Diagnosis of the Lumbar

by Sheldon C. Yao, DO

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    00:01 Diagnosing lumbar somatic dysfunction.

    00:03 So first, we're gonna start off with look-feel moves.

    00:06 So we're gonna observe, check for any sort of gross asymmetries that we may find.

    00:10 Some patients may have a previous surgical scar in the region will cue you into prior surgeries.

    00:16 We're going to feel and palpate the lumbar muscles here in the paraspinal region.

    00:22 We could feel for landmarks.

    00:24 We could feel for the PSIS which matches out with S2.

    00:27 We could feel for the Iliac crest which lines up to the interspace between L4 and L5.

    00:34 Finding our spinous process landmarks for the lower lumbar spine.

    00:38 We could walk up from the 12th rib, walk up from the PSIS and find the 12th rib here, come medially and then that takes us to T12 and we know the next one below is L1, so kinda getting a sense of our landmarks.

    00:52 The region here, feeling for any hypertonicity, tenderness in the region, TART changes to cue us in if there's any somatic dysfunctions in the lumbar spine We could motion test by doing gross motion testing in the lumbar spine and then we could fine tune and do segmental testing.

    01:09 So now we're going do some segmental motion testing for the lumbar spine.

    01:14 So we're gonna find our landmarks, find the L5 again.

    01:17 So Iliac crest, midline takes me to the L4 and L5.

    01:21 Or you could find the PSIS, takes you to S2 and you could walk your way up to L5.

    01:26 Once we're at L5 spinous process, we're gonna find the transverse process which are lateral about an inch, an inch and a half lateral from the spinous process.

    01:35 You wanna make sure you're equidistant from the spinous process in order to find the transverse process.

    01:40 The transverse processes are definitely deeper, there's more muscle between the surface to the bone in the lumbar spine.

    01:47 So, try to get equidistants and apply a gentle pressure, springing down towards the table.

    01:54 And we're looking for any sort of asymmetry in the region at L5, you can move up to L4, L3, L2 and L1.

    02:04 So as I did this quick screen, I'm just checking for any sort of asymmetry, trying to elicit any sort of tenderness and what I found was that at L2, it felt a little bit harder to push down on the right side.

    02:16 So it's posterior on the right side here.

    02:19 Now, once I find a asymmetry, I wanna double check to see if this is a neutral or non neutral dysfunction.

    02:26 So, if it's posterior at L2, what I want to do is to motion test this in flexion and extension.

    02:34 For extension, I could ask the patient to come up on their elbows, go ahead and come up on your elbows and that extends to the L2 segment.

    02:41 While in this position, I'm gonna spring again and I'm gonna see if that changes the dysfunction and if it's easier to push on that segment.

    02:49 Remember that if it's more posterior on that side, it's gonna be harder to spring on that side.

    02:54 So here, in extension, it actually felt like it got a little bit better, it's easier to spring forward.

    02:59 I'm gonna now have you go into flexion by kinda getting into a cat or child's pose, you're talking about yoga positions.

    03:05 You could see how he has rounded his back and now he's able to flex to that segment and I'm gonna spring again and here, it's feels like it's resistant, it's still a little bit firm.

    03:16 So there was a freedom of motion in extension.

    03:19 Go ahead and lie on your stomach.

    03:23 So we know that this L2 segment has a non neutral dysfunction.

    03:27 And so, if it's non neutral, side bending and rotation are coupled because it's a type II dysfunction.

    03:33 So here at L2, I have a flexion extension, so it's an ERS-right.

    03:41 So, we were able to identify a single segment restriction.

    03:45 Sometimes you might find a group curve or a couple of posterior transverse processes, at least the group of 3 is posterior and it doesn't really change with flexion and extension.

    03:56 and that would be a sign more of a group curve as opposed to a single segment dysfunction.

    04:01 So there, we reviewed and identified somatic dysfunctions in the lumbar spine.

    About the Lecture

    The lecture Diagnosis of the Lumbar by Sheldon C. Yao, DO is from the course Osteopathic Diagnosis of the Lumbar Region.

    Included Quiz Questions

    1. Posterior superior iliac spine
    2. Anterior superior iliac spine
    3. Sacral spine
    4. Coccyx
    5. Iliac crest
    1. Superior Iliac crest
    2. Sacral spine
    3. Coccyx
    4. Anterior superior iliac spine
    5. Posterior superior iliac spine

    Author of lecture Diagnosis of the Lumbar

     Sheldon C. Yao, DO

    Sheldon C. Yao, DO

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