Lumbar Exam - Impairment-Based Dx

Question 1

What are the impairment based classifications for lumbar?

Answer 1

LBP with mobility deficits
LBP with movement coordination impairments
– LBP with referred pain-most common overlap here, but also with other classifications (Referred LE pain – diffuse)
LBP with radiating pain
– Radiating pain – dermatomal, “neurogenic pain”
LBP with cognitive deficits
– LBP with cognitive/affective tendencies
– LBP with generalized pain

Question 2

3 Types of Pain

Answer 2

• Nociceptive
• Peripheral Neurogenic
• Central Sensitization

Question 3

4 PRIMARY CLINICAL PATTERNS OF Low Back Pain

Answer 3

• Joint/Soft Tissue Mobility Deficits
• Neurodynamic Deficits
• Motor Deficits: Control and Coordination
• Altered Cognition and Beliefs

More common to have a combination rather than one thing!

Question 4

Important Subjective Components

Answer 4

• General background (age, gender, occupation, etc.)
• PMH (imaging, meds, other tests, general health hx)
• Primary complaint: What brings you in to see me?
• Symptom history (mechanism, gradual vs. sudden, progression?, etc)
• Symptom behavior (location, intensity, etc)
• Other recent changes: Bowel/bladder function, body weight
• Aggravating and alleviating motions or activities (focus on FUNCTION)
• What other treatments have you tried? What has/hasn’t worked?
• General review of systems OR specify anything specific in the past history

Link subjective exam to medical screening

Question 5

Physical structure/function impairment measures

Answer 5

• Postural assessment
• Lumbar ROM (AROM, overpressure if indicated)
• Aberrant movement assessment (done during ROM testing)
• Deep squat
• Repeated movements (directional preference and centralization/peripheralization)
• Prone instability test
• Neuro screen (sensation, reflexes and myotomes)
• Neurodynamics: Slump and SLR
• Hip ROM
• Muscle strength (trunk flexors, extensors, lateral abs, TA, hip abductors, hip extensors)
• Flexibility (hip flexors, quadriceps, hamstrings, adductors, piriformis, latissimus dorsi)
• Soft tissue assessment (palpation)
• Segmental joint mobility (stiffness and symptom provocation)
  – PA’s central or unilateral

Note: PROM not often done with lumbar spine