Category Archive Physiotherapy A-Z

Hot Tub Therapy/Hot tub hydrotherapy can be a luxury you indulge in once in a while or a daily practice to help lower stress, ease physical tension, nurture relationships, and inspire regular self-care. I know that by letting my hot tub stand at the center of my circle of wellness, I cultivate a constant commitment to good health, happiness, and the lifestyle I envision. You can do the same.

If you’re struggling with arthritis, hot tub hydrotherapy can help. There’s nothing like warm water to alleviate the stiffness, joint pain, and inflammation that are often associated with arthritis.

If you suffer from the uncomfortable or painful symptoms of arthritis, here is how hot tub hydrotherapy may be able to help.

Hot Tub Therapy for Arthritis

If you suffer from joint pain from arthritis, warm water can help your body to relax. This relaxation is the first step to letting go of muscle tension, leading to more flexibility and a better flow of oxygen through the bloodstream. Soaking in jet-driven water can also help ease many of the symptoms due to the warmth and buoyancy of the water.

The symptoms of arthritis that can be mitigated with hot tub hydrotherapy include:

• Stiff joints
• Tense muscles
• Poor flexibility and range of motion
• Pain and soreness

If you gently exercise while you’re in your hot tub, you can even improve your muscle strength and your circulation because the water provides resistance.

If you want to try exercising in your hot tub or spa, start off slowly until you find your comfort level. This will prevent you from having pain flare-ups. For example, you could try straight leg raises, leg kicks, and marching on the spot.

While hot tub hydrotherapy can help to ease some of the direct symptoms of arthritis, many are not aware of the indirect health benefits that can help to further promote better health. These can include better sleep patterns, fewer feelings of stress, improved muscle recovery, and even improved mental wellness through self-care, relaxation and more time spent with loved ones.

How to Make the Most of Your Hot Tub Therapy

Medical experts recommend soaking in the warm water for anywhere from 20 to 45 minutes. How long you soak in a hot tub will depend on a number of factors, including but not limited to your health, climate and personal preferences. You may want to speak with your doctor first to ensure hydrotherapy is right for you and how to best use it when treating the symptoms of arthritis.

If you’re using your hot tub for joint pain, the water temperature should be between 98 and 102 degrees Fahrenheit.

You can maximize your hot tub therapy by using the jets. This gentle massage boosts your circulation, eases tension, and relaxes your muscles. The combination of massage and warm water softens your soft tissues, making them more flexible, so movement becomes easier. Warm water also helps increase blood flow to stiff joints and muscles and can reduce swelling and inflammation.

Relaxing your Mind

When you are living with chronic pain, it’s not just your body that needs to relax, but also your mind.

Just sitting in your hot tub, listing to the gentle bubbling of the water, and breathing slowly can provide you with the perfect opportunity to meditate.

There’s nothing better than the combination of meditation and soothing warm water to help your tension melt away, so you can deeply relax.

The Benefits of Draining and Cleaning Your Hot Tub

Even though you treat, sanitize and shock your hot tub water regularly, you will need to replace it altogether at some point. Contaminants such as body oils and lotions, cosmetics, hair products, sweat, and dead skin are introduced into the water when the tub is used. These contaminants also get into the plumbing and filters, and can create a layer of bacteria that is hard to get rid of, called a biofilm.

You can only get rid of the biofilm by carefully draining and cleaning the hot tub using the right hot tub and plumbing cleaning products. Your hot tub is due for service/maintenance if it:

• Emits bad odors
• Has cloudy or murky water, even after treatment/shocking
• Has been used by very many people in a short time-span
• Has not been used for a long while e.g. after winter

Draining Your Hot Tub

Ensure the spa is disconnected from power before attempting any maintenance tasks. Start by adding a plumbing cleaning agent before draining your hot tub. The cleaner is specially made to break down biofilm buildup in the pipes and filters. It should sit/circulate for a while (check the package) – allow a few hours of circulation or even overnight before draining.

You can drain the tub by connecting a hose and allowing gravity to push out the water, but this can take hours. Alternatively, a sump pump can empty the hot tub in minutes. The wastewater should go into the sewer system, but some people drain into their backyards or gardens.

Cleaning Your Hot Tub

Clean or replace your filter while the tub is draining off – rinse thoroughly with clean water to remove the cleaning agents. Spray the shell with a hot tub cleaner and wash, paying attention to any nooks and crannies. Remove residues with soft microfiber cloths and rinse all surfaces thoroughly. You may also want to take this opportunity to clean your hot tub filter, along with other accessories such as the steps or cover. Drain the cleaning water the same way as the dirty spa water.

Refilling Your Hot Tub

Finally, add fresh water through a hose with a filter to reduce the volume of impurities. Always use high-quality water to reduce the risks of stains and mineral deposits. Stay close to avoid flooding, especially in indoor tubs.

Bringing Your Family Together

Life these days is so busy. With work, school, family, and so much more, it can be difficult to find any time to spend together. With a new 4-person hot tub or larger, for example, you’re sure to make some room for a little family soak. Talk to one another, catch up, and relax while you are doing it.

This is also a great way to sneak in a date night while the kids are in bed. It’s hard finding alone time when you have a family, and it is difficult to take a trip and leave the kids behind. There is no need to feel guilty when getting away to your back yard.

Stress Relief

Along with the busy days comes so much built-up stress. Having a 2-person hot tub on hand gives you easy access to stress relief. Soak in a hot tub with some wine and music download. Unwind and let the daily built-up stress melt away.

Regular Low-Impact Exercise

The Sundance® Spas brand offers a variety of hot tubs to help you get in your daily workout. Some people find it much easier on their muscles and joints to work out in the water. Now you can. Just contact your local Sundance® Spas dealership today.

Muscle Relief

Spending the day on your feet, or sitting at a desk, you are sure to have some serious muscle aches and pains. A great way to relieve these pains is by soaking them in nice warm water. Heating your muscles will ease the tension and soothe your entire body.

MUSCLE MASSAGE

Massage has proven physical and mental benefits. According to the University of Minnesota, massage provokes a relaxation response in the body’s nervous system. Massage also has positive effects on the body’s soft tissue and improves blood and lymph circulation, which allows oxygen to spread more easily through the body. Relaxing muscle tissue through jet massage can help ease contractions, spasms, and nerve compression. Water pressure on the body’s muscles and joints knead away knots and soothing sore spots.

RELAXATION

As muscles relax, the mind unwinds, shedding the stress and anxiety that can build over the course of a day. The relaxation responses to jet massage reduce stress, anxiety, hypertension, and help curb insomnia.

In addition, buoyancy reduces pressure on your muscles and joints, while heat encourages them to relax and expand. This combination helps soft tissue recover.

PERSONAL AND SOCIAL CONNECTIONS

Remember when social connections came from talking to people face to face instead of online? A home hot tub can help you step away from your mobile devices and spend quality time with friends and family. A spa can foster an atmosphere of intimacy, inviting people to open up and share their thoughts. In a spa, you can connect with old friends, get to know new neighbors, and solidify bonds with your partner and your children.

Improved Sleep Patterns

Most doctors would agree that getting seven to eight hours of sleep at night is extremely important to your health. A great way to do this is by soaking for about 20 in the tub right before you head to bed.

Grab your oil diffuser and lavender, and get ready for a new bedtime routine.

Revitalize Your Outdoor Living Space

Sometimes you just want to be the talk of the town. Give your home some curb appeal. Nothing will get neighbors more jealous than coveting the new hot tub sitting in your backyard. Adding a 6-person hot tub to your backyard could even help you make those neighbors your new friends.

HOT TUB THERAPY HOW DOES IT WORK?

Hot tub therapy is a tried-and-true method of relieving stress, relaxing muscles, and experiencing renewal through warm water immersion. It is an ancient practice. People have been enjoying warm water immersion for centuries. Ancient Egyptians, Greeks, and Romans, for example, built palaces around natural hot springs. Over time, as the benefits of soaking were realized more, marvelous engineers created artificial hot springs for communal and personal use. While jets were first introduced to hot tubs in the 1950s, today’s high-quality spas feature carefully designed massage jet systems that deliver targeted and measured pressure to muscles and sore spots in the body.

WARM WATER, BUOYANCY, AND ADVANCED JET SYSTEMS WORK IN TANDEM

Hot tub therapy relaxes muscles and improves blood flow. At the same time, buoyancy in water reduces body weight by 90%, which can reduce pressure on joints and inflammation while helping to put the mind at ease. The combination of warm water immersion, buoyancy, and advanced hot tub jets provide a total-body therapeutic experience. As the warm water reduces tensions, the spa jets massage away the knots and aches in your muscles just like a gifted masseuse.

Because today’s high-quality jet systems target specific muscle groups, by adjusting your spa’s settings, you can focus on the areas of your body that need the most attention. Similarly, you can control the amount of pressure coming through the jets, so you’re always able to find just the right touch for you.

A hot tub can help relieve chronic pain and improve range of motion, elevate mood, reduce mental and physical tension, improve social and personal connections, and increase the overall quality of life. As warm water improves circulation and massage free your muscles from strain, your body can enter a restful state, where it is able to heal and recover depleted reserves of energy. Let’s take a more detailed look at the benefits of hot tub therapy.

Who should avoid hot tubs?

If you have any concerns about using a hot tub, it’s worth having a conversation with your doctor. This is especially important in the following situations:

• Heart disease. Soaking in a hot tub can affect heart rate and blood pressure. This may be beneficial to some people with cardiovascular concerns but could be unsafe for others.
• Pregnancy. It’s easy to get overheated when you’re pregnant, which can be harmful to you and your baby.

You may also want to avoid a hot tub if you have:

• Skin injuries. Wait until cuts, open sores, or rashes have healed to reduce the risk of irritation and infection.
• Low blood pressure. If you’re prone to lightheadedness or fainting, you should probably avoid the hot tub as the hot water could lower your blood pressure further.
• Urinary tract infection (UTI). Exposure to hot water when you have a UTI may worsen your symptoms.

People Also Reading

DTFM Therapy, Indications, Contraindications DTFM Therapy Indications, Contraindications Interferential Therapy Indications, Contraindications Cold Therapy Indications, Contraindications, Side Effects Ultrasound Therapy Indications, Contraindications Aquatic Therapy Red Light Therapy; Indications, Contraindications Photobiomodulation Therapy, Indications, Contraindications Photonic Stimulation Therapy, Indications, Contraindications Estrogen Therapy – Indications, Contraindications Biostimulation Therapy; Indications, Contraindications Hormone Replacement Therapy – Indications, Contraindications

Sacroiliac joint tests include discussing your history and pain experience, a physical examination, tests to rule out other sources of pain, like lumbar spine pain and hip pain, and these commonly accepted methods:

It’s often difficult to diagnose sacroiliac (SI) joint dysfunction, especially since the main symptom is low back pain, which is common to many different painful spinal disorders. In fact, SI joint dysfunction occurs more frequently than many doctors realize. And sometimes it is difficult to differentiate between low back pain and hip pain. There are various exams and tests that can help determine whether you have SI joint dysfunction.

Anatomy

It is the largest axial joint in the body. The size, shape, and surface contour shows wide individual variation. SIJ is an auricular or C- shaped joint. It lies between the first to the third sacral vertebrae. Only the anterior portion is a synovial joint and the posterior portion contains the strongest ligament in the body, the interosseous sacroiliac ligament. The innominate side is covered by fibrocartilage and the sacral side is covered by articular cartilage. The cartilage of the sacral side is thicker than the iliac side. The sacral side has a central depression and the innominate side has a central ridge.

The stability of the sacroiliac joint is provided by the sacroiliac ligaments and accessory ligaments. The sacroiliac ligaments are the anterior and posterior sacroiliac ligaments and the interosseous ligaments. The ligaments are thicker posteriorly than anteriorly. Anterior sacroiliac ligaments are thickenings in the joint capsule. Interosseous ligaments are the most important and have superficial and deep portions which in turn are divided into superior and inferior bands. Posterior ligaments connect the lateral sacral ridge and the posterior iliac spine and iliac crest. The Accessory ligaments include the iliolumbar, sacrotuberous, and sacrospinal ligaments.

The structure of the sacroiliac joint evolves with the age of the person. These changes begin after puberty and continue through one’s lifetime. During adolescence, the iliac side becomes rougher and develops areas of fibrous plaques. The changes accelerate after the third and fourth decade with surface irregularities, fibrillation, and crevice formation. Sacral side changes begin 10-20 years after the iliac side changes. The joint develops fibrous ankylosis by the sixth decade. Erosions and plaque formation become widespread by the eighth decade.

The innervation of the sacroiliac joint is not yet clearly established. As per various reports, the posterior part of the joint is innervated by branches from the dorsal rami of L3- S3, and the anterior third is innervated by branches from the ventral rami of L2-S2. Innervation from multiple segments leads to referral of pain from sacroiliac joint to different anatomical regions and diverse pain patterns can be observed. But the pain from SIJ does not refer to areas above L5.

Biomechanics

The primary function of the sacroiliac joint is to provide stability. It transmits the weight of the trunk to the lower limbs. It is weak in torsion and axial compression. The sacroiliac joint provides only small degrees of movement in all 3 axes. In males, the movement is predominantly translational and in females it is rotational. Movements are more in females.

Forward rotation of the sacrum at the SIJ is called nutation. During nutation, the sacral promontory moves anteriorly and inferiorly and the coccyx moves posteriorly and superiorly. This leads to a decrease in the anteroposterior width of the pelvic brim and an increase in the anteroposterior width of the pelvic outlet. The backward rotation of the sacrum with opposite effects is called counter-nutation. These movements are probably important during childbirth.

History

Pain in the sacroiliac region may be either due to localized causes or referred causes. Pain over the SIJ may be referred from an intervertebral disc or facet joint lesions. In addition, the pain of sacroiliac joint lesions may radiate to the buttock, lower lumbar region, or buttock. Hence it is often difficult in many patients to identify the exact source of pain.

The cause of the pain may be intra-articular or extra-articular. Intra-articular causes may be arthritis, infection, or trauma. Extra-articular causes may be enthesopathy, fractures, ligamentous injury, or lesions of adjacent ilium, sacrum, or soft tissue structures. Causes may be classified as an inflammatory disease, infection, tumor, metabolic disorders, degenerative disease, iatrogenic conditions, referred pain, and trauma.

Limb length discrepancy, abnormal gait, prolonged exercise, or scoliosis may lead to mechanical derangement of the sacroiliac joint leading to pain. Pregnancy is a well-known risk factor for sacroiliac pain due to weight gain, excessive lumbar lordosis, injury during delivery, and hormone-induced ligamentous laxity.

Symmetrical or asymmetrical sacroiliitis is a common finding in spondyloarthropathies.   Ankylosing spondylitis commonly causes symmetrical involvement and other spondyloarthropathies lead to asymmetrical involvement.

Examination and Manual Test of Sacroiliac joint tests

Many of the problems of the sacroiliac joint are missed and often attributed to hip or spine disease as the history and clinical tests are often nonspecific. Careful physical examination is needed for proper diagnosis.  Point-specific tenderness at the sacral sulcus or posterior superior iliac spine is a consistent finding in sacroiliac joint lesions. Tests for sacroiliac joint can be divided into motion palpation tests and pain provocation tests. Gillet test is the most commonly done motion palpation test.

The

Gillet test

Patient position- Standing.

Examiner position- Standing behind the patient, with one thumb over the S2 spinous process and the other thumb over the posterior superior iliac spine (PSIS) of the tested side.

Procedure- Ask the patient to maximally flex the hip on the tested side.

Interpretation- Normally PSIS moves inferiorly in relation to the S2 spinous process. If it remains at the same level then there is SIJ dysfunction.

The provocative tests done for the sacroiliac joint do not test the sacroiliac joint alone; hence lesions in the adjacent structures also will elicit a positive test. This is the main reason for lack of specificity for these tests.

Sacroiliac distraction test

Patient position- supine on a couch.

Examiner position- Standing with each hand placed over the anterior superior iliac spine on either side.

Procedure- Apply posterior directed force to distract the sacroiliac joint.

Interpretation- Pain at the sacroiliac region is suggestive of sacroiliac pathology.

Thigh thrust test

Patient position- supine on a couch with the hip and the knee flexed to 90⁰ and the hip slightly adducted.

Examiner position- Standing with one hand placed over the sacrum and the other upper limb wrapped around the knee.

Procedure- Apply posterior directed force to the vertically oriented femur to apply a shearing force on the sacroiliac joint.

Interpretation- Pain at the sacroiliac region is suggestive of sacroiliac pathology.

Gaenslen’s test

Patient position- Supine with one limb hanging over the edge of the couch.

Examiner position- Standing.

Procedure- Maximally flex one lower limb onto the abdomen and maximally extend the other hip hanging beyond the edge of the couch.

Interpretation- Pain at the sacroiliac region is suggestive of sacroiliac pathology.

Sacroiliac compression test

Patient position- Lateral position with hip and the knee bend to 90⁰.

Examiner position- Standing with both hands placed on the iliac crest.

Procedure- Apply firm pressure on the iliac crest.

Interpretation- Pain at the sacroiliac region is suggestive of sacroiliac pathology.

Patrick test or FABER (Flexion-Abduction-External rotation- Extension) test or Figure 4 test

Patient position- Supine

Examiner position- Standing.

Procedure- Ask the patient to keep the hip in flexion-abduction-external rotation position, knee in 90⁰ flexions with the foot resting on the opposite limb. Apply pressure on the knee to force the hip into extension.

Interpretation- Pain felt in the region of SIJ is suggestive of SIJ lesions.

RAB (Resisted abduction) test

Patient position- Supine.

Examiner position- Standing holding the patient’s leg at the ankle.

Procedure- Ask the patient to abduct against resistance.

Interpretation- Pain felt in the region of SIJ is suggestive.

Sacral thrust test

Patient position- Prone position.

Examiner position- Standing with both hands placed on the sacrum.

Procedure- Apply firm pressure on the sacrum.

Interpretation- Pain at the sacroiliac region is suggestive of sacroiliac pathology.

Yeoman test

Patient position- Prone position.

Examiner position- Standing and holding the patient’s tested lower limb at the knee.

Procedure- Hyperextend the hip.

Interpretation- Pain at the sacroiliac region is suggestive of sacroiliac pathology.

The thigh thrust test is most sensitive and the distraction test is the most specific. Only the thigh thrust test reaches more than 80% sensitivity and specificity. In the absence of centralization, if three provocative tests are positive then the sensitivity, specificity, and positive likelihood ratio are 93%, 89%, and 6.97%, respectively. Hence practically it is sufficient to do the thigh thrust test, sacroiliac distraction test, and the FABER test to arrive at a diagnosis.

References

People Also Reading

Yeoman’s Test – Uses, Indications, Procedure, Technique Examination of Knee Joint – Types, Technique, Procedure Sacroiliac Joint Pain – Cause, Symptom, Diagnosis Treatment Sacroiliac Joint Arthritis – Causes, Symptoms, Treatment Sacroiliac Joint Injury – Causes, Symptoms, Treatment Sacroiliac Joint Disorders – Causes, Symptoms, Treatment Sacroiliac Joint Dysfunction – Causes, Symptoms, Treatment Sacroiliac Joint Dislocation – Causes, Symptoms, Treatment Sacroiliac Joint Fracture – Causes, Symptoms, Treatment Sacroiliac Joint Trauma – Causes, Symptoms, Treatment Bowstring Sign – Uses, Indications, Procedures, Result Reverse Flip Test – Uses, Indications, Procedure, Technique

Yeoman’s test is a physical exam performed to determine if a person has sacroiliitis. With the subject prone, the test is performed by rotating the ilium with one hand and extending the hip while the knee is flexed. Pain over the ipsilateral posterior sacroiliac joint area is indicative of sacroiliitis.

This also tests for sacroiliac joint sprain or strain.

Purpose

Tests for Sacroiliac Joint involvement. More specifically, if the pain is in the sacroiliac region it may be related to anterior sacroiliac ligament pathology. If it is in the thigh it may be related to hip musculature tightness or femoral nerve tension and if it is in the lumbar region it may be due to lumbar involvement^[rx]

Use: To assess for lumbar joint dysfunction.

Technique

Starting Position

The patient lies prone

Procedure

The examiner stands at the painful side and flexes the patient’s knee to 90° and extends the hip

To perform the test, the patient lies on their stomach.  The examiner uses one hand to stabilize the pelvis while the other hand lifts the leg off the table.  If the patient has pain over the buttock, it may suggest SI joint pain.  If the pain is in the front of the thigh, it may suggest nerve pain from stretching the femoral nerve.  Back pain may indicated pain coming from the lumbar spine.

Positive Test

Pain localized to the sacroiliac joint indicates pathology in the anterior sacroiliac ligament

Anterior thigh paresthesia may indicate a femoral nerve stretch^[rx][rx]

Evidence

The thigh thrust test is most sensitive and the distraction test is the most specific. Only the thigh thrust test reaches more than 80% sensitivity and specificity. In the absence of centralization, if three provocative tests are positive then the sensitivity, specificity, and positive likelihood ratio are 93%, 89%, and 6.97%, respectively. Hence practically it is sufficient to do the thigh thrust test, sacroiliac distraction test, and the FABER test to arrive at a diagnosis.^[rx][rx]

References

People Also Reading

Slump Test – Uses, Indications, Procedure, Technique Reverse Flip Test – Uses, Indications, Procedure, Technique Bragard’s Sign Test – Uses, Procedure, Technique Injection Pushing Technique; Types, Procedure, Indications Acupuncture; Uses, Contra Indications; Procedure, Technique, Foraminotomy – Indications, Procedure, Technique Sacroiliac Joint Tests – Uses, Indications, Types, Procedure Lumbar Discectomy – Indications, Procedure, Technique Spinal Discectomy – Indications, Procedure, Technique Cholesterol Screening Test – Indications, Procedure, Result Digital Amputation – Technique, Procedure, Indications SLR Test – Types, Technique, Clinical Outcome

Slump test is a laboratory or at-site test used to measure the consistency of concrete. The slump test shows an indication of the uniformity of concrete in different batches. The shape of the concrete slumps shows the information on the workability and quality of concrete. The characteristics of concrete with respect to the tendency of segregation can be also judged by making a few tamping or blows by tapping a rod on the base plate. This test continues using since 1922 due to the simplicity of apparatus and simple procedure. The shape of the Slump cone shows the workability of concrete.

slump test measures the consistency of fresh concrete before it sets. It is performed to check the workability of freshly made concrete, and therefore the ease with which concrete flows. It can also be used as an indicator of an improperly mixed batch. The test is popular due to the simplicity of apparatus used and simple procedure. The slump test is used to ensure uniformity for different loads of concrete under field conditions.^[rx]

A separate test, known as the flow table, or slump-flow, test, is used for concrete that is too fluid (non-workable) to be measured using the standard slump test because the concrete will not retain its shape when the cone is removed.

Purpose

The Slump Test is a neural tension test used to detect altered neurodynamics or neural tissue sensitivity. The purpose of this test is to place tension on the dural sheath of the sciatic nerve.

Technique

The slump test is described differently among sources. The common factor among sources is the reproduction of pain as tension is applied to the dura during testing. The technique depicted below is adapted from Mark Dutton.

Description

To begin the test, have the patient seated with hands behind back to achieve a neutral spine. The first step is to have the patient slump forward at the thoracic and lumbar spine. If this position does not cause pain, have the patient flex the neck by placing the chin on the chest and then extending one knee as much as possible.

If extending the knee causes pain, have the patient extend the neck into neutral. If the patient is still unable to extend the knee due to pain, the test is considered positive.

If extending the knee does not cause pain, ask the patient to actively dorsiflex the ankle. If dorsiflexion causes pain, have the patient slightly flex the knee while still dorsiflexing. If the pain is reproduced, the test is considered positive. Repeat test on the opposite side. Over-pressure can be applied during any of the test positions.

Apparatus for Slump test

The followings apparatus are used in the slump test of concrete:

• Metallic mold in the shape of a frustum of a cone having bottom diameter 20 cm (8 in), top diameter 10 cm (4 in), and height 30 cm (12in).
• Steel tamping rod having 16 mm (5/8 in) diameter, 0.6 m (2 ft.) long with bullet end.

Procedure

The patient should be sitting on the edge of the table while the examiner is by the side of the patient.

The slump test consists of several different steps:

• First, the patient slumps forward, rounding the shoulders^[rx] so the examiner will then apply pressure to the trunk flexion.
• Next, the patient brings chin to chest and the knee is then actively extended.
• Afterward, the ankle is dorsiflexed. If pain is produced during any of the steps the examiner does not have to continue the test.

The test has several modifications all of which use different sequences of motions that create tension on the dural sheath.^[rx]

or

During the Slump test following steps are followed:

• First of all, the internal surface of the mold is cleaned and free from moisture and free from other old sets of concrete.
• Then place the mold on the smooth horizontal, rigid, and non-absorbant surface.
• The mold is then filled with fresh concrete in four layers with taping each layer 25 times by taping rod, and level the top surface with a trowel.
• Then the mold is slowly pulled in vertical and removed from concrete, so as not to disturb the concrete cone.
• This free concrete deform all the surface to subside due to the effect of gravity.
• That subsidence of concrete in the periphery is a SLUMP of concrete.
• The height difference between the height of subsidence concrete and mold cone in mm is ‘slump value of concrete.

Results

The positive sign is any kind of sciatic pain (radiating, sharp, shooting pain) or reproduction of other neurological symptoms. This indicates impingement of the sciatic nerve, dural lining, spinal cord, or nerve roots.^[rx] This test can have a lot of false positives and should be used with another orthopedic test to make the final diagnosis.

Evidence

Some caution is needed as the diagnostic accuracy of the slump test is under debate! During the slump test,^[3]the neural structures within the vertebral canal and foramen are slowly and progressively put on maximum stretch. A recent Cochrane review (on physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain), also looked at the available data on the Slump test.^[rx] The authors listed two studies^[rx] that reported results on the slump test. Stankovic et al (1999) present the results of the slump test at different cut-off values (angles at which pain occurred), showing that sensitivity of the slump test was poor (0.44, 95% CI:0.34 to 0.55), and specificity only slightly better (0.58, 95% CI:0.28 to 0.85) when using a strict cut-off (pain radiating below the knee). Sensitivity increased (but specificity decreased) when using a milder cut-off (pain anywhere).^[rx] Majlesi et al (2008) reported similar sensitivity (0.84), but higher specificity (0.83), using an unknown cut-off for a positive test result.^[rx] So it was not clear when a test was scored as “positive”. Also, the higher specificity might partly be the result of the case-control design of this study: patients with back pain were selected as controls if MRI findings were completely normal.

References

People Also Reading

Yeoman’s Test – Uses, Indications, Procedure, Technique Reverse Flip Test – Uses, Indications, Procedure, Technique Bragard’s Sign Test – Uses, Procedure, Technique SLR Test – Types, Technique, Clinical Outcome Acupuncture; Uses, Contra Indications; Procedure, Technique, Bowstring Sign – Uses, Indications, Procedures, Result Sacroiliac Joint Tests – Uses, Indications, Types, Procedure Lumbar Discectomy – Indications, Procedure, Technique Spinal Discectomy – Indications, Procedure, Technique Injection Pushing Technique; Types, Procedure, Indications Foraminotomy – Indications, Procedure, Technique Digital Amputation – Technique, Procedure, Indications

The Bragard’s sign (also: Braggard’s test) is a manual test to diagnose and used to evaluate whether lumbar and​/or ischiatic pain originates from lumbosacral radiculopathy, disc herniation, sciatica, low back pain, cauda equina syndrome, slipped disc, etc.

Meniscal injuries may be the most common knee injury. Meniscus tears are
sometimes related to trauma, but significant trauma is not necessary. A
sudden twist or repeated squatting can tear the meniscus. A torn
meniscus is one of the most common knee injuries. Any activity
that causes you to forcefully twist or rotate your knee, especially when
putting the pressure of your full weight on it, can lead to a torn
meniscus.

Purpose

The Bragard’s sign (also: Braggard’s test) is used to evaluate whether lumbar and/or ischiadic pain originates from lumbosacral radiculopathy (e.g. disc herniation causing nerve root compression). Perform a straight leg raise and then lower the leg below the point of pain and passively dorsiflex the ankle. The test is positive if this reproduces the patient’s pain.

Technique

The procedure used to determine whether the source of lower back pain is nervous or muscular. A straight leg raising procedure is done; if positive the leg is lowered just below the point of pain and then the ankle is dorsiflexed. If pain increases during dorsiflexion, pain is likely nervous in origin, whereas, with no increase, the source is presumed muscular.

The patient is in the supine position. The examiner lifts the straight leg passively into hip flexion until the familiar pain occurs (Straight Leg Raise test/Lasegue’s Sign). Subsequently, the leg is lowered just below the pain threshold and the foot is pulled in dorsiflexion. If the familiar pain occurs again, the Bragard’s sign is positive. This would indicate a nervous involvement in the patient’s pain’s origin.

Evidence

In a study with 506 patients, Homayouni et al. investigated the sensitivity and specificity of Bragard’s sign for the differentiation of lumbosacral radiculopathy^[rx]. They reported acceptable test performance-especially in patients with symptom duration of fewer than three weeks since the Straight Leg Raise test sensitivity and specificity decreased as sensitivity and specificity of the Bragard’s test increased.

Testing in clinical practice

Clinical examination tests work best when used in a combination of three to five tests, this is especially true for sacroiliac joint dysfunction, lumbar and/or ischiatic pain^[rx]. For a schedule of which signs to look for in different spinal diseases follow this link. Examples of further tests include for the lumbar region are

• Antalgic Posture Sign
• Bechterew’s Sitting Test
• Bowstring Sign
• Bragard’s Sign
• Cox Sign
• Slump Test

References

People Also Reading

Yeoman’s Test – Uses, Indications, Procedure, Technique Reverse Flip Test – Uses, Indications, Procedure, Technique Slump Test – Uses, Indications, Procedure, Technique Bowstring Sign – Uses, Indications, Procedures, Result Lasegue sign/ Straight Leg Raising Test (SLRT) SLR Test – Types, Technique, Clinical Outcome Lasegue Sign / Straight Leg Raising Test (SLRT) Lower Limb Examination – Technique, Procedure, Result Upper Limb Examination – Technique, Procedure, Result Deep Tendon Reflexes – Test , Diagnosis, Procedure Straight Leg Raising Test (SLRT) Examination of Knee Joint – Types, Technique, Procedure

Sciatica is a common complaint at our clinic and has been the topic of sciatic blogs. As we’ve mentioned in the past, there are various causes for “sciatic” symptoms. These causes can include a lumbar disc injury (herniation) or lumbar stenosis to name a few. The symptoms of sciatica can range from leg pain, numbness, tingling, pins, and needles, sharp pain, and also dull throbbing pain. Quite often, the challenge is to determine where and why the nerve is compressed or irritated. 

Clinical History and Examination

The journey toward sciatica diagnosis starts with a clinical history and examination. On occasion, advanced tests like MRI, CT or nerve conduction is required, but under most circumstances, we try to avoid tests that won’t change the course of treatment. This is why the initial orthopedic examination is very important and the application of orthopedic tests requires a keen knowledge of the reliability of the different tests. Perhaps this blog entry is more for the practitioners out there… 

The Flip Test Procedure

The Flip test has traditionally been used to determine whether there is nerve tension (nerve irritation related to a spinal condition like a disc herniation). This test is similar to a slump test. To perform the Flip test, the patient sits on the edge of a table with the legs dangling. The painful/symptomatic leg is extended and if the patient puts their hands on the table and “flips” backward, the test is positive. Surprisingly, this test has never really been tested in a scientific setting!  This seems to occur often, where an idea persists for so long that it becomes accepted as fact, regardless of there not being any true scientific study performed. 

A study published in the Journal Spine (2009) investigated whether the flip test was reliable for finding nerve root tension. The subjects in the study were patients with confirmed nerve compression on MRI. Interestingly, the authors of the paper found that the flip test wasn’t quite as reliable as many would think. Unfortunately, only a third of the patients displayed a positive “flip” while another third didn’t even react at all. Keep in mind; this is all on patients with confirmed nerve impingement!  So what does this mean for patients and practitioners?  As with most orthopedic tests, an astute clinician needs to combine the findings of the history as well as using more than one orthopedic test. Sometimes a test may not be reliable on its own, but when used in conjunction with a battery of tests it can help diagnose a person’s condition.

If you’re not a practitioner you’d probably find this blog entry confusing. Perhaps then the take-home point for any patients reading this entry is that if you have sciatic symptoms (numbness, tingling, pins and needles) a knowledgeable practitioner can perform an examination that helps to determine the source of pain. Once that has been achieved a course of treatment can be outlined.

References

People Also Reading

Slump Test – Uses, Indications, Procedure, Technique Yeoman’s Test – Uses, Indications, Procedure, Technique Bragard’s Sign Test – Uses, Procedure, Technique SLR Test – Types, Technique, Clinical Outcome Lumbar Discectomy – Indications, Procedure, Technique Spinal Discectomy – Indications, Procedure, Technique Foraminotomy – Indications, Procedure, Technique Digital Amputation – Technique, Procedure, Indications Cholesterol Screening Test – Indications, Procedure, Result Acupuncture; Uses, Contra Indications; Procedure, Technique, Injection Pushing Technique; Types, Procedure, Indications Bowstring Sign – Uses, Indications, Procedures, Result

Bowstring sign is also known as the popliteal compression test or posterior tibial nerve stretch sign. The patient can be examined in sitting or in a supine position. The examiner flexes the knee and applies pressure on the popliteal fossa, evoking sciatica. Some examiners do it after SLRT by flexing the knee to relieve the buttock pain. The pain would be reproduced by a quick snap on the posterior tibial nerve in the popliteal fossa.[rx]

Purpose

Bowstring sign is a passive provocative clinical test that is performed in patients presenting with low back pain to determine the lumbosacral nerve tension. It is also known as the popliteal compression test or posterior tibial nerve stretch sign.^[rx]

Technique

The patient begins lying supine with the legs extended while the examiner performs a passive straight leg raise on the involved side. If the patient reports radiating pain, the examiner then flexes the patient’s knee until symptoms are reduced. The examiner then applies pressure to the popliteal fossa to try to reproduce the radicular pain.

Patient Position

Patient in supine lying position without a pillow.

Therapist Position

Examiner stands at the tested side with a face facing towards the patient’s face.

Procedure

• Initially, the examiner performs the Straight Leg Raise ( SLR) test in which the examiner lifts the leg with the extended knee. Examiner raises the leg to the point where the patient perceives pain along with the distribution lumbosacral dermatomal level or when maximum flexion is got.
• While performing the SLR test, at the point of maximum pain (positive SLR) the examiner will slightly flex the patient’s knee approximately 20 degrees thereby reducing the pain.
• Then examiner applies pressure (via thumb) on the popliteal fossa on the sciatic nerve (posterior tibial nerve).
• If this elicits the same pain as the patient experiences during SLR, then the Bowstring sign is said to be positive.^[rx]

• This test should be performed on both legs, the normal side being the first.

Evidence

• The bowstring sign is one of the commonly used variants of the SLR test and a study published in 2020 suggests using SLRT, Femoral nerve tension test, Slump test, and bowstring test in combination. This takes about 2 minutes and could improve both the sensitivity and specificity of the physical examination for the diagnosis of sciatica.^[rx]
• There is no evidence regarding the psychometric properties of the Bowstring sign.

Positive test Result

• Reproduction of pain with popliteal compression implies sciatic nerve pathology.

References

People Also Reading

Bragard’s Sign Test – Uses, Procedure, Technique EMG; Types, Indications/Uses, Procedures, Results Lasegue Sign / Straight Leg Raising Test (SLRT) Lasegue sign/ Straight Leg Raising Test (SLRT) Reverse Flip Test – Uses, Indications, Procedure, Technique Knee Joint Examination – Indications, Technique, Result Yeoman’s Test – Uses, Indications, Procedure, Technique Slump Test – Uses, Indications, Procedure, Technique Echocardiogram; Indications, Preparetion, Procedures Urine Culture – Indications, Procedure, Mechanism, Result Cholesterol Screening Test – Indications, Procedure, Result Urodynamic Testing – Indications, Procedure, Result