In which set of special tests are you most interested?\n[[Disc Herniation and Nerve Tests|Disc]]\n[[PAs and Instability Tests|Instability]]\n[[Stenosis Tests|Stenosis]]
The Adventures of Therapization, Part 1
She demonstrates 5/5 bilateral knee extension, knee flexion, ankle plantar/dorsiflexion.\nHip abduction is 5-/5 bilaterally.\nHip extension is 4-/5 bilaterally.\nHip flexion is 4+/5 bilaterally.\nAnd she can hold a front plank for 50 seconds before fatigue.\n\nWhat next?\n[[Lumbar Spine Special Testing|Tests]]\n[[Trunk AROM and Muscle Length Testing|AROM]]\n[[Palpation|Palpation]]\n[[Reflex and Sensation Testing|Reflex]]\n[[I'm ready to prescribe treatment!|Final]]
Well done, good and faithful PT! There are still several things we need to learn about our patient:\n\nShe works in an office and sits 7-8 hours per day at the desk. She would like to be able to run a half marathon or at least a 5K in April or this summer. She sleeps 7-8 hours per night, but wakes frequently due to back pain. She sleeps on her side, which makes her hips uncomfortable, and reports it is sometimes difficult to breathe because of mid-back pain.\n\nWhat's next?\n[[Lumbar Spine Special Testing|Tests]]\n[[Trunk AROM and Muscle Length Testing|AROM]]\n[[Palpation|Palpation]]\n[[Manual Muscle Testing|MMT]]\n[[Reflex and Sensation Testing|Reflex]]\n[[I'm ready to prescribe treatment!|Final]]
The prone instability test is positive. The patient has mild pain at all end ranges of motion during the H & I test. Segmental mobility of the lumbar spine also provokes her low back pain and reveals more motion than average.\n\nWhat next?\n[[Disc Herniation and Nerve Tests|Disc]]\n[[Stenosis Tests|Stenosis]]\n[[Trunk AROM and Muscle Length Testing|AROM]]\n[[Palpation|Palpation]]\n[[Manual Muscle Testing|MMT]]\n[[Reflex and Sensation Testing|Reflex]]\n[[I'm ready to prescribe treatment!|Final]]
She is tender to palpation of L3, L4, L5, mildly to pressure over the sacrum, and over bilateral greater trochanters. She denies tenderness to palpation of the paraspinals, gluteals, piriformis, and sciatic nerve.\n\nWhat do you want to know next?\n[[Lumbar Spine Special Testing|Tests]]\n[[Trunk AROM and Muscle Length Testing|AROM]]\n[[Manual Muscle Testing|MMT]]\n[[Reflex and Sensation Testing|Reflex]]\n[[I'm ready to prescribe treatment!|Final]]
A 31 year-old female presents to your outpatient orthopedic clinic with a diagnosis of back pain. After perusing her past medical history (which is blank), what is the first question you would like to ask?\n[[Have you seen the new Hobbit movie?|Hobbit]]\n[[Will you tell me where it hurts?|Hurts]]\n[[Will you tell me what brings you here today?|Today]]
The slump and straight leg raise tests are negative bilaterally. The centralization test is also negative as she feels increased back pain with repeated motion in both flexion and extension.\n\nWhat next?\n[[PAs and Instability Tests|Instability]]\n[[Stenosis Tests|Stenosis]]\n[[Trunk AROM and Muscle Length Testing|AROM]]\n[[Palpation|Palpation]]\n[[Manual Muscle Testing|MMT]]\n[[Reflex and Sensation Testing|Reflex]]\n[[I'm ready to prescribe treatment!|Final]]
Her eyes grow wide with excitement and you two devote the next 45 minutes to talk about Middle Earth without addressing her low back pain. [[Fail.|Start]]
She points to her low back near L5's right transverse process and says "Here." You wish you would have asked an open-ended question first. [[Start over|Start]]
BJ Lehecka
[[Think again!|Tests]]
Post the following to the "Adventure" discussion board in Blackboard. Define your assessment of this patient's pathology (one sentence describing her primary limitation(s) and/or diagnosis). List which three or four exercises you would prescribe this patient. Also list at least one component of the examination that was not covered but would be helpful for a more comprehensive assessment. Lastly, set two measurable goals for this patient.
She demonstrates 0/4 reflexes at bilateral patellar tendons, 1/4 at bilateral Achilles tendons. She denies sensation loss upon testing.\n\nWhat next?\n[[Lumbar Spine Special Testing|Tests]]\n[[Trunk AROM and Muscle Length Testing|AROM]]\n[[Palpation|Palpation]]\n[[Manual Muscle Testing|MMT]]\n[[I'm ready to prescribe treatment!|Final]]
She can reach her fingertips to the middle of her lower leg with a slight increase in low back pain on the right near L3/L4. She demonstrates 2 cm of lumbar extension (measured from S2 to a point 15 cm cranially). She demonstrates full, non-painful trunk rotation and sidebending bilaterally.\n\nIn the 90/90 position, her hamstring flexibility measures 30 degrees from vertical bilaterally.\n\nThe Thomas test reveals significant hip flexor tightness bilaterally. Her rectus femoris and IT band lengths appear normal. Moreover, her hip internal and external rotation is 45 and 50 degrees, respectively, bilaterally.\n\nWhat next?\n[[Lumbar Spine Special Testing|Tests]]\n[[Palpation|Palpation]]\n[[Manual Muscle Testing|MMT]]\n[[Reflex and Sensation Testing|Reflex]]\n[[I'm ready to prescribe treatment!|Final]]
She thanks you for asking a relevant open-ended question first, then proceeds to tell you the following:\nShe reports low back pain as a child, which increased with the pregnancy of her now 8-year-old child. She reports a week away from giving birth, she sat down on the toilet and could not stand back up due to significant back pain. She saw a chiropracter when she was 9 months pregnant for pain relief. She also recalls sliding down a water slide in her earlier years as a lifeguard, hitting the water, and subsequently not being able to feel her legs and having to be carried out of the pool. After seeing a chiropracter for 1 year after the birth of her first child, she noticed pinching on what she believes to be her sciatic nerve.\nShe started running last year, which caused an increase in back pain. She got a cortisone shot in April of 2013 and an MRI on December 31st of 2013 which revealed a bulging disc at one of the segments of her lumbar spine (patient is unable to remember which level).\nShe reports intermittent radiculopathy in her right and left legs, right more often than the left, to the level of her knee.\nShe reports significant pain yesterday after being adjusted by her chiropracter, but then she did yoga in the evening and felt significantly better.\nYour time is limited (20 minutes before your next patient arrives). What would you like to do next?\n[[Lumbar Spine Special Testing|Tests]]\n[[Trunk AROM and Muscle Length Testing|AROM]]\n[[Palpation|Palpation]]\n[[Manual Muscle Testing|MMT]]\n[[Reflex and Sensation Testing|Reflex]]\n[[Ask more questions|Questions]]\n[[I'm ready to prescribe treatment!|Final]]