OMM
Lumbar Spine Dysfunctions
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Lumbar Spine Dysfunctions

Follows Fryette's laws; common in low back pain.

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◆Lumbar motion

  • •Follows Fryette's laws (Type I and II)
  • •Primary motion: flexion/extension; some rotation but limited
  • •Side-bending occurs with rotation per Fryette

◆Diagnosis

  • •Patient prone; assess transverse processes for rotation
  • •If TP posterior on side of rotation
  • •Check in neutral, flexed, and extended positions to differentiate Type I from Type II
  • •Lumbar segments often dysfunctional in low back pain, especially L4-L5 and L5-S1

◆Lumbar treatment options

  • •Muscle energy (most common): patient contracts isometrically, operator engages new barrier
  • •HVLA: lumbar rolls common; contraindications include acute disc herniation, instability
  • •Counterstrain: psoas and iliacus tender points commonly found
  • •Soft tissue: prone or lateral kneading of paraspinals
  • •MFR: direct or indirect

◆Psoas dysfunction

  • •Common cause of low back pain
  • •Patient stands with trunk flexed and shifted toward side of contracted psoas
  • •Thomas test: contracted psoas if hip doesn't extend
  • •Treatment: counterstrain (anterior tender points), muscle energy, MFR

High-yield pearls

  • ◆Low back pain + Type II lumbar dysfunction = treat the Type II first
  • ◆Always rule out red flags before OMT (fever, weight loss, neuro deficit, cancer, IV drug use)
  • ◆Psoas tender points are ANTERIOR — palpate medial to ASIS in supine
Quick check

5-question quiz on this note

Test yourself before moving on. ~1 min.

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