Lumbar

Teaching threads

To help the student understand how the assessments work, these diagnostic guides outline the path that the assessments take that lead to relevant treatment...

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Lumbar

D1 Disc pain

main diagnosis step

1: Has there been a fall/RTA/trauma? No = go 2


2: Has there been sudden onset of low back pain following an action of lifting/ twisting? Yes = go 3


3: Bending forwards, is it painful? Yes = go 6


6: Is the patient standing with a lateral pelvic shift? Yes = go 7


7: Palpate Lumbar segments, is it painful? Yes = go 8


8: Sitting slouched, straighten patient’s leg, lift toes, and bend head forward.
Is it painful or is altered sensation felt? Yes = go 9


9: Therapist lifts painful leg straight up into the air. Is it painful or is altered sensation felt?
Patient may lift head to test further. Yes =go10


10: Test reflexes, myotomes, and dermatomes. Are some positive? Yes =D1

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Lumbar

D2 Lumbar stenosis

1: Has there been a fall/RTA/trauma? No = go 2


2: Has there been sudden onset of low back pain following an action of lifting/ twisting? No = go 11


11: Palpate Lx segments, is it painful? Yes = go 12


12: Is patient over 50yrs old? Yes = go 13


13: When walking up hill or bent forward, is it less painful? No = D2


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Lumbar

D3 Facet joint pain

test diagnosis step

1: Has there been a fall/RTA/trauma? No = go 2


test diagnosis step

2: Has there been sudden onset of low back pain following an action of lifting/ twisting? Yes = go 3


test diagnosis step

3: Bending forwards, is it painful? No = go 4


test diagnosis step

4: Bending backwards, is it painful? Yes = go 11


test diagnosis step

11: Palpate Lx segments, is it painful? Yes = go 12


test diagnosis step

12: Is patient over 50yrs old? Yes

=D3
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Lumbar

D4 Muscle spasm/ strain

test diagnosis step

1: Has there been a fall/RTA/trauma? No = go 2


test diagnosis step

2: Has there been sudden onset of low back pain following an action of lifting/ twisting? Yes = go 3


test diagnosis step

3: Bending forwards, is it painful? No = go 4


test diagnosis step

4: Bending backwards, is it painful? No = go 5


test diagnosis step

5: Bending to the right and left, is it painful? Yes = go 14


test diagnosis step

14: Is increased muscle tension evident in muscles along back? Yes = go 15


test diagnosis step

15: Feel the muscle bellies along the lower spine and above the pelvis is it painful to touch? Yes

=D4
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Lumbar

D5 Arthritis

test diagnosis step

1: Has there been a fall/RTA/trauma? No = go 2


test diagnosis step

2: Has there been sudden onset of low back pain following an action of lifting/ twisting? No = go 11


test diagnosis step

11: Palpate Lx segments, is it painful? Yes = go 12


test diagnosis step

12: Is patient over 50yrs old? Yes = go 13


test diagnosis step

13: When walking up hill or bent forward, is it less painful? No

= D5
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Lumbar

D6 Myofascial tightness

test diagnosis step

1: Has there been a fall/RTA/trauma? No = go 2


test diagnosis step

2: Has there been sudden onset of low back pain following an action of lifting/ twisting? No =go11


test diagnosis step

11: Palpate Lx segments, is it painful? No = go 15


test diagnosis step

15: Feel the muscle bellies along the lower spine and above the pelvis is it painful to touch? No = go 17


test diagnosis step

17: Pick up skin, and roll it between fingers. Does it feel painful and tight? Yes

=D6
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Lumbar

D7 Fracture

test diagnosis step

1: Has there been a fall/RTA/trauma? Yes = go 16


test diagnosis step

16: Is the lumbar segment painful to tap locally? Yes

= D7
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