Algorithm #1 Lumbo-Pelvic Region Examination

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Trevor Jenkins
6 years ago
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1 Red Screen for Potentially Serious Conditions (i.e., Red Flags) including Neurologic when indicated Positive Findings Algorithm #1 Lumbo-Pelvic Region Clinical Prediction Rule Screening: Duration of symptoms <16 days Findings No symptoms distal to knee At Least 3 of 5 FABQ work score < 19 Variables Present Detection of lumbar hypomobility > 35 o hip internal rotation Less Than 3 of 5Variables Present Less Than Favorable Response Lumbopelvic Region Manipulation Favorable Response Consultation with Appropriate Healthcare Provider Centralization/Favorable Response Positioning /or Repeated Movements for Centralization (if indicated) Symptoms Do Not Centralize To Algorithm #2 Sagittal Plane Lumbar Spine Repeated Movement Exam Lumbar Single Plane Active Mobility Pain Does Not Limit Motion in Available Ranges /or Pain at End Range Does Not Produce Peripheral Symptoms To Algorithm #2 Pain During Movement, Pain Pain Limited Limits Motions in Available Nerve Mobility Ranges, or Movement Produces (SLR or Slump) Peripheral Symptoms Lateral Shift Flexion Extension Lumbar Stabilization /Modality Nerve Entrapment Reduction

2 Algorithm #2 Sagittal Plane Limited Anterior Rotation Motion Testing Limited Posterior Rotation PSIS Equal Or Positional Testing Or ASIS Equal Provocation of Sacrotuberous, /or Short Posterior Provocation of Sacrotuberous /or Short Posterior Sacroiliac Ligaments Ligament Provocation Testing Provocation of Long /or Short Posterior Provocation of Long Posterior Sacroiliac Ligaments /or Short Posterior Translation with Anterior Anterior Go To Algorithm #3 Transverse Plane Algorithm ***Must have 2 out of 3 Square Boxes for greater specificity to Treatment Category Posterior Translation with Posterior

3 Algorithm #3 Transverse Plane Limited External Rotation (Inflare) Active Motion Testing (Leg Rotation Test) Limited Internal Rotation (Outflare) Medial Positional Testing Lateral Positive ASIS Compression Test Provocation of Short Posterior SI Ligament Ligament Provocation Testing Positive ASIS Distraction Test (Suspect Anterior SI Ligament Involvement) Outflare Go To Algorithm #4 Lumbar Mobility Inflare

4 Algorithm #4 Lumbar Spine Segmental Mobility To Algorithm #5 Movement/Pain Relationship with Active Side-Bending No pain group Flexion Manipulation Group Extension Manipulation Group (Contralateral Lumbar Pain) (Ipsilateral Lumbar Pain) Transverse Process Symmetry Sitting Flexed Position Prone Extended Position Palpable positional asymmetry on Palpable positional asymmetry on Left Right Left Right Resistance with P-A Pressures Unilat PA s Reproduce Symptoms no resistance Resistance/ Resistance/ no resistance Hypermobile Hypomobile Hypomobile Hypermobile Segment Segment Segmental Muscle Hypertonicity No Yes Add STM if Present Yes No Neutral /or Flexion/SB/Rot Spinal Manipulation Neutral /or Extension/SB/Rot Spinal Manipulation To Algorithm #5

5 Algorithm #5 Associated Impairments Provide intervention intended to normalize impairments felt to be strongly associated with the patient s symptoms or functional limitations Mobility/Flexibility Deficits Lumbar Extension ROM Hip Flexors Sciatic Nerve Lumbar Flexion ROM Hip Extensors Femoral Nerve Hip Internal Rotators Dural Structures Hip External Rotators Piriformis Muscle Strength/Motor Control Deficits Upper Abdominals Trunk Extensors Hip Extensors Lower Abdominals Trunk Rotators Hip Abductors Transverse Abdominus Multifidi Low Aerobic Capacity Coordination Deficits Lower Extremity Balance Disorders Poor Ergonomic Proprioceptive Deficits Functioning

Lumbar Spine Applied Anatomy. Jason Zafereo, PT, OCS, FAAOMPT Clinical Orthopedic Rehabilitation Education

Lumbar Spine Applied Anatomy. Jason Zafereo, PT, OCS, FAAOMPT Clinical Orthopedic Rehabilitation Education Lumbar Spine Applied Anatomy Jason Zafereo, PT, OCS, FAAOMPT Clinical Orthopedic Rehabilitation Education Objectives Discuss concepts relevant to pathophysiology and differential diagnosis for lumbar radiculopathy