SECONDARY SURVEY History Observation Palpation Functional tests Neurological tests Special tests Referral & Plan
HISTORY Areas of pain Onset of injury Mechanism of injury Nature of pain Activities that cause pain Bowel and/or bladder problems Previous history of injury related to area
INSPECTION Curves of the spinal column Gait Position of the other parts of the body Alignment and symmetry Breathing patterns Posture Swelling and discoloration
PALPATION Cervical spine Thoracic spine Lumbar spine Sacrum Coccyx Pelvis Palpate of tenderness, swelling, deformity, etc.
FUNCTIONAL TESTS Range of Motion of the Spine –Active range of motion –Passive range of motion –Resistive range of motion Do not check if there is any doubt regarding severity of the injury to the spinal column.
NEUROLOGICAL TESTS SENSORY MOTOR REFLEX Check all areas: –Cervical –Thoracic –Lumbar –Sacral
SPECIAL TESTS Babinski Test Oppenheim’s Test Brachial Plexus Traction Test Cervical Axial Load Cervical Distraction Shoulder Abduction Spurling’s Test Single Leg Stance Test Straight Leg Raise Well Straight Leg Raise Valsalva Test Beevor’s Sign Milgram Test Kernig’s Test Femoral Nerve Stretch Hoover Test Lasegue’s Test Sacroiliac Tests
REFER THE ATHLETE IF: You have a doubt There is paralysis Pain or tenderness Deformity Weakness Unusual sensations Head injury involvement
A 13-year-old female gymnast comes to you complaining of low back pain. The pain increases when she extends the spine. Like most gymnasts, she is hypermobile in most of her joints. Describe you assessment plan for this athlete. What condition(s) do you suspect and what are the potential mechanisms of injury? What about competition? Can she continue?
Questions Age? Chronic? Repetitive Stress? Radiating pain? Special Tests? Impression? Referral and Plan?
A 30-year-old recreational athlete comes to you complaining of a chronic backache for 6 months duration. The pain has been gradually increasing in severity and is worse at rest and in the morning on arising from bed. When present, the pain is centered in the low back and radiates into her buttocks and posterior left thigh. Describe your assessment plan for this individual. What condition(s) do you suspect? What are the possible mechanisms of injury?