Lumbar Somatic Dysfunction

by Sheldon C. Yao, DO

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    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.

    About the Lecture

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

    Included Quiz Questions

    1. To the left
    2. To the right
    3. Superiorly
    4. Inferiorly
    5. Neutral
    1. To the left
    2. To the right
    3. Superiorly
    4. Inferiorly
    5. Neutral

    Author of lecture Lumbar Somatic Dysfunction

     Sheldon C. Yao, DO

    Sheldon C. Yao, DO

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