Diagnosing lumbar somatic dysfunctions.
So, lumbar somatic dysfunctions are diagnosed
similarly to thoracic dysfunctions.
There are 2 types.
It follows Fryette's principles.
So type I lumbar somatic dysfunctions are lateral
group curves, groups of 3 or more segments
that are usually secondary to some sort of
muscle spasm or sacral base on leveling.
So the muscles are a lot tighter on one
side, pulling and causing a side bending.
Type II somatic dysfunctions are
more single segment dysfunctions.
These are more mechanical
or could be viscerosomatic.
In these somatic dysfunctions are usually
associated of a flexion or extension component
because they are
And so in type II dysfunctions, the side bending
rotations is going to be in the same direction
while in type I, it's gonna be a neutral curve and
side bending rotation are gonna be opposite sides.
So, how do we apply diagnosis here.
We have a 50 year old male, comes
in of increased lower back pain.
On the right side on examination,
you find that
the transverse processes of L1 to L5
are more posterior on that right side.
When you flex and extend, there's no
significant change in the asymmetry.
So what is our diagnosis?
So because L1 and L5 do not change
significantly in flexion and extension,
I know that it's a neutral curve.
Remember if in a neutral curve, side
bending rotation are on opposite directions.
Here, we have the transverse processes
are more posterior on the right side,
so the segments are rotated right.
So if I have a right rotation, that means the
side bending is going to be to the left.
So I have L1-5, neutral curve, side bend left,
rotated right somatic dysfunction.
Here's another example.
We have a 20 year old female,
coming in with a lower back pain.
And the tenderness is over
the L2 transverse process.
It resist anterior springing, it is more posterior
on the left side compared to the right.
When she extends the lumbar spine,
the L2 transverse process remains the same.
And when you flex that segment,
the L2 transverse process is less tender
and is more symmetric compared to the right.
So what is our somatic dysfunction diagnosis?
So here, we have a clear improvement in
flexion and it stays asymmetric in extension.
So it's a non-neutral segment.
So we have a L2, flexed segment and because
it's more posterior on the left side,
we know that it's rotated left.
So, if we follow Fryette's principle number 2,
because it's a non-neutral segment,
it's gonna be L2 flexed,
rotated left and side bend left.