Lumbar Data Collection And Intervention

Front 1

Lumbar Spine (things to notice about posture)

Back 1

Lumbar Spine

•Posture

–Check for scoliosis, including thoracic spine

–Lordosis/pelvic tilt

•Check flexibility of hips

–Leg lengths

•Supine – ASIS to medial malleolus
•Estimate – supine with knees up and check height o fknees or forward position of tibial tubercle

–Pelvic symmetry – ASIS and PSIS

Front 2

Lumbar Spine Palpation

Back 2

Lumbar Spine

•Palpation

–Lumbar spinous processes

–PSIS – line between is S2

–Iliac crest

–ASIS

–Sacrum/lateral border–

-Quadratus lumborum

–Lumbar paraspinals

Front 3

Range of Motion

Back 3

Range of Motion

• Flexion – fingers to floor
• Extension – minimal data on norms
• Lateral flexion – 35 degrees
• Rotation – 45 degrees

Front 4

Hip Flexibility and Strength

Back 4

Hip Flexibility and Strength

•Hip flexors – Thomas test

•Hamstrings – sit and reach, toe touch, supine

•Hip internal and external rotation – should
have approximately 45 degrees each

•Adductors – supine – 20-30 degrees

•Manual muscle test – hip FL, EXT, ADD, IR/ER,
knee FL and EXT

–Trendelenburg – checks gluteus medius

Front 5

Straight Leg Raise (give possible causes of positive results)

Back 5

Straight Leg Raise

• Possible causes of positive results

–HNP

–Hamstring tightness

–Sciatic nerve irritation

–Dural stretch

Front 6

Name muscle of Posterior tilt and those of Anterior tilt

Back 6

Posterior tilt (erector abdominis and Hamstrings)

Anterior tilt (back extensors and hip flexors)

Front 7

Leg Length Discrepancy Name causes

Back 7

Leg Length Discrepancy

•Causes

–Femur length difference

–Tibia length difference

–Pelvic assymetry – changes acetabulum position

–Soft tissue contractures of the knee/hip

–Scoliosis – reverts to pelvic assymetry

•Classified as true vs. functional

•Measure ASIS to medial malleolus

Front 8

Segmental Mobility

(Assess quality of lumbar movement)

Back 8

Segmental Mobility
•Assess quality of lumbar movement

–Quadruped – arch/sag

•Assess thoracic and lumbar mobility

–Standing and forward flex

•Assess “where” movement occurs, not “how much”

Front 9

Quadratus Stretching

Assisted manual lateral flexion

Back 9

Quadratus Stretching

•Assisted manual lateral flexion

–Client prone or sidelying over the edge of table

•May be done sidelying on ball as well

–Stabilize pelvis/lumbar spine
–Client actively stretches away from tight (concave) side in prone position
–Client passively stretches away from tight(concave) side in sidelying
–May use towel roll or pillows to accentuate specific stretch in sidelying

Front 10

Soft Tissue Techniques

(Iliocostalis lumborum)

Back 10

Soft Tissue Techniques

•Iliocostalis lumborum

–Generally using longitudinal strokes, either deep or superficial
–May work perpendicular with friction or bow-stringing

Front 11

Soft Tissue Techniques (Quadratus lumborum)

Back 11

•Quadratus lumborum

–May use lateral approach with patient in prone
–Better approach is patient in sidelying (pillow under quadratus on down side if tolerated)
–Longitudinal stripping, broad compression (fingers or elbow)