| Which structures would you palpate? (Lumbar) | Spinous processes
Transverse processes
Erector spinae/obliques/rectus abdominals |
| What are we looking for in an anterior posture observation? | Ears, Shoulder, Clavicle, Iliac crest, Patella (base + apex), Medial malleolus. |
| What are we looking for in a lateral posture observation? | Centre of ear, Shoulder joint, Greater trochanter, through knee, anterior to lateral malleolus. |
| What are we looking for in a posterior posture observation? | Ears, shoulders, Inferior angle, Iliac crest, Knee creases, Medial malleolus. |
| How would you clear around the cervical spine? | Shoulder- Active movement and overpressure.
Flexion, extension, abduction.
Thoracic- Active movement and overpressure.
Flexion, extension, side flexion (both sides), rotation. |
| What are we testing for active ROM (Cervical)? | Flexion, extension, side flexion, rotation.
Apply overpressure. |
| What are we testing for passive ROM (Cervical)? | Flexion, extension, side flexion, rotation. |
| How would you complete active resisted muscle testing? (Cervical) | Flexion- Scalene
Extension- Sternocleidomastoid
Side flexion- Sternocleidomastoid
Rotation- Sternocleidomastoid |
| What structures would you palpate? (Cervical) | Spinous processes
Transverse processes
Muscles (Sternocleidomastoid) |
| Which reflex tests are relevant for cervical spine? | Biceps tendon reflex
Triceps tendon reflex
Brachioradialis tendon reflex |
| What are the dermatomes of cervical spine? | C2- Back of head (top half)
C3- Back of head (occipital bone)
C4- Above/on clavicle
C5- Under clavicle
C6- Over middle of deltoid
C7- Back of arm over tricep (Index + Middle finger)
C8- Back of arm behind tricep (Pinky + Ring finger) |
| What are the myotomes of the cervical spine? | C1/C2- Neck flexion
C3- Side flexion
C4- Shoulder shrug
C5- Shoulder abduction
C6- Elbow flexion and wrist extension
C7- Elbow extension and wrist flexion
C8- Finger flexion + Thumb extension |
| What neurodynamic tests are for cervical spine? | Upper Limb Tension Test 1
Upper Limb Tension Test 3 |
| Describe upper limb tension test 1 | Tests For Median Nerve
Shoulder depression, shoulder abduction, external rotation, forearm supination, wrist + finger extension |
| Describe upper limb tension test 3 | Tests For Ulnar Nerve
Shoulder depression, shoulder abduction, shoulder external rotation, wrist + finger extension, elbow flexion, shoulder abduction. |
| What is the structure of the assessment? | Observation (posture + gait)
Active movement with overpressure
Passive movement with overpressure
Clearing (above + below)
Active resisted muscle testing
Passive ROM
Palpation
Neurological assessment (reflex, myotomes, dermatomes)
Neurodynamic tests |
| What are we looking for when assessing gait? | Normal gait
Heel strike, Foot flat, Midstance, Toe off. |
| How would you clear around the lumbar spine? | (Apply overpressure)
Above- Thoracic
Flexion, extension, side flexion, rotation.
Below- SIJ
Place thumbs on SIJ joint and get patient to perform hip flexion on both legs. Feeling for any asymmetry. |
| What are we testing for active ROM? (Lumbar) | Flexion, extension, side flexion, rotation.
Apply overpressure and ask if any pain. |
| What are we testing for passive ROM? (Lumbar) | Flexion, extension, side flexion, rotation. |
| How would you complete active resisted muscle testing? (Lumbar) | Flexion- Rectus abdominals
Extension- Erector spinae
Side flexion- External obliques
Rotation- External obliques |
| Which structures would you palpate? (Lumbar) | Spinous processes
Transverse processes
Erector spinae/obliques/rectus abdominals |
| What reflex tests are relevant for lumbar spine? | Patella tendon test
Achilles tendon test |
| What are the dermatomes for lumbar spine? | L1- Below belly button, over iliac crest.
L2- Below iliac crest to top of inner thigh.
L3- Greater trochanter along inside of leg, inner side of gastrocnemius.
L4- Over majority of quads, over knee and along inside of shin. (Big toe)
L5- Outside of thigh and along tibialis anterior. (Toes 2-4). |
| What are the myotomes for lumbar spine? | L2- Hip Flexion
L3- Knee extension
L4- Ankle dorsiflexion
L5- Big toe extension |
| What neurodynamic tests are relevant for lumbar spine? | Slump test
Femoral Slump test |
| Describe the Slump test | Tests sciatic nerve
Patient sat down
Patient places hands behind back
Patient flexes neck and slumps body forwards
Knee extension and dorsiflexion of foot |
| Describe the femoral slump test | Tests femoral nerve
Patient lays on side with tested side on top
Patient holds lower knee against chest with neck flexed
Upper leg passively moved into hip extension and knee flexion |
| How many cervical vertebrae are there? | 7 cervical vertebrae
8 cervical nerves |
| How many lumbar vertebrae are there? | 5 lumbar vertebrae
5 lumbar nerves |
| Why is palpation important? | For identifying any tender areas or bone asymmetry. |
| Why is it important to assess posture? | To identify any muscle imbalances or abnormalities to normal anatomy. |
| Why is gait assessment important? | To identify any muscle imbalances. |
| Why is it important to clear above and below? | To identify any referred pain. |
| Why is active resisted muscle testing important? | To ensure the patient has full strength and range of motion. |
| Why are neurodynamic/neurological assessments important? | To identify any nerve damage and the source. |
| How would you find L4? | Find vertebrae in line with iliac crest. |
| What would you do for PIVMS/PAIVMS? | PIVMS- Find intervertebral space by palpating vertebrae and moving patient into extension.
PAVIMS- Use pisiform technique to put added pressure on vertebrae. |
