REIDER PART 2
80

Lumbar Spinc

340_Chaihf.r 9

Heel Walking. Heel walking tests the strength of the ankle dorsiflexors. The paticnt is askcd to walk on his or her heels with the toes held high off the floor (Fig. 9-5). Because this is an unusual activity, the examiner may have to demonstrate the maneuver for the patient. The patient should be asked to take about 10 steps with each foot. This maneuver tests for weakness of the L4 innervated tibialis anterior, which would most commonly be weak-encd by a herniation of the L3-L4 disk. In the presence of sevcrc weakness, the patient is unable to lift the front part of the foot off the floor at all. In milder dcgrecs of wcak-ness, the patient is not able to lift the forefoot as high off the floor as on the other side, or the muscles are noted to fatigue after a few steps have been taken.

Toe Walking. Toe walking reąuires the SI innervated gastrocsoleus muscle group that would most commonly be weakened by a herniation of the L5-S1 disk. The patient is asked to walk on the toes with the heels held high off the floor, again taking about 10 steps on each foot (Fig. 9-6). Again, severe weakness is manifested by the patients complete inability to elear the heel of the involved side off the floor. Whcn morę subtlc degrees of weakness are present, the heel of the involved side is not held as far off the floor as the heel of the oppositc side or the muscles are noted to fatigue after a few steps.

Figurę 9-5. Heel walking.

Figurę 9-7. Lumbar flexion.