Good morning.
Today we're going to do the the virtual back and hip exam flow.
And so good morning, ma'am.
Today, we're going to be doing some movements
and some testing of strength and looking for things that are painful.
I'm going to start by having
you cross your arms on your chest and stand up from your chair.
And this is looking for strength. Very good.
And then go ahead and go to the side of your chair
so you can hang on to the back.
And I'm going to have you lift
one leg and and squat down with the other leg like a mini squat.
We're looking for strength and alignment of her leg, other side.
Now, again, we're looking for strength
and we're looking for symmetry and differences between the two.
Go ahead and walk towards me
looking again for
stability and alignment and you can turn around and walk back
and looking for the Trendelenburg gait of her pelvis
as well, looking for that drop.
Now I'm going to have you turn towards your corner of your room there.
Go ahead and walk on your toes.
And this is testing S1 motor again, looking for strength and symmetry.
And if she can keep her heels off the ground and turn around.
Walk back with your on your heels, with your toes in the air.
And this is looking at the L4, and it's fine to hold on a little bit for stability.
We don't want anyone falling during the exam.
Now, go ahead and come towards me.
Stand in front of your chair and let me see your back, please.
If you'll bring your shirt up.
We're looking for alignment, posture.
See if her hips are level.
Does she have any scars, rashes, any atrophy or asymmetry?
Now the next thing is the palpation.
So the first thing would be to have her point to
whatever area is painful that she wants you to evaluate.
And now we're going to do palpation of structures in general.
So put your hands on your hips for me.
That's the iliac crest.
That's the landmark to start.
Now you're going to feel up the spine in the center.
Those are the spinous processes and then come back down over the muscles.
Those are the lumbar paraspinals muscles
looking for spasm, pain, tightness.
Now she's going to go to the psis just below the belt line
and then move your thumbs in just a little bit and kind of march down
towards your tailbone.
That's the sacral sulcus, again, looking for discomfort
and then out to the gluteal muscles again, looking for discomfort or asymmetry.
Piriformis muscle is a little bit deeper
and then Ischial Tuberosity is the sit bone.
You can go ahead and bring your knee up and feel your sit bone on the right.
There you go. Just palpate.
See if that's tender.
That's where the hamstrings attach also.
And then the other side again, if it was tender, you would do it
just on the affected side.
Now go ahead and turn to the side.
I want to see the painful side towards me and I want you to feel
the side of your hip that's the greater trochanter.
So if you can't find it, you can kind of move your foot around.
You should feel a bone that's like sticking out a little bit.
There you go. That's the greater trochanter.
And then down the side of your leg for tightness or let me know if it's tender.
That's the ILIO tibial band. Very good.
Now you're going to face me and you're going to again
put your hands on your hips.
But I want you to find the hipbone in the front that kind of sticks out.
That's the ASIS.
And then just below it, let me know if that's uncomfortable.
Those are the hip flexor tendons.
Now I'm going to have you turn to the side.
We're going to look at your range of motion.
So you're going to go ahead, bend
all the way forward, see if you can touch the floor.
Looking at the back and the hip range of motion.
Very good.
Come back up and now you can bend backwards.
Looking for how good her extension is.
Is it uncomfortable?
Now turn your back to the camera for me.
I'm going to.
Have you been to the side?
You can slide your arm down your side.
Let me know if that's uncomfortable. Good.
Other way.
Again, looking for symmetry, looking for pain or discomfort.
Cross your arms on your chest and rotate your back.
And that again, just looking for discomfort or symmetry.
Go the other way for me. There you go. Perfect.
And now oblique extension.
I'm going to have you turn back this time towards me and look back
at the camera, kind of even down towards the floor
looking for that oblique extension that's loading the forceps.
And on the other side, back towards me, look over your shoulder, back down
towards the floor. There you go.
All right.
Now I'm going to go ahead and have you sit down in your chair
facing me.
And we're going to go ahead and first look at your range of motion.
So I'm going to
have you bring your hip up to your chest, bring your knee towards your chest,
kind of hug it to your body.
And again,
looking at hip flexion and knee flexion, same thing on the other side up.
Hug it towards you. Hip and knee flexion there.
Now I'm going to have you keeping your your thighs parallel to the floor.
Bring your foot out.
And we're looking at internal rotation of the hip.
Do it on the other side.
There you go.
And that's just looking at a comparison of both sides and how they how they look
and now bring again, thighs level, bring your heel in.
And that's the external rotation. Good.
And now same thing on the other side.
Like you're crossing your ankles almost right.
There you go. Good.
And that's that that rotation next is provocative testing
so the FADIR I'm going to have you bring your knee up to your chest
so flexion abduction bring it across the body towards the other shoulder
and then bring the foot out a little bit.
That's the internal rotation that's FADIR.
Looking for pain in the hip and symmetry side to side.
So do it on the other side.
Knee up across the body, bring the foot out.
There you go.
And that's just looking for, again, symmetry and pain or discomfort.
Now the FABER bring your bring your knee back up, grab your heel
and put it on the other knees you're making like a finger for.
There you go.
Like you're sitting cross-legged.
Now you can push on your knee a little bit, see if that brings any pain
out. Discomfort, symmetry, again, also same thing on the other side.
Knee up.
There you go. Good. Yep.
Heel and push.
Looking for discomfort, symmetry.
Next thing we're going to do is the neurologic exam.
Remember that we did L4 and S1 with the heel on the toe walking,
so we just need to do L2, L3, L5 so L2 hip flexion,
bring your knee up and then resist with your hands.
Resist that strength. Good.
And do it on the other side.
Bring the knee up and resist.
And you're looking for the patient to feel like they need to do a different
amount of force on each side.
Now, knee extension so you can bring your knee
up towards your body and then you want to hold the foot out,
sort of push it out and now push with your hand on your shin.
Push down, resist. There you go. Good.
Now you're going to do same thing on the other side.
That's L three testing the quads knee extension
and then L5 is the is the big toe extension.
So go ahead and bring your knee up towards your chest.
You're going to bring your your big toe up or all
your toes up and push with your other hand checking the strength.
There you go. Yep. And now same thing on the other side.
Knee up, bring the up, check the strength.
And you're looking for symmetry, looking to see if it's different on either side.
Now, sensory is next.
You're going to touch the middle of your thighs.
That's L2 tell me feels different or funny or numb.
L3 is the middle of the knee.
L4 down near the now heel.
There you go. Good.
And then top of the foot is L5.
Outside of the foot is S1.
There you go. Good.
And then come back up.
And then last is the slump.
So go ahead and straighten your leg out for me.
Bring your foot up towards you.
And again, looking for
reproducing the symptoms of Radiculopathy and then bend over.
And that's kind of that final slump looking for reproduction of pain.
And then you can do the same thing on the other side.
Put out, bring the foot up.
There you go and bend. Perfect.
And that's looking for, again, Radiculopathy.
Thank you so much.
That's it.