Lumbar Spine Assessment
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Transcript of Lumbar Spine Assessment
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Lumbar Spine Assessment
Chapter 10, p. 319
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Low Back Pain (LBP)
90% of all Americans Minor insultsmajor injuries Maintain normal lordotic and kyphotic curves
to avoid injury
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Clinical Anatomy—p.319
5 vertebrae=lumbar spine P.320, fig. 10-2
– Facets– Processes– Foramen– “Scotty Dog”
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Evaluation—p329
Primary role of ATC:– On-field evaluation:
Rule out (R/O) bony trauma which has, or may, damage to spinal cord
– Clinical evaluation: Evaluate specific cause of injury and devise a rehabilitation
plan
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Historyp. 329
Location of pain:– Localized or radiating?
Onset of pain:– Acute, chronic, insidious?
Consistency of pain:– Constant/intermittent?– Improves/Worsens with
activity? Mechanism:
– Flex, ext, rotation, lat. Flex– Direct blow/trauma
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Historyp. 330
PMH of injuries/surgery? Smoker? Bowel/bladder symptoms?
– Incontinence or frequency
– Immediate referral Referral history
– Time in the medical system?
– # of physicians seen?
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Inspection/Observationp. 333
Sagittal curvature Scoliosis Frontal curvature Normal curves Standing posture Shoulders Head Walking posture (gait)
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Observation/ Inspection
Paravertebral muscles Symmetry / spasm PSIS level Overall attitude
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Palpation—p. 335
Transverse processes Spinous processes PSIS Paravertebral
musculature– Symmetry– spasm
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Functional testing—p.337
Gross ROM assessment only
Trunk Extension = 45º– Lordosis should increase
Trunk Flexion = 9045º– Lordosis should decrease
Rotation Lateral flexion Symmetry > Goniometry
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Pathologies/Injuriesp. 353
Muscle strains—p.353 Facet joint syndrome-
p.353 Disk lesion—p. 354 Spondylopathies—p.292
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Muscle Strains—p.284
Pain localized to paraspinal musculature & PSIS
Spasm probable Limited flex. & ext. (pain) No radiating pain May not correlate to
specific mechanism
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Facet Joint Syndrome-p.353
Table 10-10,p.354 ~40% of all LBP Vague symptoms that mimic
other pathologies Common with repeated spine-
loading activities Localized pain \ Often improves with activity Nerve entrapment may result
from compensatory posturing
Worsened by:– Repeated spine-loading
activities (ext, side bending, rotation)
– Poor LE flexibility– Poor Trunk strength
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Disk lesion—p.354, Table 10-11 (355)
Crack in annulus fibrosus herniation of nucleus pulposus
Pressure on nerve rootpain/burning sensation
“Bulge” pathology Radiating pain into
buttocks and down leg MRI for best diagnosis
Altered standing posture Symptoms with activity Bilateral or unilateral
symptoms Usually acute onset
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Spondylopathies—p.357, Table 10-13 (359)
Vertebral defect May occur at any
age/sports Congenital? Stress fx? Common is sports with
forced hyperextension Generally occurs at L4-
L5 or L5-S1 levels
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Spondylolysis—p. 358 (Fig. 10-26)
Defect at pars interarticularis Unilateral or bilateral Signs/ Symptoms:
– NL spinal alignment– LBP during & after activity– Localized lumbar spine pain– NL flex; restricted ext.– (-) neuro. Test
X-rays show “collared” Scotty Dog
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Spondylolysthesis—p.358 (fig.10-28)
May occur with spondylolysis
Anterior displacement of proximal vertebrae on distal
Pain more intense/constant than spondylolysis
Neuro signs sometimes (+) if displacement worsens
Possible step-off deformity X-rays show “decapitated”
Scotty Dog (+) Stork test
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Straight leg raise test (SLR)—p.347, fig. Box 10-9
Supine with knees extended PROM hip flexion to point of
discomfort or end of range hip flexion and move into
passive dorsiflexion (+) = pain reproduced and
recurs with reduced SLR (-) =pain reproduced but does
not return with reduced SLR
If pain does not recur:– Tight hamstrings
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Well-leg SLR testp.348, Box 10-10
Supine with knees extended
Passively raise one leg– Similar to SLR test– Raise leg with symptoms – Provocation test
(+)=Symptoms felt in the other leg (“well” leg)
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Valsalva maneuverp. 344, Box 10-6
Increasing intrathecal pressure to reproduce symptoms
(+)=Reproduced symptoms :Radiating pain or
Numbness
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Kernig’s Test—p. 346
Box 10-8 Provocation test to elongate
the spinal cord Active SLR until point of pain
(knee straight) Flex knee @ point of pain (+)= pain in LB or radiating
pain in LE Brudzinski’s Test=Kernig with
cervical flexion
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Hoover testp.351, Box 10-13
Tests compliance & effort “Malingering” Procedure:
– Supine with knees extended– Active hip flexion– Pressure should be felt on
opposite leg as SLR is attempted
(+)=No pressure=low effort
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Babinski testp. 383, Box 11-3
Tests presence of upper motor neuron pathology
Blunt device moved across plantar aspect of foot from calcaneus to 1st metatarsal head (great toe)
– (-)=toe flexion– (+)=great toe extension with
splaying of other toes Normally (+) in newborns
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Hamstring flexibility
Tripod sign 90-90 position for testing Tight hamstrings
pelvic tiltStretched extensorsPain/spasm
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Strength tests
Isometric strength tests Held for 60 sec. Flexor strength testing Extensor strength testing
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Lifting Technique
Maintain natural curves– Sitting, standing, walking,
lifting 10:1 ratio Use large LE muscles Keep items close to body Hip = axis (not LS) Avoid rotating spine Get help when needed