OMM-2, #17
February 11, 2003, 9am
Alexa von Lindeman PDF
Fred Puckett
p. 1 of 3
Lumbar Screening, Diagnostic Tests and Soft Tissue
The objective of this session in the ptr was to review screening techniques, neurologic
tests and soft tissue techniques for use in the lumbar region.
Statistics from most recent edition of Foundations: Back pain affects 85% of all people at
some time in life, most common cause for limited activity in people under 45 y.o.a.,
second most common reason for seeing a doctor, fifth most common cause for admission
to hospital, third most common site for surgical procedures.
I.
Neurologic exam review by lumbar level
a. Deep tendon reflexes
i. L 4: patellar reflex
ii. L 5: none
iii. S1: Achilles tendon
b. Muscle strength (motor)
i. L 4: tibialis anterior m. -foot inversion against resistance
ii. L5: extensor hallucis longus m. -dorsiflex big toe against
resistance or ask pt. to walk on heels.
iii. S1: muscles for foot eversion or ask patient to walk on their toes.
c. Sensation (always compare bilaterally)
i. L4: medial aspect of leg and foot
ii. L5: lateral side of leg and dorsum of the foot
iii. S1: lateral malleolus and lateral aspect of foot
d. Special test
i. Hip drop test: screens for lumbar and lumbar-thoracic sidebending
away from dropping hip.
1. place hands on iliac crest
2. pt. bends a knee without lifting heel and drops hip
(compare bilaterally)
a. Negative finding: iliac crest on side of bent knee
should drop about 20 degrees with no restriction to
lumbar, thoracic-lumbar sidebending on
contralateral side.
b. Positive finding: less than 20 degrees indicates
restriction in lumbar thoracic-lumbar sidebending to
contralateral side.
ii. Straight leg raise test: designed to reproduce back or leg pain,
determine cause pt. supine: doc. Raises leg by heel while holding
hand on top of knee to maintain straight leg. Should get to 70-90
degrees
OMM-2, #20
February 11, 2003, 9:00
Alexa von Lindeman PDF
Fred Puckett
p. 2 of 3
II.
III.
1. electric like pain that radiates down leg past knee may
indicate sciatica. Always ask pt. to characterize the pain
because their pain may be hamstring tightness and not
sciatica.
iii. Braggards test: extension of straight leg raise test
1. Lower leg slightly from retriction encountered at straight
leg test, flex foot, if pain electric like radiating pain occurs
a. positive for sciatica if pain increased with
dorsiflexion of foot. Dorsiflexion stretches the
sciatic n.and its nerve branches.
b. negative for sciatica if specific electric like
radiating pain does not worsen.
iv. Thomas test: important test in distinguishing between sciatica
radiopathy and iliopsoas or piriformis spasm or tightness. Psoas
and piriformis dysfunction may resemble sciatica radiopathy.
1. pt. lays supine and is asked to bring thigh toward chest
2. doc monitors popliteal region of contralateral side for
lifting off of table
a. positive: thigh and knee do not remain flat on table
with contralateral flexion of thigh.
Range of motion testing: be sure to check both active and passive range of
motion. Passive motion gives important information about end-motion feel.
a. Gross motion testing
1. Examine active (standing or seated) and passive (seated)
forward-bending, backward-bending, side-bending, and
rotation.
b. Segmental motion testing
Diagnosis
a. TART (compare bilaterally)
b. Segmental vertebral motion: assess all planes of motion (FB, BB, SB,
Rot.)
i. Somatic dysfunction is named for preference of motion.
ii. Fryette’s Principles
1. Type 1-neutral mechanics
a. (BB) SxRy- backward-bent because of normal
lordosis of lumbar region.
2. Type 2-non-neutral mechanics
(FB) RxSx-forward bending is non-neutral in lordotic lumbar region.
OMM-2, #20
February 11, 2003, 9:00
Alexa von Lindeman PDF
Fred Puckett
p. 3 of 3
IV.
iii. Sagittal plane motion (FB, BB)
1. pads of fingers placed in between spinous processes to
monitor motion in forward and backward bending
2. rule of thumb: hands at iliac crest rotate thumbs to spinous
process at level of iliac crest find L4.
3. grab pts. flexed legs and forward and backward bend them
by flexing and extending thighs and hips.
iv. Sidebend at body of vertebrae
v. Rotation- transverse processes at same level as spinous process.
Soft tissue techniques-review. Soft tissue good for evaluating and treating
somatic dysfunction, relaxing tight or constricted tissues, reduce edema or
lymphatic congestion, remove or modify pain via gating mechanisms, enhance
circulation to myofacial structures, improve immune function by increasing
circulation of immune factors
a. Kneading-bow muscle 90 degrees to its length.
i. ASIS lift kneading technique
ii. Leg scissor kneading technique
iii. Lateral recumbent kneading technique (pt. lies on side and faces
doc.)
b. Stretching-separates origin from insertion.