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Lumbar Spine Assessment
Chapter 10, p. 319
Low Back Pain (LBP)
90% of all Americans Minor insultsmajor injuries Maintain normal lordotic and kyphotic curves
to avoid injury
Clinical Anatomy—p.319
5 vertebrae=lumbar spine P.320, fig. 10-2
– Facets– Processes– Foramen– “Scotty Dog”
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
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
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?
Inspection/Observationp. 333
Sagittal curvature Scoliosis Frontal curvature Normal curves Standing posture Shoulders Head Walking posture (gait)
Observation/ Inspection
Paravertebral muscles Symmetry / spasm PSIS level Overall attitude
Palpation—p. 335
Transverse processes Spinous processes PSIS Paravertebral
musculature– Symmetry– spasm
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
Pathologies/Injuriesp. 353
Muscle strains—p.353 Facet joint syndrome-
p.353 Disk lesion—p. 354 Spondylopathies—p.292
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
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
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
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
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
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
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
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)
Valsalva maneuverp. 344, Box 10-6
Increasing intrathecal pressure to reproduce symptoms
(+)=Reproduced symptoms :Radiating pain or
Numbness
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
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
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
Hamstring flexibility
Tripod sign 90-90 position for testing Tight hamstrings
pelvic tiltStretched extensorsPain/spasm
Strength tests
Isometric strength tests Held for 60 sec. Flexor strength testing Extensor strength testing
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