PHTY301 Documentation - Lumbar Spine

Patient Interview
Body chart …

Physical Examination
Observation In standing:
From behind
Spinal Curves (lordosis / kyphosis / scoliosis / flat / hinges / creases /
LIST)
Levels - shoulder + waist + PSIS + knee crease levels
Foot posture, Muscle tone and bulk, Symmetry, Lesions e.g. scars

From the side

Pelvic tilt (posterior/anterior), Spinal Curves, Rib contours
Centre of gravity (sway back, trunk forward?)

From the front

Levels, rib contours,
abdominal tone, breathing pattern

In sitting:
Natural posture (slumped, excessive extension, flat back)

Functional Movements Walking, STS, single leg stand, picking something from floor, socks,
squatting, rolling in bed
- Pain level, pattern of spine movement in these tasks

STS: PLx (R) 6/10, flat back on return to extension

AROM (active, ROM (fingertips), pain location and severity (/10 or mild/mod/sev),
repeated, combined) quality of movement and limiting factor (R2/P2)
Full pain free movement = double tick
* - for those AROMs that best reproduce or ease patient symptoms

Flex: P1 to superior patella; PLx (R) mod; thoracic flex; P2 inferior

to patella; PLx (R) sev
…
Adjacent joints Screening test, side, pain/stiffness/instability, ROM

Hip Quadrant (L): PLx sev, mid-range

Palpation Skin rolling: Soft tissue texture, temperature and muscle tone
PAIVMs Movement: Segment, joint position, pain (mild/mod/sev), degree of
stiffness (mild, mod, sev), limiting factor (R2/P2).
NOTE: If P2, can’t gauge stiffness, R2 is assumed if not denoted.

Central PA: L2 flex, PLx++, P2

Central PA: L4 neut, PLx++, stiff +, P2

PPIVMs Movement: Segment, hypermobile/hypomobile

NOTE: can quantify mobility with /,//,///
NOTE: PPIVMs should not reproduce pain

Lateral flexion: L3, slightly hypomobile

Rotation: L4, severely hypomobile

Neurological testing Muscle strength (MMT0-5), Reflexes (patella / achilles, hypo, hyper,
normal, absent), Sensation (elevated, reduced, altered, blurry)
Neurodynamic testing Specific NTPT, side, degrees, position and location of symptom
reproduction, limiting factor, effect of structural differentiation

(L) SLR, 70 degrees P2

Slump double tick with Lx flex and Cx flex
(R) knee ext -10 degrees, back of leg R2; Cx ext = reduced
stiff
(L) knee ext -30 degrees, (L) PLx P2, Cx ext = reduced pain

Muscle length tests

Treatment
PAIVMs Movement, segment, Grade, time, sets, asterisk reassessment
(AROM, functional movement)

(R) Central L4 – G3 x 45s x 2

Ext: P1 to knee crease, PLx (mod), thoracic hinge; P2 2cm below
knee crease, PLx (sev).

PPIVMs Movement, Grade, time, sets, asterisk reassessment (AROM,

functional movement)

(R) Segmental Rot L4 G4 x 45s x 2

(R) LF: R1 to knee level, PLx (mod); R2 3cm below knee level, PLx
(mod)

SNAGs
Neurodynamic (sliders Movement, structural differentiation, time/dosage +
and tensioners) response to treatment (reassessment as per above)