Low Back/Spine Evaluation Module

Subjective/History

Determine ⁶: activity, MOI, location of pain, type of pain, severity of pain, onset of pain, unusual sounds/sensations, actions that increase & decrease pain, S/S, change in S/S over time, prior injury/ surgery, family history & general medical health

Objective

Inspection ^1,6:

General: swelling, discoloration, deformity, muscle symmetry/atrophy

Skin: neurofibroma, Faun's Beard, Cafe Au Lait Spots, blisters, discoloration, open wounds, scars& skin infections

Anterior View: pelvic obliquity

Posterior View: Scoliosis

Lateral View: pelvic tilt, lordotic curvature, kyphotic curvature

Postural Assessment:

Gait Assessment:

Low Back Palpation Rollover: using internet explorer rollover the images to trace some anatomy of the low back

Bony Palpation ¹:

Anterior Aspect: ASIS, iliac crest, iliac tubercle, greater trochanter & pubic tubercles

Posterior Aspect: PSIS, ischial tuberosity, SI, sacral and lumbar spinous processes

Soft Tissue Palpation ¹:

Midline: supraspinous and interspinous ligaments, paraspinal muscles

Iliac Crest: cluneal nerves

Sciatic Nerve: sciatic nerve

Femoral Triangal: borders (inguinal ligament, sartorius, adductor longus muscle) floor (pectineus, iliopsoas) contents (femoral artery, femoral nerve, femoral vein, lymph chain)

Greater Trochanter: trochanteric bursa, gluteus medius

Hip & Pelvic Muscles: iliopsoas, sartorius, rectus femoris, gracilis, pectineus, adductor longus, adductor brevis, adductor magnus, gluteus medius, gluteus maximus, hamstrings

Range of Motion ^1,5:

AROM: Flexion, Extension, Lateral Flexion & Rotation

PROM: Flexion, Extension, Lateral Flexion & Rotation

RROM: Flexion, Extension, Lateral Flexion & Rotation

Manual Muscle Testing  ²:

Gluteus Maximus, Gluteus Medius, Gluteus Minimus, Hip Adductors (Pectineus, Adductor magnus, Gracilis, Adductor brevis, Adductor longus), Hip Internal Rotators (Tensor fascia latae, Gluteus minimus, and Gluteus medius), Iliopsoas, Biceps Femoris, Semitendinosus, Semimembranosus, Quadriceps, Sartorius, Tensor Fascia Latae

Neurovascular Exam

Special Tests  ^3,7:

Weber–Barstow Maneuver, Supine to Long–Sit, Supine "True" Leg Length Discrepancy, Supine "Apparent" Leg Length Discrepancy, Clinical Discrimination Between Foral & Tibial Leg Length Discrepancy, Craig's, Gaenslen's, Fulcrum's, Nelaton's Line, Hip Scouring, Torque, Gillet's, Sacroiliac Compression, Sacroiliac Distraction, Piriformis Tightness, 90–90 Straight Leg Raising, Ely's, Thomas's, Patrick's, Trendelenburg's, Valsalva, Seated Straight Leg Raise, Oppenheim, Bowstring, Babinski, Slump, Single Straight Leg Raise, Bilateral Leg raise, Malinger's, Kernig, Stork, Hoover

Assessment

Identifies examiner's impression of injury & potientally complicating factors based on subjective & objective information

Plan

Explains examiner's goals as well as how the examiner intends on meeting these goals through initial managent, treatment, rehabilitation