Physiotherapy Webinars: Revision Notes
Relevance to patient:
- Is it appropriate?
- Which tissues is causing the pain?
- Soft tissue
- Poor stability
- Are the diagnostic test reliable/valid?
- What exercises will compliment the intervention?
- See slides (8.01 on webinar)
- Active Physiological Movement ( back AROM)
- Quadrant movements (combined movements)
- Clinical usefulness of quadrant testing: Achieves unilateral end range movement (ie maximum end range of facet joint)
- Neural test were normal
- SI tests normal
- Functional test : Single leg balance with knee bend- lateral shift of hips to left when standing on left. ?loss of stability.
- TOP L5/ S1 segment
- Weakness of left glut med,
- Tight, hypertonic, trigger point formation within gluts will create shortening effected in muscle – lose optimum position (length/tension)
- By shortening muscles functionally places sacromeres in a shortened position (bio mechanical disadvantage – reduced strength and power generation – resting state of hypertonicity).
- How to determine which segment (if any are problematic)
- How do we treat effectively?
- Passive Physiological Interverterbral movements (PIVIMs)
- Passive accessory intervertebral movements (PAVIMs)
- These determines biomechanical segment restrictions.
- Palpating to feel gapping between interspinous space.
- Lumbar facet joint = 2 glides
- Posterior inferior, associated with extension.
- Anterior superior, associated with flexion.
- Direction of the glide is named by the superior bone of the segment.
- If a facet joint’s PIVIM/PAVIM feels hypermobile or ‘stuck’ then it is appropriate for mobilization.
- If the joint feels hypermobile, then stability testing may indicate that it is NOT appropriate for mobilisation.
- Hypermobile joints need stabilization through strengthening exercises.
Case study –
- Hypomobile right L5/S1
- Loss of posterior/inferior glide at right L5/S1
- Hypermobile L4/L5 and L5/S1 on testing
- Hypermobile joints may require stability testing. Left L5S1 was unstable with left rotation
- Locking the spine
- Minimize movement at other joints above and below.
- Locking upper level
- Bottom lever
- Grades 1-5
- Mobilization force in 3 different planes.
- Posterior/inferior glide (restore extension)
- Anterior superior glide (restore flex)