Lumbar Assessment

Welcome to Vrije Universiteit Brussel's Evidence-based Practice project. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Ben Vandoorne

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Subjective

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
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 (Snider et al).

Movement Testing

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