Lumbopelvic Exam PDF

Lumbopelvic Examination Adam Squires PT, DPT, Cert SMT, Cert DN Board Certified Specialist in Orthopedic Physical Therapy  Objectives Understand and demonstrate ability to assess lumbopelvic mobility. Understand and demonstrate ability to assess lumbopelvic streng...

Lumbopelvic Examination Adam Squires PT, DPT, Cert SMT, Cert DN Board Certified Specialist in Orthopedic Physical Therapy  Objectives Understand and demonstrate ability to assess lumbopelvic mobility. Understand and demonstrate ability to assess lumbopelvic strength. Understand and demonstrate ability to assess lumbopelvic joint assessment.  Subjective Exam Outcome Measures  Subjective Exam Where is the pain? Fill it out on a body chart Initial hypothesis What makes it worse? What is it? How much does it take? What makes it better? What is it? How much does it take? History – MOI, timeframe, etc. Working Hypothesis  Outcome Measures Oswestry Disability Index (ODI) Patient Specific Functional Scale (PSFS) Fear Avoidance Beliefs Questionnaire (FABQ) Numeric Pain Rating Scale (NPRS)  Oswestry Disability Index 10 questions Related to activities limited by back pain Each scored 1-5 Total out of 50 Then multiply by 2 to get percentage Minimum Clinically Important Difference (MCID) 6-10 point change (12-20% change) 50% reduction considered “successful” treatment in most research  Patient Specific Functional Scale Patient chooses 3-5 activities he/she has difficulty doing Rated on scale from 0-10 0: unable to perform activity 10: able to perform activity at same level as before injury/problem Average of ratings Patient-valued activities MCID – 1.5 points Minimum Detectable Change – 2.5 points Fear Avoidance Beliefs Questionnaire Focuses on how beliefs about activity and work contribute to low back pain 16 questions 0-6 – “completely disagree” to “completely agree” Higher scores = increased fear avoidance behaviors Physical Activity Subscale Work Subscale MCID – 25%  Numeric Pain Rating Scale 0-10 0 = no pain 10 = worst pain imaginable MCD and MCID – both 2 points https://www.redbubble.com/i/poster/Improved-Pain-Scale-by-PicturePerfects/34686689.LVTDI Physical Exam  Purpose of the Physical Exam Confirm/refute your working hypothesis Hypothetico-deductive reasoning Diagnosis/Prognosis Reproduce the patient’s familiar symptoms If symptoms are reproducible, they are generally reducible If not reproducible, screen for referral Identify impairments and functional limitations Targets for intervention  Overview Lumbar ROM Overpressure Repeated motions Dermatomes Myotomes Hip Screen Joint accessory motion assessment  Lumbar ROM Flexion “Tuck chin to chest, slide hands down your legs as far as you can.” Institute of Clinical Excellence Lumbar Spine Management  Lumbar ROM Extension “Cross your arms and lean back as far as you can.” Institute of Clinical Excellence Lumbar Spine Management  Lumbar ROM Lateral Flexion “Slide your hand down the side of your leg as far as you can.” Institute of Clinical Excellence Lumbar Spine Management  Lumbar ROM Rotation Patient seated “Turn and look behind you as far as possible.” https://www.youtub e.com/watch?v=Zo bPkVbQKxI&t=52s  Repeated Motions 5-10 repetitions of motion in one direction Centralization vs Peripheralization https://www.physio-pedia.com/Directional_Preference https://www.atipt.com/blog/low-back-pain-solution https://samarpanphysioclinic.com/lumbar-flexion-and-extension/  LE Dermatomes Test light touch sensation from L2-S2 Compare bilaterally Indicative of nerve root pathology  Dermatomes L2: Anteromedial mid-thigh L3: Medial epicondyle of knee L4: Medial malleolus L5: Dorsal 3rd MTP S1: Lateral heel S2: Midline popliteal fossa Dermatomes https://www.ncbi.nlm.nih.gov/books/NBK585755/figure/ch2.Fig59/  LE Myotomes L2 through S2 Stabilize proximally Apply moderate force and hold for 5 seconds Assessing for weakness Indicative of nerve root or other motor neuron pathology Upper motor neuron vs lower motor neuron lesions  Myotomes L2: Hip flexion L3: Knee extension L4: Ankle dorsiflexion L5: Great toe extension S1: Ankle plantarflexion S2: Knee flexion  Hip Screen Hip ROM Flexion, IR, ER, Extension FABER FADIR Assessing for reproduction of symptoms and/or deficits  Hip Screen https://www.uprighthealth.com/fai-tests https://www.researchgate.net/figure/a-f-Passive-hip-ROM-in- flexion-a-internal-rotation-with-90-of-hip-flexion-b_fig2_340926739  Joint Assessment Passive Accessory Intervertebral Joint Movement (PAIVM) Cannot be actively performed, but is still needed for movement Reproduction of symptoms Quality of movement – normal, hypomobile, hypermobile Not very reliable from person to person Central Posterior-Anterior glides (CPA glides) Unilateral Posterior-Anterior glides (UPA glides) Passive Physiological Intervertebral Movements (PPIVM) Passively performing movements that could be performed actively Again, reproduction of symptoms and quality of movement  Joint Assessment Central Posterior-Anterior (PA) and Unilateral PA glides Patient prone Broad contact Nose over area assessing Slowly sink into tissue – lower body, DON’T poke with fingers Assess for pain provocation and resistance Be systematic so that you are consistent!  Joint Accessory Motion Lumbar CPA Hypothenar eminence “Dummy” hand Lumbar UPA “Dummy” or stacked thumbs https://www.physio-pedia.com/Spinal_Manipulation https://brookbushi nstitute.com/cours es/joint- mobilization- lumbar-spine-and- sacroiliac-joint  Objectives Understand and demonstrate ability to assess lumbopelvic mobility. Understand and demonstrate ability to assess lumbopelvic strength. Understand and demonstrate ability to assess lumbopelvic joint assessment. Questions