Lumbar

spine diagnosis L1 L5 vertebrae

Possiblediagnoses
TypeIdysfunction(3
ormorevertebrae,
groupcurve)
NRRSL

Rotationfindings

Sidebendingfindings

Findingswithflexion
andextension

RightTPsaremore
posterior

Sidebentleft

NRLSR

LeftTPsaremore
posterior

Sidebentright

Rotationand
sidebendingfindings
areunchangedwith
flexionandextension
Rotationand
sidebendingfindings
areunchangedwith
flexionandextension
Findingswithflexion
andextension
Rotationand
sidebendingfindings
aremoreequalwith
flexion(childspose
orrollingfingersover
topofTPs)
Rotationand
sidebendingfindings
aremoreequalwith
flexion(childspose
orrollingfingersover
topofTPs)
Rotationand
sidebendingfindings
aremoreequalwith
extension(patientup
onforearmsorrolling
fingersunderTPs)
Rotationand
sidebendingfindings

TypeIIdysfunction(1 Rotationfindings
or2vertebrae)
FRSR
RightTPismore
posterior

Sidebendingfindings

FRSL

LeftTPismore
posterior

Sidebentleft

ERSR

RightTPismore
posterior

Sidebentright

ERSL

LeftTPismore
posterior

Sidebentleft

Sidebentright

Copyright2013NewYorkInstituteofTechnologyCollegeofOsteopathicMedicine
DepartmentofOsteopathicMedicine

arem
moreequalw
with
exten
nsion(patien
ntup
onforearmsorro
olling
fingerrsunderTPss)

Figure3Ch
hild'sposetoinduceflexion

Figure4Pattientuponforeearmstoinduceextension

Figure5Fllexionbyrollinggthumbsupove
erTPsandpressingup

wnoverTPsandpressingdown
Figure6Exxtensionbyrolliingthumbsdow

Copyrightt2013NewYorkInstitute
eofTechnolo
ogyCollegeoffOsteopathiccMedicine
Departme
entofOsteop
pathicMedicin
ne

RelatedA
Anatomy:

Briefdesscription:TheelumbarspinnemayeitherrhaveaTypeeIdysfunctionn(groupcurvve,threeorm
more
vertebrae
einvolved)oraTypeIIdysfunction(two
oorfewerve rtebraeinvolved).Whend
diagnosing,usse
grossmottiontestingaswellassegm
mentaltomakeadiagnosiis.

Look(ob
bservation):Lookintheluumbarregionforanyscarss,differencesinwaistcreaases(canindiccate
sidebendiing),asymme
etryorscolioticcurves.

Feel(palpation):
Physician
nposition:SStandorsittooeithersideoofthepatientt
Patientp
position:Proneorseated
Handpositioning:Ussethepadsoffyourthumbbstopalpatetthespinouspprocesses(SPss)andtransverse
processess(TPs).

ue:
Techniqu
1. Withthepati
W
enteitherp
proneorseatted,runyouurindexfingeerovertheSSPsfromL1L5.
Fe
eelforanyccurveinthespinethatm
mayindicatesidebendingg.
2. Nowuseyou
N
ersandrunyyourhanddowntheTPssfromL1LL5.
rindexandmiddlefinge
Fe
eelforanyp
posteriorTPssthatmayin
ndicaterotation.
3. Totestforind
dividualverttebrastartb
byfindingL1.Inorderto
ofindL1,palpatethe12tthrib
andfollowitbacktoT12,,thendropd
downtoL1. Youmayalssostartfrom
mL5byfinding
th
heiliaccrestts,cometotthemiddleo
oftheback(yyouwillbeb
betweenL4andL5SPs)and
th
hendropdowntoL5SP..
4. Afterconfirm
A
mingyouareontheL1SP
P,moveyouurfingerslateerallyfromttheSPtopalpate
th
heTPs.

Copyrightt2013NewYorkInstitute
eofTechnolo
ogyCollegeoffOsteopathiccMedicine
Departme
entofOsteop
pathicMedicin
ne

5. Todeterminethedysfunction,feelforwhichTPisposterior(thisisthedirectionof
rotation).Ifitisagroupcurvetherotationwillbeoppositetothedirectionof
sidebending,ifitisaTypeIIdysfunctionthenthedirectionofrotationandsidebending
willbethesame.
6. Testingforflexionandextensionmaybedonemultipleways.Withthepatientprone,
youcancheckflexionbyhavingthepatientgointochildsposeandcheckextensionby
havingthepatientcomeupontotheirforearms(asifwatchingtv).Finally,themore
advancedmethodcanbeusedintheproneposition.Simplyrollyourthumbsoverthe
topoftheTPsandpressupwardtoinduceflexion;youreyourthumbsundertheTPs
andpressdowntoinduceextension.
7. TonameTypeIdysfunctions,theTPsfor3ormorevertebraewillberotatedinthe
samedirectionanduponflexion/extensiontherewillbenoimprovement.(Ex.L1L5TPs
areallposteriorontherightanddonotimprovewithflexion/extension.Sidebendingis
oppositeofrotationwithTypeIdysfunctionssothediagnosisisL1L5NeutralRRSL.)
8. TonameTypeIIdysfunctions,theTPwillbeposteriorononeside(directionofrotation).
Rotationwillbeinthesamedirectionassidebending.TheTPswillfeelmoreevenin
eitherflexionorextension.(Ex.L4TPfeelsmoreposteriorontheleftandtheTPsfeel
moreeveninflexion.ThediagnosiswillbeL4FRSL.)

Move(motiontesting):
Activemotiontesting:
1. Askthepatienttoextendbackwardsasfaraspossible.Observehowfarthepatientcan
moveaswellasfluidityofmotion.
2. Askthepatienttobendforward(flexion)asfaraspossible.Observehowfarthepatient
canmoveaswellasfluidityofmotion.
3. Askthepatienttobendtowardstherightandleft(sidebending)asfaraspossible.
Observehowfarthepatientcanmoveaswellasfluidityofmotion.
4. Askthepatienttoturntowardstherightandleft(rotation)asfaraspossible.Usethe
shouldersasareference.Observehowfarthepatientcanmoveaswellasfluidityof
motion.

Passivemotiontesting:
1. Withthepatientseated,induceallmotions(flexion,extension,rotationand
sidebending).Lookforanyasymmetry.

Copyright2013NewYorkInstituteofTechnologyCollegeofOsteopathicMedicine
DepartmentofOsteopathicMedicine