Lumbar Somatic Dysfunction

00:01 Diagnosing lumbar somatic dysfunctions.

00:03 So, lumbar somatic dysfunctions are diagnosed similarly to thoracic dysfunctions.

00:09 There are 2 types. It follows Fryette's principles.

00:12 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 unleveling.

00:25 So the muscles are a lot tighter on one side, pulling and causing a side bending.

00:30 Type II somatic dysfunctions are more single segment dysfunctions.

00:33 These are more mechanical or could be viscerosomatic.

00:36 In these somatic dysfunctions are usually associated of a flexion or extension component because they are non-neutral dysfunctions.

00:45 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.

00:58 So, how do we apply diagnosis here.

01:01 We have a 50 year old male, comes in of increased lower back pain.

01:04 On the right side on examination, you find that the transverse processes of L1 to L5 are more posterior on that right side.

01:11 When you flex and extend, there's no significant change in the asymmetry.

01:15 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.

01:27 Remember if in a neutral curve, side bending rotation are on opposite directions.

01:31 Here, we have the transverse processes are more posterior on the right side, so the segments are rotated right.

01:37 So if I have a right rotation, that means the side bending is going to be to the left.

01:41 So I have L1-5, neutral curve, side bend left, rotated right somatic dysfunction.

01:47 Here's another example.

01:48 We have a 20 year old female, coming in with a lower back pain.

01:52 And the tenderness is over the L2 transverse process.

01:57 It resist anterior springing, it is more posterior on the left side compared to the right.

02:03 When she extends the lumbar spine, the L2 transverse process remains the same.

02:08 And when you flex that segment, the L2 transverse process is less tender and is more symmetric compared to the right.

02:15 So what is our somatic dysfunction diagnosis? So here, we have a clear improvement in flexion and it stays asymmetric in extension.

02:31 So it's a non-neutral segment.

02:33 So we have a L2, flexed segment and because it's more posterior on the left side, we know that it's rotated left.

02:40 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.