CP 1 Connor Stuart 12051576

Physical Exam Plan

Gait and Postural Analysis

- Observing both from two planes focussing on movement of lower lumbar and SIJ on the
right side during gait

Full Active and Passive ROM

- Check sacrum, lumbar and mid-lower thoraces

- Check hip ROM, extension and flexion for power and pain due to tension/compression of
right side posterior tissue
- Check lumbosacral joint for any restrictions which may be causing or been caused by the
injury
- Spring area and challenge vertebrae for motion

Palpation

- Palpate all through lumbar and sacral region for tenderness, pain
- Feel for compensatory muscle tightness/weakness

Muscle Testing

- Lower back and hip muscles should be tested and graded for strength/weakness

Orthopaedic Tests

- Adam’s
- Supported Adams
- Lumbar Instability
- Homer Pheasants
- Ely’s
- Nachlas
- Yeoman’s
- Patrick Fabere
- Hip Telescoping
- Quadrant
- Allis

All chosen tests focus on the lumbar-hip region to assist in locating the location of tissue and
possible conditions associated with pain in the specified area.

Sensory Testing

- Test muscles, deep tendon reflexes and dermatomes (Lumbar and sacral nerve levels)

Systems Review

- Basic systems questions asked in history, findings in physical exam will dictate further
systems investigations. Would likely call for imaging referral.

Physical Exam Findings after History

Gait & Inspection (must be viewed from a minimum of two directions and skin must be exposed at some stage with
consent) (uses language patient understands)
CP 1 Connor Stuart 12051576

Gait
o Decreased right hip extension
o Under-facilitation of right glute
o Shorted left stride length (approx. 6cm)
o Right arm slightly greater movement during swing phase
Posture
o Right mastoid process higher (approx.. 1cm)
o Bilateral forward rounded shoulders with elevated right AC joint
o Increased right carrying angle
o Iliac crest and SIJ level
o Diffuse swelling in right popliteal fossa
o Three toes visible on each side
AROM of the Lumbar spine must be appropriate and diagnostic.
o Cervical; decreased right lateral flexion and rotation
o Thoracic; decreased left rotation and lateral flexion
o Lumbar; decreased extension and left lateral flexion
o No painful ROM reported
Static palpation must be appropriate and diagnostic.
o Right SIJ pain with pressure over reported injury site
o Pulling sensation reported with SIJ rocking
PROM / Motion Palpation (MP) and/or Resisted ROM must be appropriate and diagnostic.
o Resisted ROM not completed
o Springing testing on both sacrum and lumber segments
o Cervical; right rotation and lateral flexion restriction still present
o Thoracic; right rotation and lateral flexion restriction towards end range
o Lumbar; restricted extension (reported tightness of lower back posterior musculature)

Muscle Testing
o Gluteus Maximus and Medius (5/5 Bilateral)
o Gluteus Minimus (3/5 Right)
o Lumbar Erector Spinae (5/5 Bilateral)
o Quadratus Lumborum (5/5 Bilateral)
Special Tests must be appropriate and diagnostic - Must inquire about patient comfort or pain if applicable.
o Adam’s (-)
o Supported Adams (-)
o Lumbar Instability (-) Pain reported due to previously diagnosed L4 Spondylolisthesis not
stated in history
o Homer Pheasants (-)
o Ely’s (-)
o Nachlas (-)
o Yeoman’s (-)
o Patrick Fabere (+ for tight adductors)
o Hip Telescoping (-)
o Quadrant (-)
o Allis (+ Right side long tibia approx. 1-2cm)

SMR- completes appropriate sensory, motor and reflex examination must be appropriate and diagnostic.
o Sensory of lower limbs insignificant (sharp/dull and light touch on Bilateral L2-S1 dermatomes)
o DTR of Hamstring, Patellar and Achilles all +2 Bilateral
Systems review seemed unnecessary after history, vitals and history findings.