Lumbar Assessment
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, WikiSysop, Wanda van Niekerk, 127.0.0.1 and Rishika Babburu
Notes on Assessment[edit | edit source]
Assessment of the lumbar spine should allow clinical reasoning to include appropriate data collection tests from those listed below.
Examination procedures should be performed from standing-sitting-lying and pain provocation movements saved until last.
Subjective
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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
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- 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
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- Radiological Considerations
Objective[edit | edit source]
Observation[edit | edit source]
- Posture
- Movement Patterns
Functional Tests
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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 - seated rotation with combined movements and overpressure
- Sacroilliac joints - sacral clearing test, cluster tests
- Hips - PROM with overpressure
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
