An Introduction to Clearing the Lumbar Spine

Getting in The Right AreaThis article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (22/04/2021)

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Introduction

The lumbar spine is one of the most common areas physiotherapists treat. Low back pain is the leading cause of injury and disability worldwide, and presents a huge economic burden to society. Part of the reason for this is that many back pain complaints remain unresolved and poorly managed, and this may be due to many factors. This can become even more confusing when a patient is unsure about the history of their condition and the exact cause of their concern. It therefor essential for a physiotherapists to have the skills to clear the lumbar spine effectively. We all know that the lumbar spine can refer symptoms to other areas of the body, particularly the leg. There are also cases where lumbar spine symptoms may be produced by other areas, making the clinical picture that the patient is presenting with a tricky area of clinical practice to navigate through.

Getting In The Right Area

Its all about connecting the dots, but first you need to find the dots. We know that the lumbar spine may refer down into the leg, but at the same time, that other non lumbar structures may produce symptoms that can be masked as low back pain. It is also important to have a sound knowledge of visceral structures that may refer into the lumbar spine, and these are referred to as Spinal Masqueraders.These visceral symptoms present as low back pain, through the presentation of a non mechanical referred pain. It is important to have a sound understanding of the lumbar spine in terms of its anatomy, the different lumbar presentations and their signs and symptoms and of course different pain presentations when it comes to the lumbar spine.

Pain Sources When Looking At Clearing The Lumbar Spine

When looking at pain, there various ways to classify pain. You can look at pain behaviour for one, where pain can be classified as nociceptive, nociceptive inflammatory and neuropathic. Pain assessment is also valuable in understanding the clinical picture of the patient, and specific low back screening tools such as the STarT Back Tool may be employed early on to build the clinical picture of your patient even further, and to guide design making with regards to treatment pathways for patients who are categorised as low, medium or high risk patients.

Another simple way of looking at clearing the lumbar spine when being presented with a list of symptoms is to classify or group the symptoms into one of three boxes.

i) The symptoms are obviously coming from the spine (Obvious Spinogenic)

ii) The symptoms are obviously not coming from the spine (Not Obvious Spinogenic)

iii) The symptoms are obviously not coming from the spine (Obviously Not Spinogenic)

Obvious Spinogenic Symptoms

Some examples may include:

• Pain in the back
• Restricted lumbar range of motion
• Pain produced in limb with lumbar range of motion

Not Obvious Spinogenic

Obviously Not Spinogenic

Body chart helps us to clear out the involved areas in the body that are involved. You can also use the body chart to identify areas that may be problematic but not a current issue. This way, it may elude to a possible link between a peripheral symptom and a spinal issue. The body chart can also highlight peripheral neurological symptoms, and depending on the exact presentation, may lead towards obvious lumbar links.

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