Podcast
Questions and Answers
What is the primary goal of taking a patient history during a physical examination?
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?
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?
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?
What is a working diagnosis, as described in the context of patient history?
What technique is essential after open-ended questions in the patient history-taking process?
What technique is essential after open-ended questions in the patient history-taking process?
When assessing gait deviations in the lumbopelvic region, what is a key observation to make?
When assessing gait deviations in the lumbopelvic region, what is a key observation to make?
During the functional neurological screen, which specific movement assesses the integrity of the L4-L5 myotome?
During the functional neurological screen, which specific movement assesses the integrity of the L4-L5 myotome?
What is the primary purpose of the upper motor neuron testing components, such as the Babinski and Clonus tests during a neurological examination?
What is the primary purpose of the upper motor neuron testing components, such as the Babinski and Clonus tests during a neurological examination?
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?
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?
The neurological examination is integrated into the comprehensive lumbar physical examination to achieve which objective?
The neurological examination is integrated into the comprehensive lumbar physical examination to achieve which objective?
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?
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?
The 'Quadrant Test' is a component of which aspect of the lumbar physical examination?
The 'Quadrant Test' is a component of which aspect of the lumbar physical examination?
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?
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?
Which factor is NOT considered when assessing a patient's symptom behavior?
Which factor is NOT considered when assessing a patient's symptom behavior?
What type of symptom onset suggests a clear, identifiable cause?
What type of symptom onset suggests a clear, identifiable cause?
Which of the following is least likely to be part of a patient's medical history review?
Which of the following is least likely to be part of a patient's medical history review?
What is indicated by the presence of hypomobility during joint assessment?
What is indicated by the presence of hypomobility during joint assessment?
Which method should be utilized to first assess a joint's mobility?
Which method should be utilized to first assess a joint's mobility?
Which symptom duration and severity may indicate high irritability?
Which symptom duration and severity may indicate high irritability?
What does an empty end-feel during passive range of motion signify?
What does an empty end-feel during passive range of motion signify?
In the context of joint mobility testing, what is the primary goal of passive accessory movements?
In the context of joint mobility testing, what is the primary goal of passive accessory movements?
What should be important to consider when assessing a high irritability joint?
What should be important to consider when assessing a high irritability joint?
Which statement about assessing contralateral sides is true?
Which statement about assessing contralateral sides is true?
What is the primary concern when reviewing a patient's social history during assessment?
What is the primary concern when reviewing a patient's social history during assessment?
During joint assessment, which sequence is recommended for assessing mobility?
During joint assessment, which sequence is recommended for assessing mobility?
Which of the following would most likely indicate the need for a limited physical examination?
Which of the following would most likely indicate the need for a limited physical examination?
What is the purpose of recognizing a patient's irritability level during assessment?
What is the purpose of recognizing a patient's irritability level during assessment?
Which of the following is NOT a symptom of pelvic pain related to female urogenital conditions?
Which of the following is NOT a symptom of pelvic pain related to female urogenital conditions?
What psychological factor may lead to increased rates of disability in patients with low back pain?
What psychological factor may lead to increased rates of disability in patients with low back pain?
Which condition is associated with a forward displacement of one vertebral body over another?
Which condition is associated with a forward displacement of one vertebral body over another?
Which screening instrument is recommended for identifying signs of depression?
Which screening instrument is recommended for identifying signs of depression?
Which symptom is common in both prostate issues and pelvic inflammatory disease?
Which symptom is common in both prostate issues and pelvic inflammatory disease?
What is a common immediate management technique for facet joint pain?
What is a common immediate management technique for facet joint pain?
Which sign is indicative of Major Depressive Disorder?
Which sign is indicative of Major Depressive Disorder?
What factors can exacerbate symptoms of facet joint pain?
What factors can exacerbate symptoms of facet joint pain?
In what situation is referral to a mental health professional indicated?
In what situation is referral to a mental health professional indicated?
Which condition describes degenerative changes in the spine commonly due to aging?
Which condition describes degenerative changes in the spine commonly due to aging?
What does the 'severity' component of the S.I.N.S.S. assessment primarily evaluate?
What does the 'severity' component of the S.I.N.S.S. assessment primarily evaluate?
In the context of symptom irritability, which description defines a 'maximal' level of irritability?
In the context of symptom irritability, which description defines a 'maximal' level of irritability?
What is the primary goal of Grade 1 mobilization in joint treatment?
What is the primary goal of Grade 1 mobilization in joint treatment?
Which category indicates a condition that has persisted for more than six weeks?
Which category indicates a condition that has persisted for more than six weeks?
When should Grade 4 mobilization techniques be applied?
When should Grade 4 mobilization techniques be applied?
What is typically included in the physical examination plan based on patient history?
What is typically included in the physical examination plan based on patient history?
What defines the Minimal Clinically Important Difference (MCID)?
What defines the Minimal Clinically Important Difference (MCID)?
Which of the following best describes the 'nature' of symptoms in the S.I.N.S.S. assessment?
Which of the following best describes the 'nature' of symptoms in the S.I.N.S.S. assessment?
Which stage indicates that a patient has experienced symptoms for less than three weeks?
Which stage indicates that a patient has experienced symptoms for less than three weeks?
Which tool assesses a patient's functional ability to complete specific activities?
Which tool assesses a patient's functional ability to complete specific activities?
In the assessment of stability, what does 'waxing and waning' mean?
In the assessment of stability, what does 'waxing and waning' mean?
What does the Osteopatic Disability Index (ODI) score indicate?
What does the Osteopatic Disability Index (ODI) score indicate?
Which of the following describes a characteristic of the Muscle Energy Technique (MET)?
Which of the following describes a characteristic of the Muscle Energy Technique (MET)?
What is the primary goal of conducting a patient history during a visit?
What is the primary goal of conducting a patient history during a visit?
Which of the following best describes a 'moderate' stage of irritability?
Which of the following best describes a 'moderate' stage of irritability?
In the context of joint treatment, what does 'muscle guarding' refer to?
In the context of joint treatment, what does 'muscle guarding' refer to?
How should a provider fill out the body chart in the symptom location assessment?
How should a provider fill out the body chart in the symptom location assessment?
Which Maitland mobilization grade is applied to improve mobility with large amplitude into resistance?
Which Maitland mobilization grade is applied to improve mobility with large amplitude into resistance?
What aspect does the 'stage' component of S.I.N.S.S. address?
What aspect does the 'stage' component of S.I.N.S.S. address?
What does the Orebro Musculoskeletal Pain Screening Questionnaire focus on?
What does the Orebro Musculoskeletal Pain Screening Questionnaire focus on?
In a scenario where a patient shows consistent lower back pain with recent exacerbation, which category does this represent?
In a scenario where a patient shows consistent lower back pain with recent exacerbation, which category does this represent?
What is a primary characteristic of the Roland-Morris Disability Questionnaire?
What is a primary characteristic of the Roland-Morris Disability Questionnaire?
What should the initial greeting in a patient history session aim to achieve?
What should the initial greeting in a patient history session aim to achieve?
During assessment, what does a hypermobile segment indicate?
During assessment, what does a hypermobile segment indicate?
Which of the following describes the symptom assessment process using the body chart?
Which of the following describes the symptom assessment process using the body chart?
Which screening tool is designed to identify subgroups of patients with low back pain?
Which screening tool is designed to identify subgroups of patients with low back pain?
What does a chronic stage suggest about a patient's symptoms?
What does a chronic stage suggest about a patient's symptoms?
What is the main purpose of using mobilization with movement (MWM)?
What is the main purpose of using mobilization with movement (MWM)?
What is the primary purpose of assessing a patient's living environment during evaluation?
What is the primary purpose of assessing a patient's living environment during evaluation?
Which factors should be prioritized during a physical examination according to the S.I.N.S.S model?
Which factors should be prioritized during a physical examination according to the S.I.N.S.S model?
In the context of medical screening, what distinguishes red flags from yellow flags?
In the context of medical screening, what distinguishes red flags from yellow flags?
What initial action should a clinician take if a patient presents with concerning features during a screening?
What initial action should a clinician take if a patient presents with concerning features during a screening?
Which statement accurately reflects the importance of listening to the patient during the subjective examination?
Which statement accurately reflects the importance of listening to the patient during the subjective examination?
How should a clinician address a patient's symptoms that are difficult to reproduce during a physical examination?
How should a clinician address a patient's symptoms that are difficult to reproduce during a physical examination?
What is the first step in the clinical decision-making process regarding patient concerns?
What is the first step in the clinical decision-making process regarding patient concerns?
What should be considered if a patient presents without any red or yellow flags?
What should be considered if a patient presents without any red or yellow flags?
What role do yellow flags play in the screening process?
What role do yellow flags play in the screening process?
What aspect of a patient's occupation might influence their treatment plan?
What aspect of a patient's occupation might influence their treatment plan?
Which tool is more effective for predicting 'work' outcomes?
Which tool is more effective for predicting 'work' outcomes?
What does a higher score on the FABQ-W indicate?
What does a higher score on the FABQ-W indicate?
Which cutoff score on the FABQ-W suggests a patient's likelihood of returning to work?
Which cutoff score on the FABQ-W suggests a patient's likelihood of returning to work?
The Pain Catastrophizing Scale (PCS) assesses which aspect related to pain?
The Pain Catastrophizing Scale (PCS) assesses which aspect related to pain?
What does a TSK score greater than 37 indicate?
What does a TSK score greater than 37 indicate?
When should self-reporting information from patients be used?
When should self-reporting information from patients be used?
Which of the following is NOT a category to consider while assessing patient history?
Which of the following is NOT a category to consider while assessing patient history?
What type of mechanism of injury is associated with a specific incident?
What type of mechanism of injury is associated with a specific incident?
What signifies a patient with unilateral localized low back pain?
What signifies a patient with unilateral localized low back pain?
Which instrument assesses fear of movement?
Which instrument assesses fear of movement?
Which patient history factor is crucial in making clinical judgments for establishing prognosis?
Which patient history factor is crucial in making clinical judgments for establishing prognosis?
What do 'aggravating and easing factors' refer to in symptom assessment?
What do 'aggravating and easing factors' refer to in symptom assessment?
What could prior episodes of pain indicate?
What could prior episodes of pain indicate?
What is the purpose of using the movement or activity that reproduces symptoms?
What is the purpose of using the movement or activity that reproduces symptoms?
What T-score range is indicative of osteopenia?
What T-score range is indicative of osteopenia?
Which of the following is the most common cause of sacroiliac joint pain?
Which of the following is the most common cause of sacroiliac joint pain?
How many stages are there in the progression of a disc herniation?
How many stages are there in the progression of a disc herniation?
What is the most common type of disc herniation?
What is the most common type of disc herniation?
What does a normal T-score range from?
What does a normal T-score range from?
Which symptom is NOT typically associated with sacroiliac joint pain?
Which symptom is NOT typically associated with sacroiliac joint pain?
Which is a common characteristic of degenerative disc disease?
Which is a common characteristic of degenerative disc disease?
At what age range is intervertebral disc herniation most commonly observed?
At what age range is intervertebral disc herniation most commonly observed?
What is a consequence of the annulus fibrosis being disrupted during an extrusion stage of disc herniation?
What is a consequence of the annulus fibrosis being disrupted during an extrusion stage of disc herniation?
What percentage of symptomatic disc herniations regress spontaneously over time?
What percentage of symptomatic disc herniations regress spontaneously over time?
What is the most common cause of spondylolysis?
What is the most common cause of spondylolysis?
At which lumbar levels is spondylolysis most commonly found?
At which lumbar levels is spondylolysis most commonly found?
What type of spondylolisthesis is often associated with adolescents engaged in athletics?
What type of spondylolisthesis is often associated with adolescents engaged in athletics?
Which clinical presentation is characteristic of isthmic spondylolisthesis?
Which clinical presentation is characteristic of isthmic spondylolisthesis?
What grading indicates a 50% forward displacement of one vertebra over another in spondylolisthesis?
What grading indicates a 50% forward displacement of one vertebra over another in spondylolisthesis?
Which imaging technique is primarily used to diagnose scoliosis?
Which imaging technique is primarily used to diagnose scoliosis?
What is the primary management strategy for symptomatic Grade I and II spondylolisthesis?
What is the primary management strategy for symptomatic Grade I and II spondylolisthesis?
What is the risk factor associated with the progression of spondylolisthesis?
What is the risk factor associated with the progression of spondylolisthesis?
What is a characteristic of structural scoliosis type?
What is a characteristic of structural scoliosis type?
Which of the following factors does NOT contribute to primary osteoporosis?
Which of the following factors does NOT contribute to primary osteoporosis?
At what degree of curvature does surgical fixation become a treatment option for scoliosis?
At what degree of curvature does surgical fixation become a treatment option for scoliosis?
What defines lumbar spinal stenosis?
What defines lumbar spinal stenosis?
Which symptom is typically associated with lumbar radiculopathy?
Which symptom is typically associated with lumbar radiculopathy?
Which type of scoliosis is most commonly idiopathic?
Which type of scoliosis is most commonly idiopathic?
What is a common symptom associated with osteoporosis?
What is a common symptom associated with osteoporosis?
Which of the following is a key clinical presentation of lumbar spinal stenosis?
Which of the following is a key clinical presentation of lumbar spinal stenosis?
What is a method used to assess skeletal maturity in scoliosis patients?
What is a method used to assess skeletal maturity in scoliosis patients?
What is the recommended initial management for mild to moderate lumbar spinal stenosis?
What is the recommended initial management for mild to moderate lumbar spinal stenosis?
What mechanism of injury is most common for a lumbar muscle strain?
What mechanism of injury is most common for a lumbar muscle strain?
What is a common characteristic of the pain associated with lumbar muscle strain?
What is a common characteristic of the pain associated with lumbar muscle strain?
When may neurological signs be absent in lumbar radiculopathy?
When may neurological signs be absent in lumbar radiculopathy?
What is a crucial aspect to assess during functional testing?
What is a crucial aspect to assess during functional testing?
What may indicate a hypomobile sacroiliac joint during the Marcher’s test?
What may indicate a hypomobile sacroiliac joint during the Marcher’s test?
What role does posture assessment play during the evaluation?
What role does posture assessment play during the evaluation?
In which situation should surgical options be considered for a patient with lumbar spinal stenosis?
In which situation should surgical options be considered for a patient with lumbar spinal stenosis?
What does increased mechanosensitivity in nerve roots indicate during lumbar radiculopathy?
What does increased mechanosensitivity in nerve roots indicate during lumbar radiculopathy?
What type of sensation do patients with lumbar spinal stenosis commonly report?
What type of sensation do patients with lumbar spinal stenosis commonly report?
What should be assessed as part of the vital assessment upon initial evaluation?
What should be assessed as part of the vital assessment upon initial evaluation?
For a patient with a history of cancer and unexplained weight loss presenting with low back pain, what is the most appropriate initial investigation?
For a patient with a history of cancer and unexplained weight loss presenting with low back pain, what is the most appropriate initial investigation?
What is the most appropriate referral pathway for a patient presenting with severe, progressive neurological deficit affecting both legs, saddle anesthesia, and bladder dysfunction?
What is the most appropriate referral pathway for a patient presenting with severe, progressive neurological deficit affecting both legs, saddle anesthesia, and bladder dysfunction?
What is the most appropriate imaging modality for initial assessment of a patient with suspected abdominal aortic aneurysm?
What is the most appropriate imaging modality for initial assessment of a patient with suspected abdominal aortic aneurysm?
Which clinical feature is considered a red flag for spinal malignancy?
Which clinical feature is considered a red flag for spinal malignancy?
What is the most common site of metastases in the spine?
What is the most common site of metastases in the spine?
Which of the following is NOT a clinical feature suggestive of spinal infection?
Which of the following is NOT a clinical feature suggestive of spinal infection?
What is the most appropriate referral pathway for a patient with suspected ankylosing spondylitis?
What is the most appropriate referral pathway for a patient with suspected ankylosing spondylitis?
Which of the following clinical features are suggestive of Ankylosing Spondylitis? (Select all that apply)
Which of the following clinical features are suggestive of Ankylosing Spondylitis? (Select all that apply)
Which of the following is NOT a risk factor for abdominal aortic aneurysm?
Which of the following is NOT a risk factor for abdominal aortic aneurysm?
Which of the following is a typical feature of Cauda Equina Syndrome?
Which of the following is a typical feature of Cauda Equina Syndrome?
What is the point prevalence of spinal fractures causing low back pain?
What is the point prevalence of spinal fractures causing low back pain?
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?
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?
What is the most appropriate referral pathway for a patient with low back pain, fever, and chills?
What is the most appropriate referral pathway for a patient with low back pain, fever, and chills?
Which of the following conditions is characterized by a prevalence of 0.2-0.5%?
Which of the following conditions is characterized by a prevalence of 0.2-0.5%?
Which of the following is a clinical feature associated with Ankylosing Spondylitis?
Which of the following is a clinical feature associated with Ankylosing Spondylitis?
Which of the following is a red flag for a referred pain pathology related to the digestive system?
Which of the following is a red flag for a referred pain pathology related to the digestive system?
The Innominate Rotation Test assesses for which of the following?
The Innominate Rotation Test assesses for which of the following?
During the Limb Length Test - Long Sitting Test, what does a change from a short to a long leg length indicate?
During the Limb Length Test - Long Sitting Test, what does a change from a short to a long leg length indicate?
The "Sign of Buttock" test is used to identify potential pathology in which area?
The "Sign of Buttock" test is used to identify potential pathology in which area?
During the Prone Instability Test, what does a decrease in symptoms when applying CPA while the legs are raised off the floor indicate?
During the Prone Instability Test, what does a decrease in symptoms when applying CPA while the legs are raised off the floor indicate?
In the Passive Lumbar Extension Test, how is the patient positioned?
In the Passive Lumbar Extension Test, how is the patient positioned?
What specific joint is assessed during the Quadrant Test?
What specific joint is assessed during the Quadrant Test?
Which structure is NOT palpated during the palpation section of the examination?
Which structure is NOT palpated during the palpation section of the examination?
What is the PRIMARY objective of the "Hip AROM with Overpressure" test?
What is the PRIMARY objective of the "Hip AROM with Overpressure" test?
During the Thomas Test, what does a limitation in hip extension indicate?
During the Thomas Test, what does a limitation in hip extension indicate?
During the 90/90 Straight Leg Raising Test, what is considered a positive result?
During the 90/90 Straight Leg Raising Test, what is considered a positive result?
Which of the following is NOT a special test mentioned in the context of "Clearing the Hip"?
Which of the following is NOT a special test mentioned in the context of "Clearing the Hip"?
During the palpation section of the examination, which bony landmark would a clinician palpate to help identify the L4 spinous process?
During the palpation section of the examination, which bony landmark would a clinician palpate to help identify the L4 spinous process?
Which of the following statements BEST describes the function of the "Hip AROM with Overpressure" test?
Which of the following statements BEST describes the function of the "Hip AROM with Overpressure" test?
What is the PRIMARY objective of "Clearing the Hip" during a lumbar physical examination?
What is the PRIMARY objective of "Clearing the Hip" during a lumbar physical examination?
What is the PRIMARY purpose of the "Thomas Test"?
What is the PRIMARY purpose of the "Thomas Test"?
What is the purpose of "special lumbar tests" in the context of this document?
What is the purpose of "special lumbar tests" in the context of this document?
During an Active Range of Motion – Lateral Flexion assessment, how should the clinician apply overpressure?
During an Active Range of Motion – Lateral Flexion assessment, how should the clinician apply overpressure?
Which of these is NOT an assessment tool used to assess lumbar joint mobility?
Which of these is NOT an assessment tool used to assess lumbar joint mobility?
What is a positive finding in the Slump Test?
What is a positive finding in the Slump Test?
When assessing neurodynamics, what is the primary purpose of using a sensitizing maneuver after symptom provocation?
When assessing neurodynamics, what is the primary purpose of using a sensitizing maneuver after symptom provocation?
What is the primary purpose of conducting a Thigh Thrust Test during sacroiliac joint assessment?
What is the primary purpose of conducting a Thigh Thrust Test during sacroiliac joint assessment?
Which of these is NOT a component of the Sacroiliac Joint Pain: Test Item Cluster?
Which of these is NOT a component of the Sacroiliac Joint Pain: Test Item Cluster?
Which muscle group is assessed using resisted isometric movements in sitting?
Which muscle group is assessed using resisted isometric movements in sitting?
What is the primary focus of the Repeated End Range Testing in Weightbearing assessment?
What is the primary focus of the Repeated End Range Testing in Weightbearing assessment?
Which of these is a positive finding in the Prone Knee Bend Test?
Which of these is a positive finding in the Prone Knee Bend Test?
Which of these is a key consideration when performing a Straight Leg Raise Test?
Which of these is a key consideration when performing a Straight Leg Raise Test?
During a Crossed Straight Leg Raise Test, how should the clinician stabilize the knee?
During a Crossed Straight Leg Raise Test, how should the clinician stabilize the knee?
What are two key questions to be answered and documented for each joint during a Lumbar Segmental Accessory Assessment?
What are two key questions to be answered and documented for each joint during a Lumbar Segmental Accessory Assessment?
What is the primary purpose of a comprehensive lumbar physical examination?
What is the primary purpose of a comprehensive lumbar physical examination?
Which of the following is NOT a specific area of focus when considering motion quality?
Which of the following is NOT a specific area of focus when considering motion quality?
Which of these is a key consideration when applying overpressure during an Active Range of Motion assessment?
Which of these is a key consideration when applying overpressure during an Active Range of Motion assessment?
Which of these is an example of an aberrant motion during active range of motion assessment?
Which of these is an example of an aberrant motion during active range of motion assessment?
Flashcards
Patient History
Patient History
The process of gathering detailed information from a patient about their health and concerns.
Open-ended questions
Open-ended questions
Questions that allow patients to express their thoughts freely, encouraging detailed responses.
Active listening
Active listening
Engaging fully in the patient's narrative, showing understanding and empathy.
Closed-ended questions
Closed-ended questions
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Working diagnosis
Working diagnosis
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Symptom History
Symptom History
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Mechanism of Injury
Mechanism of Injury
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Irritability
Irritability
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Aggravating Factors
Aggravating Factors
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Easing Factors
Easing Factors
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24-Hour Day Pattern
24-Hour Day Pattern
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Social Determinants of Health
Social Determinants of Health
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Past Medical History
Past Medical History
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Joint Assessment
Joint Assessment
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Active Range of Motion (AROM)
Active Range of Motion (AROM)
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Passive Range of Motion (PROM)
Passive Range of Motion (PROM)
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End-Feel Assessment
End-Feel Assessment
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Joint Hypomobility
Joint Hypomobility
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Joint Hypermobility
Joint Hypermobility
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Barrier Concept
Barrier Concept
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S.I.N.S.S
S.I.N.S.S
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Severity
Severity
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Nature
Nature
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Stage
Stage
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Stability
Stability
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Patient History Purpose
Patient History Purpose
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Initial Greeting
Initial Greeting
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Body Chart
Body Chart
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Symptom Descriptors
Symptom Descriptors
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Numeric Pain Rating
Numeric Pain Rating
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Symptom Relationships
Symptom Relationships
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Chronic Pain
Chronic Pain
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Acute on Chronic
Acute on Chronic
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Moderate Irritability
Moderate Irritability
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OMPSQ
OMPSQ
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SBST
SBST
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FABQ
FABQ
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FABQ-PA
FABQ-PA
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FABQ-W
FABQ-W
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PCS
PCS
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Kinesiophobia
Kinesiophobia
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TSK
TSK
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Patient Self-Reporting
Patient Self-Reporting
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Functional Re-assessment Sign
Functional Re-assessment Sign
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History Taking
History Taking
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Joint Structures
Joint Structures
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Red Flags
Red Flags
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Hypothesis Generation
Hypothesis Generation
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Hypermobile Segment
Hypermobile Segment
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Pain or Muscle Guarding
Pain or Muscle Guarding
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Maitland Grades of Movement
Maitland Grades of Movement
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Grade 1 Mobilization
Grade 1 Mobilization
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Grade 2 Mobilization
Grade 2 Mobilization
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Grade 3 Mobilization
Grade 3 Mobilization
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Grade 4 Mobilization
Grade 4 Mobilization
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Grade 5 Mobilization
Grade 5 Mobilization
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Muscle Energy Technique (MET)
Muscle Energy Technique (MET)
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Mobilization with Movement (MWM)
Mobilization with Movement (MWM)
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Numeric Pain Rating Scale (NPRS)
Numeric Pain Rating Scale (NPRS)
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Patient Specific Functional Scale (PSFS)
Patient Specific Functional Scale (PSFS)
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Roland-Morris Disability Questionnaire
Roland-Morris Disability Questionnaire
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Oswestry Disability Index (ODI)
Oswestry Disability Index (ODI)
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STarT Back Screening Tool (SBST)
STarT Back Screening Tool (SBST)
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Urogenital System Conditions
Urogenital System Conditions
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Pelvic Pain
Pelvic Pain
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Yellow Flag Considerations
Yellow Flag Considerations
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Depressive Illnesses
Depressive Illnesses
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PHQ-2 Screening Instrument
PHQ-2 Screening Instrument
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Major Depressive Disorder Symptoms
Major Depressive Disorder Symptoms
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Patient Goals
Patient Goals
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Facet Joint Pain
Facet Joint Pain
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Spondylosis
Spondylosis
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Living Environment
Living Environment
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Spondylolisthesis
Spondylolisthesis
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Bone Pathology Terminology
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Yellow Flags
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Medical Screening
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Eco-ergonomic Assessment
Eco-ergonomic Assessment
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Physical Exam Planning
Physical Exam Planning
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Clinical Decision-Making Steps
Clinical Decision-Making Steps
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Patient Listening
Patient Listening
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Emergency referral
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Urgent referral
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Watchful waiting
Watchful waiting
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Safety netting
Safety netting
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Cauda Equina Syndrome
Cauda Equina Syndrome
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Spinal Fracture
Spinal Fracture
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Spinal Malignancy
Spinal Malignancy
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Spinal Infection
Spinal Infection
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Abdominal Aortic Aneurysm (AAA)
Abdominal Aortic Aneurysm (AAA)
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Ankylosing Spondylitis
Ankylosing Spondylitis
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Signs of digestive issues
Signs of digestive issues
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Renal conditions
Renal conditions
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Referral pathway for spinal conditions
Referral pathway for spinal conditions
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Clinical features of spinal malignancy
Clinical features of spinal malignancy
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Referral for cauda equina
Referral for cauda equina
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Osteoporosis T-score
Osteoporosis T-score
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DEXA scan
DEXA scan
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Sacroiliac Joint Pain
Sacroiliac Joint Pain
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Fortin’s Sign
Fortin’s Sign
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Annulus Fibrosis
Annulus Fibrosis
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Intervertebral Disc Herniation
Intervertebral Disc Herniation
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Stages of Disc Herniation
Stages of Disc Herniation
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Degenerative Disc Disease
Degenerative Disc Disease
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Spontaneous Regression
Spontaneous Regression
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Aggravating Activities
Aggravating Activities
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Common sites for Spondylolysis
Common sites for Spondylolysis
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Mechanism of injury for Spondylolysis
Mechanism of injury for Spondylolysis
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Clinical presentation of Spondylolysis
Clinical presentation of Spondylolysis
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Imaging for Spondylolysis
Imaging for Spondylolysis
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Grading Spondylolisthesis
Grading Spondylolisthesis
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Types of Spondylolisthesis
Types of Spondylolisthesis
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Isthmic Spondylolisthesis Symptoms
Isthmic Spondylolisthesis Symptoms
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Spondylolisthesis imaging
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Scoliosis
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Non-structural vs. Structural Scoliosis
Non-structural vs. Structural Scoliosis
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Cobb method
Cobb method
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Scoliosis Management
Scoliosis Management
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Primary vs. Secondary Osteoporosis
Primary vs. Secondary Osteoporosis
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Functional Testing
Functional Testing
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Sagittal Plane
Sagittal Plane
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Neurological Examination
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Myotomes
Myotomes
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Babinski Reflex
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Quadrant Test
Quadrant Test
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Compensation Patterns
Compensation Patterns
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Disc regression
Disc regression
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Lumbar Radiculopathy
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Myotome weakness
Myotome weakness
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Dermatome sensory loss
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Reflex loss
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Lumbar Spinal Stenosis
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Lumbar Muscle Strain
Lumbar Muscle Strain
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Pain during muscle contraction
Pain during muscle contraction
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Soft tissue mobilization
Soft tissue mobilization
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Marcher's Test
Marcher's Test
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Pelvic positioning
Pelvic positioning
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Symptom modulation
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Observation in assessment
Observation in assessment
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Active Range of Motion - Flexion
Active Range of Motion - Flexion
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Overpressure in Flexion
Overpressure in Flexion
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Aberrant Motion
Aberrant Motion
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Lumbopelvic Rhythm Reversal
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Straight Leg Raise (SLR) Test
Straight Leg Raise (SLR) Test
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Slump Test
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Prone Knee Bend Test
Prone Knee Bend Test
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Muscle Performance Testing
Muscle Performance Testing
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Sacroiliac Joint Testing
Sacroiliac Joint Testing
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Sacroiliac Joint Pain - Thigh Thrust Test
Sacroiliac Joint Pain - Thigh Thrust Test
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Neurodynamics
Neurodynamics
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Active Straight Leg Raise Test
Active Straight Leg Raise Test
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Joint Mobility Assessment
Joint Mobility Assessment
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Pain Arc
Pain Arc
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Upper and Lower Abdominal Strength Testing
Upper and Lower Abdominal Strength Testing
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Innominate Rotation Test
Innominate Rotation Test
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Limb Length Test
Limb Length Test
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Clearing the Hip
Clearing the Hip
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Hip AROM
Hip AROM
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FADIR Test
FADIR Test
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FABER Test
FABER Test
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Prone Instability Test
Prone Instability Test
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Sign of Buttock
Sign of Buttock
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Passive Lumbar Extension Test
Passive Lumbar Extension Test
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Thomas Test
Thomas Test
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90/90 Straight Leg Raising Test
90/90 Straight Leg Raising Test
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Muscle Flexibility Tests
Muscle Flexibility Tests
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Palpation
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Bone Landmarks
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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.
- Grade 1: Small amplitude out of resistance, typically used for pain reduction at the beginning of ROM.
- 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.
- Observation: Resting posture, movement quality, symmetry, muscle atrophy/wasting.
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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