Lumbar Spine Assessment

Chapter 10, p. 319

Low Back Pain (LBP)

 90% of all Americans

 Minor insultsmajor injuries
 Maintain normal lordotic and kyphotic curves
to avoid injury
Clinical Anatomy—p.319

5 vertebrae=lumbar spine
 P.320, fig. 10-2
– Facets
– Processes
– Foramen
– “Scotty Dog”
Evaluation—
p329

 Primary role of ATC:

– On-field evaluation:
 Rule out (R/O) bony trauma which has, or may, damage to
spinal cord
– Clinical evaluation:
 Evaluate specific cause of injury and devise a rehabilitation
plan
History
p. 329

 Location of pain:
– Localized or radiating?
 Onset of pain:
– Acute, chronic, insidious?
 Consistency of pain:
– Constant/intermittent?
– Improves/Worsens with
activity?
 Mechanism:
– Flex, ext, rotation, lat. Flex
– Direct blow/trauma
History
p. 330

 PMH of injuries/surgery?
 Smoker?
 Bowel/bladder symptoms?
– Incontinence or ⇑
frequency
– Immediate referral
 Referral history
– Time in the medical
system?
– # of physicians seen?
Inspection/Observation
p. 333

 Sagittal curvature
 Scoliosis
 Frontal curvature
 Normal curves
 Standing posture
 Shoulders
 Head
 Walking posture (gait)
Observation/ Inspection
 Paravertebral muscles
 Symmetry / spasm
 PSIS level
 Overall attitude
Palpation—
p. 335

 Transverse processes
 Spinous processes
 PSIS
 Paravertebral
musculature
– Symmetry
– spasm
Functional testing—
p.337

 Gross ROM assessment

only
 Trunk Extension = 45º
– Lordosis should increase
 Trunk Flexion = 9045º
– Lordosis should decrease
 Rotation
 Lateral flexion
 Symmetry > Goniometry
Pathologies/Injuries
p. 353

 Muscle strains—p.353
 Facet joint syndrome-
p.353
 Disk lesion—p. 354
 Spondylopathies—p.292
Muscle Strains—
p.284

 Pain localized to
paraspinal musculature &
PSIS
 Spasm probable
 Limited flex. & ext. (pain)
 No radiating pain
 May not correlate to
specific mechanism
Facet Joint Syndrome-p.353
 Table 10-10,p.354  Worsened by:
 ~40% of all LBP – Repeated spine-loading
 Vague symptoms that mimic activities (ext, side
other pathologies bending, rotation)
 Common with repeated spine- – Poor LE flexibility
loading activities – Poor Trunk strength
 Localized pain \
 Often improves with activity
 Nerve entrapment may result
from compensatory posturing
Disk lesion—
p.354, Table 10-11 (355)

 Crack in annulus fibrosus  Altered standing posture

herniation of nucleus  Symptoms ⇑ with activity
pulposus  Bilateral or unilateral
 Pressure on nerve symptoms
rootpain/burning  Usually acute onset
sensation
 “Bulge” ≠ pathology
 Radiating pain into
buttocks and down leg
 MRI for best diagnosis
Spondylopathies—
p.357, Table 10-13 (359)

 Vertebral defect
 May occur at any
age/sports
 Congenital?
 Stress fx?
 Common is sports with
forced hyperextension
 Generally occurs at L4-
L5 or L5-S1 levels
Spondylolysis—
p. 358 (Fig. 10-26)

 Defect at pars interarticularis

 Unilateral or bilateral
 Signs/ Symptoms:
– NL spinal alignment
– LBP ⇑ during & after activity
– Localized lumbar spine pain
– NL flex; restricted ext.
– (-) neuro. Test
 X-rays show “collared” Scotty
Dog
Spondylolysthesis—
p.358 (fig.10-28)

 May occur with  Possible step-off deformity

spondylolysis  X-rays show “decapitated”
 Anterior displacement of Scotty Dog
proximal vertebrae on  (+) Stork test
distal
 Pain more
intense/constant than
spondylolysis
 Neuro signs sometimes
(+) if displacement
worsens
Straight leg raise test (SLR)—
p.347, fig. Box 10-9

 Supine with knees extended  If pain does not recur:

 PROM hip flexion to point of – Tight hamstrings
discomfort or end of range
 ⇓ hip flexion and move into
passive dorsiflexion
 (+) = pain reproduced and
recurs with reduced SLR
 (-) =pain reproduced but does
not return with reduced SLR
Well-leg SLR test
p.348, Box 10-10

 Supine with knees

extended
 Passively raise one leg
– Similar to SLR test
– Raise leg with symptoms
– Provocation test
 (+)=Symptoms felt in the
other leg (“well” leg)
Valsalva maneuver
p. 344, Box 10-6

 Increasing intrathecal
pressure to reproduce
symptoms
 (+)=Reproduced
symptoms :
Radiating pain or
Numbness
Kernig’s Test—p. 346
 Box 10-8
 Provocation test to elongate
the spinal cord
 Active SLR until point of pain
(knee straight)
 Flex knee @ point of pain
 (+)= pain in LB or radiating
pain in LE
 Brudzinski’s Test=Kernig with
cervical flexion
Hoover test
p.351, Box 10-13

 Tests compliance & effort

 “Malingering”
 Procedure:
– Supine with knees extended
– Active hip flexion
– Pressure should be felt on
opposite leg as SLR is
attempted
 (+)=No pressure=low effort
Babinski test
p. 383, Box 11-3

 Tests presence of upper

motor neuron pathology
 Blunt device moved across
plantar aspect of foot from
calcaneus to 1st metatarsal
head (great toe)
– (-)=toe flexion
– (+)=great toe extension with
splaying of other toes
 Normally (+) in newborns
Hamstring flexibility
 Tripod sign
 90-90 position for testing
 Tight hamstrings
pelvic tilt
Stretched extensors
Pain/spasm
Strength tests
 Isometric strength tests
 Held for 60 sec.
 Flexor strength testing
 Extensor strength testing
Lifting Technique
 Maintain natural curves
– Sitting, standing, walking,
lifting
 10:1 ratio
 Use large LE muscles
 Keep items close to body
 Hip = axis (not LS)
 Avoid rotating spine
 Get help when needed