Answer 4

  • Wash hands
  • Gain informed consent again
    • Ensure the patient is comfortable to continue by asking them directly. 
  • Proceed with objective assessment
    • Observe both the left and right side
      • Check gait, posture
    • Check range of motion of hip, thoracic spine and lumbar spine
      • It would be important to check for range of motion in these joints as it can further narrow down the site of injury as well as give the patient a baseline for treatment progression and regression. Additionally, this helps identify if it is more of a structural or a soft tissue injury.
    • Check strength of hip flexors, extensors, abductors, adductors, core muscles.
      • Check to see strength for baseline purposes. Important to add that you would only perform strength testing if you believe that the injury was not too acute which could potentially aggravate the injury.
    • Neuro scan
      • Check myotomes, dermatomes, and reflexes as Paul is presenting with neurological symptoms.
    • Palpation
      • Lumbar spine spinous process and transverse processes.
      • Quadratus lumborum, erector spinae muscles, glute muscles, iliopsoas, rectus femoris, hamstrings, piriformis, trochanteric bursa
    • Special tests
      • SIJ testing (Compression, Distraction, Thigh thrust)
      • SLR
      • Slump test 
    • Outcome measures
      • Oswestry low back disability
      • Berg balance scale
      • Rhomberg test 
      • Numeric pain rating scale
    • Document assessment and allow Paul to ask questions.