Diagnosing lumbar spine somatic dysfunction
Notes
Lumbar spine
Diagnosing thoracic and lumbar spine somatic dysfunction
RULE OF THREES - THORACIC SPINE
- T1–T3: spinous processes are at the same level as transverse processes of same vertebra
- T4–T6: spinous processes are ½ level inferior to transverse processes of same vertebra
- T7–T9: spinous processes are one level inferior to transverse processes of same vertebra
- T10: spinous process is one level inferior to transverse processes of same vertebra
- T11: spinous process is ½ level inferior to transverse processes of same vertebra
- T12: spinous process is at the same level as transverse processes of same vertebra
DIAGNOSING THORACIC AND LUMBAR SPINE
Diagnosing somatic dysfunction in the thoracic and lumbar spine begins with assessing the transverse processes. On palpation, when transverse processes are found to be more posterior (prominent) on one side, this indicates that these vertebrae are rotated to that side. The more posterior transverse process may also be described as “resisting posterior-anterior (PA) pressure.”
Since testing side bending is difficult in the thoracic and lumbar spine, we use Fryette laws to assume the side bending based on the rotation. If a group of vertebrae is rotated right, we assume that group is side bent left (type I mechanics). If a single vertebra is rotated right, we assume it is side bent right (type II mechanics). For type II somatic dysfunctions, we also ask the patient to flex and extend at that area while we palpate the transverse processes to assess for restoration of symmetry (ease of motion).
Since testing side bending is difficult in the thoracic and lumbar spine, we use Fryette laws to assume the side bending based on the rotation. If a group of vertebrae is rotated right, we assume that group is side bent left (type I mechanics). If a single vertebra is rotated right, we assume it is side bent right (type II mechanics). For type II somatic dysfunctions, we also ask the patient to flex and extend at that area while we palpate the transverse processes to assess for restoration of symmetry (ease of motion).
DIAGNOSING THORACIC AND LUMBAR SPINE SOMATIC DYSFUNCTION | |||||||||
| TYPE OF DYSFUNCTION | SYMMETRY RESTORATION | TRANSVERSE PROCESSES | EXAMPLE | ||||||
I | Transverse processes most symmetric in neutral position | More posterior (prominent) on left, resists PA pressure on left | N SRRL | ||||||
I | Transverse processes most symmetric in neutral position | More posterior (prominent) on right, resists PA pressure on right | N SLRR | ||||||
II | Transverse processes more symmetric in flexion, less in extension | More posterior (prominent) on right, resists PA pressure on right | F SRRR | ||||||
II | Transverse processes more symmetric in flexion, less in extension | More posterior (prominent) on left, resists PA pressure on left | F SLRL | ||||||
| II | Transverse processes more symmetric in extension, less in flexion | More posterior (prominent) on right, resists PA pressure on right | E SRRR | ||||||
| II | Transverse processes more symmetric in extension, less in flexion | More posterior (prominent) on left, resists PA pressure on left | E SLRL | ||||||
Author: Arman Israelyan, OMS-III
Editor: Matt Lipinski, DO
Editor: Robyn Hughes, MScBMC