Today I brought in a fellow student to the marjon clinic who was complaining of low back pain. The goal of this session was to practice a full lumbar spine objective assessment for future patients and my upper limb assessment exam next week. As such I constructed a full lumbar spine objective assessment guidance with the help of course lecture notes, physiopedia and the orthopedic special tests book by Konin et al. (2016). This guidance sheet included observation (general posture, head position, spine position, anterior pelvic tilt), clearing above/below joints with AROM (thoracic spine and hips), palpation (spinous and transverse processes of L1-L5, Sacrum, muscles), AROM, PROM of lumbar spine, neurological assessment for potential nerve compression/pathology (dermatomes, myotomes, reflexes, neurological tests such as straight leg raise) and finally PA accessory movements (assessing vertebrae mobility and pain). Other special tests such as prone knee bend (assessing femoral nerve, L2-L4 region) and clonus and Babinski (assesses integrity of nervous system) were also included. Diagnosis of patient was unspecific LBP as none of these tests were +ve. Lower back pain is defined as lower back pain that has symptoms of tension, soreness/ or stiffness without an identifiable specific cause of pain (Savigny, Watson & Underwood, 2009).
After my patient left I then talked to my clinic supervisor on how to quickly find specific vertebrae for palpation and I was told the following: C7/T1 protrude a lot (to find which is which palpate then ask patient to rotate head, if it moves it’s C7), T3 is on height with spine of scapula, T7 is on height with inferior scapula angle, L1 is around the area where the ribs stop, L4 is on height with iliac crest and S2 is on height with the PSIS. This advice was really helpful as I will need to quickly locate specific vertebrae in my practical exam.
This session went fairly well, and I learnt a lot especially in terms of PA, palpation and neurological testing. However, it’s clear that I need to revise the application and reasoning behind the neurological testing (Dermatomes, myotomes, neurodynamic tests such as straight leg raise). As such I will revise this with the help of the special tests book by Konin, Lebsack, Valier, & Isear (2016) and the physiotutors YouTube channel (Video demonstrations of tests) to prepare for future patients and my exam.
Physiotutors YouTube channel: https://www.youtube.com/user/Physiotutors/videos
Konin, J., Lebsack, D., Valier, A., & Isear, J. (2016). Special tests for orthopedic examination (4th ed., pp. 364-390). SLACK incorparated.
Savigny, P., Watson, P., & Underwood, M. (2009). Early management of persistent non-specific low back pain: summary of NICE guidance. BMJ, 338(jun04 3), b1805-b1805. doi: 10.1136/bmj.b1805