Lumbar Assessment

Original Editors - Ben Vandoorne

Top Contributors - Admin, Rachael Lowe, Kim Jackson, Jess Bell, Laura Ritchie, Vandoorne Ben, Carin Hunter, Naomi O'Reilly, Kai A. Sigel, Lucinda hampton, Aminat Abolade, Evan Thomas, Simisola Ajeyalemi, 127.0.0.1, Rishika Babburu, WikiSysop and Wanda van Niekerk  

Subjective

When evaluating the lumbar spinal column, it is convenient to use the index card of “centers for rehab services”. So you can see if there are problems like Lumbar Instability.

Patient Intake

• Self‐report
• Performance‐based outcome measures
• Region‐specific historical examination

Special Questions

• Red Flags:

During the investigationyou must pay attention to any ‘red flag’ that might be present. Koes et al (2006) mentioned the following ‘red flags’:
• Onset age < 20 or > 55 years
• Non-mechanical pain (unrelated to time or activity)
• Thoracic pain
• Previous history of carcinoma, steroids, HIV
• Feeling unwell
• Weight loss
• Widespread neurological symptoms
• Structural spinal deformity

• Yellow Flags
  

Investigations

• Radiological Considerations
  

Objective

Observation

• Posture
• Movement Patterns

Functional Tests

Provocation tests: these tests are used to measure the pain. The test is positive when it causes pain while being carried out.
• Regional test:
     - Subject lies on his belly
     - Ventral and vertical pressure on the low back. This means you push the back in lordosis/extension.
• Segmental test:
     - Subject lies on his belly
     - “muzzle grip” around a processus spinosus
mobility tests:
• flexion when lying on one’s side: to investigate the mobility towards flexion of the lumbosacral facet joint in the anterior posterior region
      - regional or segmental
• extension when lying on one’s side: to investigate the mobility towards extension of the lumbosacral facet jointin the anterior posterior region
      - Regional or segmental
• lateral flexion when lying on one’s belly: to investigate the mobility towards lateral flexion
      - fixing of T12 with “muzzle grip”
• rotation when lying on one’s belly: to investigate the mobility towards rotation
      - fixing of T12 with thumb on homolateral side

Palpation

It is crucial for a reliable diagnosis and intervention of treatment to adequately palpate the lumbar processi.
Within the scientific world there has been a debate about the palpation of the processi spinosi because scientists assumed that often different persons indicated the processi on a different place (Mckenzie et al). However, Snider et al (2011) has shown that the indicated points of the different therapists lie that the distance between the indicated points of the different therapists is much smaller than it had always been claimed. Obviously there were differences because some therapists have more experience and others have more anatomical knowledge. Also the difference in personality between the therapists led to differences in locating the processi.
Furthermore, this investigation has proven that it is more useful to indicate different points instead of just 1 point. Also it’s proven that a manual examination to detecte the lumbar segmental level is highly accurate when accompanied by a verbal subject response (Philips 1996)
There are of course elements that hinder the palpation. For example, a BMI (body mass index) of 30kg/m2 considerably diminishes the accuracy (Ferre et al). Anatomical abnormalities might also cause problems. The abnormality of the 12th rib leads, for example, to a negative palpal accuracy in the region L1-L4 for all therapists .

Movement Testing

• AROM, PROM, and Overpressure
• Passive Intervertebral Motion
• Muscle Strength
  

Special Tests

Active Sit-Up Test Alternate Gillet Test Crossed Straight Leg Raise Test Extensor Endurance Test FABER Test Fortin's Sign Gaenslen Test Gillet Test Gower's Sign Lumbar Quadrant Test POSH Test Posteroanterior Mobility Prone Knee Bend Test Prone Instability Test Resisted Abduction Test Sacral Clearing Test Seated Forward Flexion Test SIJ Compression/Distraction Test Slump Test Sphinx Test Spine Rotators & Multifidus Test Squish Test Standing Forward Flexion Test Straight Leg Raise Test Supine to Long Sit Test