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