Diagnosing lumbar somatic dysfunction.
So first, we're gonna start off
with look-feel moves.
So we're gonna observe, check for any sort of
gross asymmetries that we may find.
Some patients may have a previous surgical scar
in the region will cue you into prior surgeries.
We're going to feel and palpate the lumbar
muscles here in the paraspinal region.
We could feel for landmarks.
We could feel for the PSIS
which matches out with S2.
We could feel for the Iliac crest which lines up
to the interspace between L4 and L5.
Finding our spinous process landmarks
for the lower lumbar spine.
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
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.
So now we're going do some segmental
motion testing for the lumbar spine.
So we're gonna find our landmarks,
find the L5 again.
So Iliac crest, midline takes me to
the L4 and L5.
Or you could find the PSIS, takes you to
S2 and you could walk your way up to L5.
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.
You wanna make sure you're
equidistant from the spinous process
in order to find the transverse process.
The transverse processes are
definitely deeper, there's more muscle
between the surface to the bone
in the lumbar spine.
So, try to get equidistants and apply a gentle
pressure, springing down towards the table.
And we're looking for any
sort of asymmetry in the region
at L5, you can move up to L4,
L3, L2 and L1.
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.
So it's posterior on the right side here.
Now, once I find a asymmetry,
I wanna double check to see if this is
a neutral or non neutral dysfunction.
So, if it's posterior at L2, what I want to do
is to motion test this in flexion and extension.
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.
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
Remember that if it's more posterior on that side,
it's gonna be harder to spring on that side.
So here, in extension, it actually felt like it got
a little bit better, it's easier to spring forward.
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.
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.
So there was a freedom of motion in extension.
Go ahead and lie on your stomach.
So we know that this L2 segment
has a non neutral dysfunction.
And so, if it's non neutral, side bending and rotation
are coupled because it's a type II dysfunction.
So here at L2, I have a flexion
extension, so it's an ERS-right.
So, we were able to identify
a single segment restriction.
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.
and that would be a sign more of a group curve
as opposed to a single segment dysfunction.
So there, we reviewed and identified
somatic dysfunctions in the lumbar spine.