time, indicating improvement, worsening, or unchanged.

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Patient History Purpose

To develop rapport, gain insight into symptoms, and plan effective examination.

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Initial Greeting

Welcoming the patient and outlining the visit to make them comfortable.

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Body Chart

A visual tool for mapping pain locations and symptom areas.

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Symptom Descriptors

Adjectives patients use to describe their pain, like achy or sharp.

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Numeric Pain Rating

A scale from 0-10 for patients to rate their best, worst, and current pain.

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Symptom Relationships

Exploring connections between different pain areas or symptoms.

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Chronic Pain

Pain lasting longer than 6 weeks, often requiring different management.

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Acute on Chronic

A combination of a chronic condition with a recent acute exacerbation.

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Moderate Irritability

Symptoms may rebound after activity, but can be treated with rest.

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OMPSQ

A questionnaire developed to predict pain and work outcomes.

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SBST

The STarT Back Screening Tool, used primarily to allocate treatments.

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FABQ

Fear-Avoidance Beliefs Questionnaire, assessing fear related to physical activity and work.

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FABQ-PA

FABQ physical activity scale, ranges from 0 to 24, higher scores indicate more fear-avoidance.

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FABQ-W

FABQ work scale, ranges from 0 to 42, used to predict return-to-work status.

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PCS

Pain Catastrophizing Scale, measuring catastrophic thinking about pain.

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Kinesiophobia

Fear of movement, which can hinder rehabilitation efforts.

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TSK

Tampa Scale of Kinesiophobia, measures fear of movement with 17 items.

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Patient Self-Reporting

Using questionnaires to guide physical exams and interventions.

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Functional Re-assessment Sign

Movement causing symptoms, used to gauge recovery progress.

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History Taking

Gathering patient information to assess their condition and create treatment plans.

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Joint Structures

Potential sources of symptoms include joints and bony structures like facet joints.

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Red Flags

Concerning features in a patient history that require urgent referral.

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Hypothesis Generation

Creating possible causes of symptoms based on patient history.

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Hypermobile Segment

A joint that exceeds the expected range of motion, leading to pain.

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Pain or Muscle Guarding

Pain onset occurs within the expected range, restricting movement.

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Maitland Grades of Movement

A system used to grade joint mobilizations based on pain and resistance.

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Grade 1 Mobilization

Small amplitude movement out of resistance to decrease pain.

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Grade 2 Mobilization

Large amplitude movement out of resistance to decrease pain.

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Grade 3 Mobilization

Large amplitude movement into resistance to improve motion.

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Grade 4 Mobilization

Small amplitude movement into resistance to improve mobility.

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Grade 5 Mobilization

High velocity, low amplitude thrust to improve motion and decrease pain.

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Muscle Energy Technique (MET)

A manual technique involving patient muscle contractions against resistance.

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Mobilization with Movement (MWM)

Combines therapist-glide and patient movement applied pain-free.

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Numeric Pain Rating Scale (NPRS)

Patient rates pain from 0 (no pain) to 10 (worst pain).

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Patient Specific Functional Scale (PSFS)

Rates a patient's ability to complete specific activities on a scale from 0-10.

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Roland-Morris Disability Questionnaire

Measures functionality in patients with low back pain using 24 items.

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Oswestry Disability Index (ODI)

A ten-item questionnaire assessing disability percentage from 0-100.

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STarT Back Screening Tool (SBST)

A scoring tool identifying subgroups for patients with low back pain.

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Urogenital System Conditions

Health issues related to the urogenital system in males and females.

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Pelvic Pain

Discomfort or pain located in the pelvic region.

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Yellow Flag Considerations

Psychosocial factors that increase risk for persistent pain.

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Depressive Illnesses

Mental health conditions that can worsen chronic pain.

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PHQ-2 Screening Instrument

A tool used to identify signs of depression in patients.

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Major Depressive Disorder Symptoms

Persistent low mood and lack of interest occurring nearly every day.

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Patient Goals

Specific objectives a patient hopes to achieve through treatment.

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Facet Joint Pain

Localized pain due to issues in lumbar facet joints.

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Spondylosis

Degenerative changes in spinal joints and discs with aging.

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Living Environment

The physical and social setting where a patient resides, impacting their health.

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Spondylolisthesis

Forward slipping of a vertebral body over another due to defects.

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Bone Pathology Terminology

Terminology for common bone and joint conditions.

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Yellow Flags

Psychosocial factors indicating potential chronic pain issues.

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Medical Screening

Evaluation to determine if a patient is suitable for physical therapy.

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Eco-ergonomic Assessment

Evaluating workplace setup to optimize health and performance.

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Physical Exam Planning

Organizing the physical examination based on priority hypotheses.

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Clinical Decision-Making Steps

A structured approach to evaluate and respond to clinical findings.

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Patient Listening

Actively hearing and understanding the patient's concerns.

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Emergency referral

Immediate referral for urgent medical workup due to high concern.

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Urgent referral

Referral for medical workup within 5 days due to moderate to high concern.

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Watchful waiting

Close surveillance allowing time to monitor symptoms before intervention.

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Safety netting

Providing advice and signs to monitor for serious health changes.

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Cauda Equina Syndrome

Condition from nerve compression often requiring immediate referral.

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Spinal Fracture

Break in the spine from trauma or non-trauma requiring imaging.

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Spinal Malignancy

Cancer spread often causing back pain; requires imaging for diagnosis.

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Spinal Infection

Infection in or near the spine that may require urgent imaging.

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Abdominal Aortic Aneurysm (AAA)

A bulge in the aorta that may rupture; needs emergent referral.

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Ankylosing Spondylitis

Chronic inflammatory disease affecting spine and posture, often underdiagnosed.

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Signs of digestive issues

Symptoms like heartburn, changes in appetite, or abdominal pain.

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Renal conditions

Kidney-related issues leading to symptoms like difficulty urinating.

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Referral pathway for spinal conditions

Recommended actions based on suspicion level (emergency, urgent, watchful waiting).

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Clinical features of spinal malignancy

Signs indicating potential malignancy include weight loss and severe pain.

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Referral for cauda equina

Immediate MRI and surgical opinion for high suspicion cases.

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Osteoporosis T-score

A measurement indicating bone density; ≤ -2.5 signifies osteoporosis.

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DEXA scan

A preferred imaging method to measure bone mineral density.

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Sacroiliac Joint Pain

Pain localized to the gluteal region, often indicating SI joint issues.

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Fortin’s Sign

A clinical sign where pain is pointed to around the SI joint.

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Annulus Fibrosis

The outer layer of an intervertebral disc that holds the nucleus pulposus.

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Intervertebral Disc Herniation

A condition where the disc's inner material protrudes, possibly affecting nerves.

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Stages of Disc Herniation

Progresses from protrusion to sequestration with increased severity.

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Degenerative Disc Disease

Age-related decrease in disc height and integrity, leading to pain.

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Spontaneous Regression

The natural improvement of disc herniation symptoms over time.

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Aggravating Activities

Actions that worsen pain, such as sitting or flexing.

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Common sites for Spondylolysis

Most frequently affects L4-L5 and L5-S1 vertebrae.

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Mechanism of injury for Spondylolysis

Injuries often involve repetitive loading and trunk extension.

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Clinical presentation of Spondylolysis

Causes non-radiating unilateral low back pain during loading, extension, and rotation.

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Imaging for Spondylolysis

Oblique view radiographs show the defect in the pars interarticularis.

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Grading Spondylolisthesis

Grades range from 1 (25% slip) to 4 (100% slip of vertebra).

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Types of Spondylolisthesis

Includes isthmic, traumatic, degenerative, dysplastic, and pathologic.

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Isthmic Spondylolisthesis Symptoms

Symptoms include pain after activities, low back pain, and radiating pain to lower extremities.

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Spondylolisthesis imaging

Lateral view radiographs are typically used, and MRI if neurological issues.

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Scoliosis

Lateral deviation of the spine from midline, including vertebral and rib deformations.

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Non-structural vs. Structural Scoliosis

Non-structural is flexible, while structural is inflexible and often idiopathic.

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Cobb method

Used in radiographs to assess curvature in scoliosis and determine treatment options.

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Scoliosis Management

Depends on curve size; minor cases often need monitoring, moderate requires bracing, major could need surgery.

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Primary vs. Secondary Osteoporosis

Primary osteoporosis is age-related, while secondary has other specific causes like hyperparathyroidism.

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Functional Testing

Assessment of a patient’s movements and compensations during activities.

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Sagittal Plane

Vertical plane that divides the body into left and right sections.

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Neurological Examination

Assessment to determine the integrity of the nervous system.

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Myotomes

Muscle groups innervated by specific spinal nerves, tested for strength.

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Babinski Reflex

A neurological test where the foot is stroked to assess nerve response.

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Quadrant Test

Assessment technique used to evaluate motion in multiple planes simultaneously.

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Compensation Patterns

Movements adopted by patients to avoid pain during functional activities.

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Disc regression

Poor correlation with improved clinical outcomes after treatment.

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Lumbar Radiculopathy

Condition involving nerve root or cord compression causing nerve symptoms.

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Myotome weakness

Weakness in specific muscle groups due to nerve root involvement.

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Dermatome sensory loss

Loss of sensation in skin areas corresponding to specific nerve roots.

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Reflex loss

Absence or reduction of normal reflex responses indicating nerve issues.

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Lumbar Spinal Stenosis

Narrowing of the spinal canal due to soft tissue or bony growth.

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Lumbar Muscle Strain

Injury to lumbar muscles from flexion or rotation; localized pain.

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Pain during muscle contraction

Experiencing pain when muscles are actively engaged.

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Soft tissue mobilization

Manual therapy technique to decrease muscle guarding.

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Marcher's Test

Test for SI joint mobility using hip flexion to assess movement.

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Pelvic positioning

Assessment of pelvis alignment by palpating bony landmarks.

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Symptom modulation

Adjusting treatment based on changing symptoms to improve outcomes.

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Observation in assessment

Careful monitoring of posture and movement during patient evaluation.

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Active Range of Motion - Flexion

The ability to bend forward while keeping knees straight, with feet shoulder-width apart.

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Overpressure in Flexion

Additional pressure applied to the lumbar spine to enhance stretching during flexion testing.

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Aberrant Motion

Abnormal movement patterns observed during joint motion, indicating underlying issues.

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Lumbopelvic Rhythm Reversal

A dysfunction where the normal coordination of lumbar and pelvic movements is disrupted.

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Straight Leg Raise (SLR) Test

A test assessing nerve irritation by raising the limb while noting symptoms.

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Slump Test

A seated test that evaluates nerve tension through a slumped position and leg extensions.

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Prone Knee Bend Test

A test for femoral nerve irritation performed while the patient is lying face down.

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Muscle Performance Testing

Assessing strength and coordination of muscles through isometric or resisted movements.

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Sacroiliac Joint Testing

Evaluating the sacroiliac joint to identify pain sources related to lumbar symptoms.

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Sacroiliac Joint Pain - Thigh Thrust Test

Test where force is applied through the femur to assess sacroiliac joint pain.

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Neurodynamics

The study of nervous system flexibility and movement in relation to symptoms.

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Active Straight Leg Raise Test

A test assessing hip and lumbar stability while the patient raises one leg.

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Joint Mobility Assessment

Evaluating joint movement to determine perceived segmental mobility status.

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Pain Arc

The range during motion where pain occurs but eases at end ranges.

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Upper and Lower Abdominal Strength Testing

Assessing the strength and coordination of abdominal muscles for functional performance.

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Innominate Rotation Test

A test assessing pelvic movement by evaluating leg length discrepancies during positioning.

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Limb Length Test

A test that assesses limb length discrepancies to evaluate pelvic rotation.

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Clearing the Hip

Assessment process to rule out hip involvement in symptoms affecting the low back.

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Hip AROM

Active Range of Motion testing for the hip, evaluating flexion, extension, and rotation.

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FADIR Test

A special test for hip pathology involving flexion, adduction, and internal rotation.

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FABER Test

A hip special test assessing pain with flexion, abduction, and external rotation.

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Prone Instability Test

A test assessing low back pain relief when the legs are lifted, comparing pressures.

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Sign of Buttock

A test examining hip flexion differences to check for underlying pathologies.

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Passive Lumbar Extension Test

A test assessing pain relief by lifting legs while extending the lower back.

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Thomas Test

A flexibility test for hip flexors while stabilizing the pelvis in a supine position.

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90/90 Straight Leg Raising Test

A test for hamstring flexibility measuring knee angle when extending from 90 degrees of hip flexion.

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Muscle Flexibility Tests

Assessments to evaluate the flexibility of muscles around joints like the hip.

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Palpation

The process of using hands to examine and assess soft tissue and bone landmarks.

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Bone Landmarks

Important anatomical points on the body for guiding physical assessments.

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Study Notes

Musculoskeletal (MSK) Patient History

  • Objectives: Apply patient history concepts, generate hypotheses, plan physical exams, interpret data for diagnosis and prognosis, guide management.
  • Patient History Process: Begin with open-ended questions, use active listening and clarifying questions, then move towards closed-ended questions.
  • History Goals: Establish a working diagnosis, plan the physical examination.
  • S.I.N.S.S. Construct: Evaluate symptoms using Severity, Irritability, Nature, Stage, and Stability.

Severity

  • Description: Pain intensity and its impact on daily activities.
  • Categories:
    • Minimal: 0-3/10 pain, no limitations on daily activities.
    • Moderate: 4-7/10 pain, moderate impact on daily activities/work.
    • Maximal: 8-10/10 pain, maximum impact on daily activities.

Irritability

  • Description: Activities that aggravate or ease symptoms.
  • Categories:
    • Minimal: Tolerates high-repetition, vigorous, sustained activities before symptom onset; symptoms ease quickly with rest.
    • Moderate: Tolerates moderate activity; symptoms may appear and improve with rest; sleep interruptions may occur but resolved within 30 minutes.
    • Maximal: Tolerates very little activity; significant recovery time required; frequent/prolonged sleep interruptions (>30 minutes).

Nature

  • Description: Type and characteristics of pain.
  • Categories:
    • Musculoskeletal: Mechanical (reproduced with specific movements) or non-mechanical (not reproduced with single movement, but over a period).
    • Non-Musculoskeletal (not related to muscles or bones).

Stage

  • Description: Timeframe of the condition.
  • Categories:
    • Acute: Days to <3 weeks; recent onset.
    • Subacute: 3–6 weeks.
    • Chronic: >6 weeks.
    • Acute on chronic: Existing chronic condition with acute exacerbation.
    • Subacute on chronic: Existing chronic condition with subacute exacerbation.

Stability

  • Description: Symptom progression over time.
  • Categories:
    • Improving: Decreasing intensity, frequency, or location.
    • Worsening: Increasing intensity, frequency, or location.
    • Not changing: No improvement or worsening.
    • Waxing and waning: Symptoms fluctuate between better and worse.

Patient History Purposes

  • Develop rapport and therapeutic alliance.
  • Develop hypotheses about symptom causes and contributing factors.
  • Establish patient goals and expectations.
  • Develop a physical exam plan.
  • Assess patient suitability for evaluation.

Patient History Structure

  • Greeting: Welcome warmly and outline the visit duration.
  • Body Chart and Symptom Location:
    • Use a body chart, visually mapping symptom regions.
    • Use patient descriptions (achy, sharp, etc).
    • Determine severity.
    • Note relationships between symptom areas.
  • Symptom History/Timeline:
    • Onset dates.
    • Injury mechanism (sudden, overuse, insidious, unknown).
    • Symptom improvement/worsening (stability).
    • Past treatments and results.
  • Symptom Behavior:
    • Aggravating/easing factors.
    • 24-hour day pattern variations.
  • Medical History: Past medical diagnoses, surgeries, hospitalizations, medications, allergies, health habits.
  • Family History: Relevant family history if applicable.
  • Review of Systems: Screening questions; typically closed-ended.
  • Social History and Goals: Patient perspectives on the complaint, social/personal factors, occupations, environmental/social determinants of health/habits, and goals.
  • Wrap-up: Review understanding of patient history, transition to physical examination, and explain next steps.

Joint Assessment and Treatment

  • Principles: Comfortable patient positioning; therapist comfort and proper body mechanics; "soft, intentional hands."

  • Assessment: Compare contralateral/adjacent segments before the involved side. Begin with open-pack position and small oscillations; note patient response during movements.

  • Assessment Sequence: Active ROM, Passive ROM, Passive Accessory Motion (arthrokinematics/osteokinematics)

Passive Joint Mobility Testing

  • Passive Physiological Movement: Osteokinematics (bone movement).
  • Passive Accessory Movement: Arthrokinematics (joint surface movements)

Passive Range of Motion (ROM)

  • End-Feel Assessment:
    • Observe end-feel (soft, firm, hard, empty), comparing to the uninvolved side.
  • Abnormal End-Feels:
  • Hypomobility: Early end-feel compared to normal.
  • Hypermobility: Late end-feel compared to normal.
  • Empty: Acute inflammation/other abnormal conditions.
  • Soft: Edema/increased soft tissue swelling.
  • Firm: Increased muscle tightness/shortening.
  • Hard: Fractures, bone fragments, DJD/OA.
  • Pain-limited: Pain stops the movement before full ROM.

Passive Accessory Segmental Testing

  • Three Levels: Low, medium, and high resistance; assess symptom response as you increase resistance.

Barrier Concepts

  • Hypomobile: Resistance felt sooner than expected.
  • Hypermobile: Resistance felt later than expected.
  • Pain/Muscle Guarding: Resistance encountered mid-range.

Joint Treatment (Mobilization/Manipulation)

  • Techniques: Joint mobilizations, manual therapy.
  • Grades (Maitland): Use to classify mobilizations
    • Grade 1: Small amplitude out of resistance, typically used for pain reduction at the beginning of ROM.
      • Grade 2: Large amplitude out of resistance, used for pain reduction from early to mid range of ROM.
    • Grade 3: Large amplitude into resistance used to improve ROM at the mid range to late range of motion.
    • Grade 4: Small amplitude into resistance, used to improve ROM in stiff joints that are not painful.
    • Grade 5: High velocity, low amplitude thrust into resistive barrier; used to improve ROM in stiff painful joints.
  • Selection: Determined by dominant feature (pain, stiffness, pain/stiffness combination).

Additional Manual Therapy Techniques

  • Muscle Energy Technique (MET): Patient contractions against therapist resistance.
  • Mobilization with Movement (MWM): Therapist glides while patient actively moves.

Patient Self-Report Measures

  • Purpose: Assess biological, physical, and psychosocial factors; guide intervention.
    • Examples: NPRS, PSFS, RMDQ, ODI, OMPSQ, SBST, FABQ, PCS, TSK, MDC (Minimal Detectable Change), & MCID (Minimal Clinically Important Difference)
  • Interpreting MDC & MCID: Understand minimum amounts needed for meaningful change.

Lumbar Spine Patient History

  • Chief Complaint: Location (localized or generalized).
  • Lower Extremity Symptoms: Assess for dermatome patterns and relationship to low back pain.
  • Symptom Behavior: Directional preference (flexion vs. extension), functional reassessment signs, S.I.N.S.S.
  • Possible Symptom Sources: Joints, discs, muscles, related structures, and rule out non-MSK conditions (cancer, visceral referral, or ankylosing spondylitis).
  • Symptom History: Mechanism of injury (traumatic/atraumatic), prior episodes, frequency/severity trends.
  • Previous Tests/Treatments: Past procedures and patient interpretations.
  • Medical History: Related conditions, surgeries, medications.
  • Review of Systems: Ensure appropriate level of concern.
  • Social/Personal Factors: Environment, occupation (ergonomics), expectations.
  • Physical Exam Planning: Strategy for examination based on hypothesis and S.I.N.S.S.; consider symptom reproduction and flare-up prevention, and degree of functional testing.

Screening for Medical Referral

  • Red Flags: Associated with serious disorders (infection, inflammation, cancer, fracture); raising suspicion.
  • Yellow Flags: Unhelpful beliefs about pain, stress, anxiety, fear-avoidance, and over-reliance on medical intervention.
  • Concern Levels: Emergency, urgent, watchful waiting, and safety netting (referrals).
  • Clinical Decision-Making:
    • Step 1: Decide the concern level.
    • Step 2: Choose a clinical action.
    • Step 3: Plan the referral path.

Red Flag Pathologies

  • Cauda Equina Syndrome: Possible compression; immediate referral.
  • Spinal Fracture: Possible trauma; urgent referral.
  • Spinal Malignancy: Possible cancer; emergent referral.
  • Spinal Infection: Possible infection; emergent referral.
  • AAA (Abdominal Aortic Aneurysm): Possible rupture; emergency referral.

Referred Pain Pathologies

  • Digestive/GI, Renal/Urinary, Urogenital Systems: Potential sources of referred pain. Specifically ask about potential urinary complaints.

Yellow Flag Considerations

  • Psychological Comorbidities: depression, fear avoidance, catastrophizing, stress, and anxiety. Brief screening for depression.

###Bone and Joint Pathologies

  • Facet Joint Pain: Unilateral low back pain; aggravated by extension, lateral flexion, or extension quadrant.
  • Spondylosis: Degenerative changes (DJD, OA); symptoms dependent upon site and structure.
  • Spondylolysis: Defect in vertebral arch; usually from stress fracture.
  • Spondylolisthesis: Vertebral slippage (forward).
  • Scoliosis: Lateral spinal curvature. Differentiate from lateral shift.
  • Osteoporosis: Reduced bone density.

Disc and Neural Conditions

  • Disc Herniation/Protrusion
  • Lumbar Radiculopathy: Nerve compression signs.
  • Lumbar Spinal Stenosis: Spinal canal narrowing.

Muscle Contractile Tissue Pathologies

  • Muscle Strain: Localized low back pain; aggravated by muscle contraction/stretching.

Observation and Posture Assessment

  • Vital Assessment: Initial evaluation; for baseline and risk factors.
    • Observation: Resting posture, movement quality, symmetry, muscle atrophy/wasting.
      • Landmark Palpation: Precise measurement of reference points
      • Pelvic Positioning: Note ASIS, PSIS, and iliac crest heights.

Functional and Gait Assessment

  • Functional Testing: Observe and evaluate how patients move. If appropriate, ask about and evaluate functional activities, such as donning/doffing shoes, lifting objects.
    • Gait: Observe gait from different views.
  • Specific Functional Movements: Assess movements such as bilateral squat, single leg stance/squat, lateral step-down.
  • Abnormal Movements: Look for instability, asymmetries, pain arcs.

Neurological Examination

  • Purpose: Assessing neurological system integrity and appropriateness for PT.
  • Functional Tests: Heel/toe walk.
  • Upper Motor Neuron Testing: Babinski reflex and clonus.

Range of Motion and Joint Mobility Assessment

  • Active ROM: (flexion, extension, lateral flexion, rotation) with overpressure; assess for pain/symmetry/control.
  • Lumbar Segmental Accessory Assessment (PAIVMs),
  • Lumbar Central Posterior to Anterior (CPAs),
  • Lumbar Unilateral Posterior to Anterior (UPAs)

Neurodynamics Assessment

  • Assess when nerve irritation is suspected.
  • Straight Leg Raise (SLR), Crossed SLR, Slump Test, Prone Knee Bend Test: Sensitizing maneuvers; Assess for positive response patterns consistent with nerve-related impairments or irritation

Muscle Performance Testing

  • Resisted Isometric Movements: In sitting to examine contractile tissue integrity.

Sacroiliac and Hip Joint Testing

  • Purpose: Rule out SIJ and hip as pain sources; assess for related impairments.
  • Tests: Include thigh thrust, distraction, sidelying compression, Gaenslen's, sacral thrust, active straight leg raise, innominate rotation test, limb length test.

Special Tests

  • Assess for possible pathology. Examples include: Sign of the Buttock, Prone Instability Test, Passive Lumbar Extension Test, Quadrant Test.

Muscle Flexibility Tests (e.g., Thomas, 90/90)

Palpation (e.g., bone landmarks, muscle palpation)

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