Lumbar Assessment: Difference between revisions
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== Subjective<br> == | == Subjective<br> == | ||
=== Patient Intake === | === Patient Intake === | ||
*Self‐report (patient history, past medical history, drug history, social history) | *Self‐report (patient history, past medical history, drug history, social history) | ||
*Performance‐based outcome measures | *Performance‐based outcome measures | ||
*Region‐specific questions | *Region‐specific questions | ||
| Line 18: | Line 18: | ||
During the investigationyou must pay attention to any ‘red flag’ that might be present. Koes et al (2006) <ref>Koes B.W. van Tulder M. W., Thomas S.; diagnosis and treatment of low back pain; BMJ volume 332, 17 june 2006; 1430-1434</ref>mentioned the following ‘red flags’: | During the investigationyou must pay attention to any ‘red flag’ that might be present. Koes et al (2006) <ref>Koes B.W. van Tulder M. W., Thomas S.; diagnosis and treatment of low back pain; BMJ volume 332, 17 june 2006; 1430-1434</ref>mentioned the following ‘red flags’: | ||
*Onset age < 20 or > 55 years | *Onset age < 20 or > 55 years | ||
*Non-mechanical pain (unrelated to time or activity) | *Non-mechanical pain (unrelated to time or activity) | ||
*Thoracic pain | *Thoracic pain | ||
*Previous history of carcinoma, steroids, HIV | *Previous history of carcinoma, steroids, HIV | ||
*Feeling unwell | *Feeling unwell | ||
*Weight loss | *Weight loss | ||
*Widespread neurological symptoms | *Widespread neurological symptoms | ||
*Structural spinal deformity | *Structural spinal deformity | ||
<span> </span>Yellow Flags | <span> </span>Yellow Flags | ||
=== Investigations<br> === | === Investigations<br> === | ||
| Line 42: | Line 42: | ||
=== Functional Tests<br> === | === Functional Tests<br> === | ||
Functional Demonstration of pain provoking movements<br> | Functional Demonstration of pain provoking movements<br> | ||
=== Movement Testing === | === Movement Testing === | ||
*AROM, PROM, and Overpressure | *AROM, PROM, and Overpressure | ||
*Passive Intervertebral Motion | *Passive Intervertebral Motion | ||
*Muscle Strength | *Muscle Strength | ||
=== Neurologic Assessment === | === Neurologic Assessment === | ||
*Myotomes | *Myotomes | ||
*Dermatomes | *Dermatomes | ||
*Reflexes | *Reflexes | ||
*Neurodynamic testing | *Neurodynamic testing | ||
=== Palpation === | === Palpation === | ||
It is crucial for a reliable diagnosis and intervention of treatment to adequately palpate the lumbar processi. <br>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)<ref>McKenzie AM, Taylor NF. Can physiotherapists locate lumbar spinal levels by palpation? Physiotherapy 1997;83: 235-9.</ref>. However, Snider et al (2011)<ref>Karen T. Snider, Eric J. Snider, Brian F. Degenhardt, Jane C. Johnson and James W. Kribs; palpatory accuracy of lumbar spinous processes using multiple bony landmarks. ournal of Manipulative and Physiological Therapeutics; 2011</ref> 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. <br>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)<ref>Phillips D. R.; Twomey L. T.; A comparison of manual diagnosis with a diagnosis established by a uni-level lumbar spinal block procedure; manual therapy, march 1996, pages 82-87</ref><br>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)<ref>3. Ferre RM, Sweeney TW. Emergency physicians can easily obtain ultrasound images of anatomical landmarks relevant to lumbar puncture. Am J Emerg Med 2007;25:291-6.</ref>. 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 <ref>Karen T. Snider, Eric J. Snider, Brian F. Degenhardt, Jane C. Johnson and James W. Kribs; palpatory accuracy of lumbar spinous processes using multiple bony landmarks. ournal of Manipulative and Physiological Therapeutics; 2011</ref>. | It is crucial for a reliable diagnosis and intervention of treatment to adequately palpate the lumbar processi. <br>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)<ref>McKenzie AM, Taylor NF. Can physiotherapists locate lumbar spinal levels by palpation? Physiotherapy 1997;83: 235-9.</ref>. However, Snider et al (2011)<ref>Karen T. Snider, Eric J. Snider, Brian F. Degenhardt, Jane C. Johnson and James W. Kribs; palpatory accuracy of lumbar spinous processes using multiple bony landmarks. ournal of Manipulative and Physiological Therapeutics; 2011</ref> 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. <br>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)<ref>Phillips D. R.; Twomey L. T.; A comparison of manual diagnosis with a diagnosis established by a uni-level lumbar spinal block procedure; manual therapy, march 1996, pages 82-87</ref><br>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)<ref>3. Ferre RM, Sweeney TW. Emergency physicians can easily obtain ultrasound images of anatomical landmarks relevant to lumbar puncture. Am J Emerg Med 2007;25:291-6.</ref>. 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 <ref>Karen T. Snider, Eric J. Snider, Brian F. Degenhardt, Jane C. Johnson and James W. Kribs; palpatory accuracy of lumbar spinous processes using multiple bony landmarks. ournal of Manipulative and Physiological Therapeutics; 2011</ref>. | ||
=== Clear Adjacent Joints === | |||
*Thoracic spine | |||
*Sacroilliac joints | |||
*Hips<br> | |||
=== Special Tests === | === Special Tests === | ||
Revision as of 11:10, 30 April 2014
Original Editors - Ben Vandoorne
Top Contributors - Admin, Rachael Lowe, Kim Jackson, Laura Ritchie, Jess Bell, Vandoorne Ben, Carin Hunter, Naomi O'Reilly, Kai A. Sigel, Lucinda hampton, Evan Thomas, Simisola Ajeyalemi, Aminat Abolade, 127.0.0.1, Rishika Babburu, WikiSysop and Wanda van Niekerk
Subjective
[edit | edit source]
Patient Intake[edit | edit source]
- Self‐report (patient history, past medical history, drug history, social history)
- Performance‐based outcome measures
- Region‐specific questions
Special Questions
[edit | edit source]
- Red Flags:
During the investigationyou must pay attention to any ‘red flag’ that might be present. Koes et al (2006) [1]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
[edit | edit source]
- Radiological Considerations
Objective[edit | edit source]
Observation[edit | edit source]
- Posture
- Movement Patterns
Functional Tests
[edit | edit source]
Functional Demonstration of pain provoking movements
Movement Testing[edit | edit source]
- AROM, PROM, and Overpressure
- Passive Intervertebral Motion
- Muscle Strength
Neurologic Assessment[edit | edit source]
- Myotomes
- Dermatomes
- Reflexes
- Neurodynamic testing
Palpation[edit | edit source]
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)[2]. However, Snider et al (2011)[3] 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)[4]
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)[5]. 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 [6].
Clear Adjacent Joints[edit | edit source]
- Thoracic spine
- Sacroilliac joints
- Hips
Special Tests[edit | edit source]
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
References[edit | edit source]
- ↑ Koes B.W. van Tulder M. W., Thomas S.; diagnosis and treatment of low back pain; BMJ volume 332, 17 june 2006; 1430-1434
- ↑ McKenzie AM, Taylor NF. Can physiotherapists locate lumbar spinal levels by palpation? Physiotherapy 1997;83: 235-9.
- ↑ Karen T. Snider, Eric J. Snider, Brian F. Degenhardt, Jane C. Johnson and James W. Kribs; palpatory accuracy of lumbar spinous processes using multiple bony landmarks. ournal of Manipulative and Physiological Therapeutics; 2011
- ↑ Phillips D. R.; Twomey L. T.; A comparison of manual diagnosis with a diagnosis established by a uni-level lumbar spinal block procedure; manual therapy, march 1996, pages 82-87
- ↑ 3. Ferre RM, Sweeney TW. Emergency physicians can easily obtain ultrasound images of anatomical landmarks relevant to lumbar puncture. Am J Emerg Med 2007;25:291-6.
- ↑ Karen T. Snider, Eric J. Snider, Brian F. Degenhardt, Jane C. Johnson and James W. Kribs; palpatory accuracy of lumbar spinous processes using multiple bony landmarks. ournal of Manipulative and Physiological Therapeutics; 2011
