Gait: able to heel and toe walk, gait intact ROM: limited AROM of the L spine in all planes Motor: 4/5 b/l hip extension and abduction 5/5 strength in the bilateral lower extremities including HF,KE, KF,AD, EHL, PF, inversion, eversion Sensation: intact to light touch in all dermatomes tested from L2- S1 bilaterally Reflexes: 2+ b/l patella and Achilles, plantar response down going, proprioception intact Palpation: Diffusely tender over lumbar paraspinals -TTP over the b/l greater trochanters and bilateral SI joint Tone: normal in the b/l LEs Lymph: no lymphadenopathy at groin or popliteal fossa Provacative tests: - SLR, seated root (slump test), Kemp, FABER testing, FADIR testing, Elys test to 0 degrees, Obers negative bilaterally
Gait Eval Look at feet, ankle, and knees Heel strike, lat foot, then cross over medially to big toe off Look at shoe wear What is trendelenberg ?
Trendelenberg Marilyn Monroe Weak Glut med Hip Abductor Sup gluteal N L4/L5 S1
Controversial if should do this, can worsen pain Flexion 90 degrees Extension 30 degrees Lat Bending 30 degrees
Muscle Grading 5 full strength and full range 4 less than full strength, full range 3 against gravity full range 2 gravity eliminated, full range 1 twitch 0 nothing
HE; one of the core muscles Range 0-30 Glut max Hamstrings How isolate hamstring? Does it matter? Glut max prime mover (inf gluteal nerve L5, S1, S2) What is the most common herniation?
HF Range 0-125 Iliopsoas (iliopsoas nerve L2,L3) prime hip flexor Rectus femoris, sartorius (fem nerve L2,L3,L4)
KF Range 0-135 Need greater than 90 degrees to stand up out of chair Hamstrings: Semimembranosus (sciatic, tibial portion L4/L5/S1/S2 Semitendinosus (sciatic, tibail portion L4/L5/S1/S2 Biceps Femoris(Long head (sciatic, tibial portion L5/S1/S2, SHORT head common fibular portion L4/L5/S1/S2
AD Range 0-20 Tibialis anterior, deep peroneal nerve L4/L5/S1
EHL does toe extension Deep fibular nerve L4/L5/S1
PF Range 0-50 Muscles Gastroc/Soleus primarily S1
Inversion Tibialis posterior, tibial nerve L4/L5/S1 More subtle than AD
Eversion Peroneus longus and brevis, superficial fibular nerve L4/L5/S1
Patient with AD weakness and HE weakness, where is the lesion?
Dermatomes Useful to differential muscle weakness vs nerve involvement vs myopathy
Lumbar paraspinals Consistent with muscle sprain and facet issues
Greater Trochanter Bursitis versus gluteus medius tendinosis
SI joint SI joint or gluts
What is tone? What is spasticity?
What do you rule out here? What maneuver’s can you double up on Check pop fossa during SLR Check groin during FABER
SLR/Seated Root Positive from 30 to 70 degrees
FABER: Flexion/Abduction, External Rotation Opp SI joint, or hip pain
Ober’s Check’s TFL tightness Press on TFL to find tender points which also signifies tightness Found a lot in runners Changes running mechanics
FADIR Flexion, ADduction, Internal Rotaion
ELY’S test, tests quad tightness Causes pelvic tilt Putting more stress on facets