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Lumbar Assessment 2022

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Wardah Khalid
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21 views6 pages

Lumbar Assessment 2022

Uploaded by

Wardah Khalid
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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General Patient Information © Lumbar Spine Assessment Form www.cyriax.

eu

Date: Name:

Address:

Date of birth: Sex: m – f

Referral / diagnostic information:

Treatment procedure / analysis

Date first treatment: Date last treatment:

Treatment strategy:

Evolution / treatment adaptation:

Total number of treatment sessions:

Results:
Specific history

What is your main complaint: pain – paraesthesia – limitation of movement – weakness

PAIN
When did it start:
How did it start:
• Spontaneously
• overuse – injury
• describe :

• sudden – slow onset


• suddenly, slowly worse
• slowly, suddenly worse

How can you influence the symptoms, what makes it better or worse:

Evolution since the start: better-worse-unchanged

Evolution Start → Evolution → Now


Where do you feel the
pain:

Lumbar region
low – high – central
left – right – bilateral

Gluteal region
bilateral – alternating
left – right
cranial – caudal

Lower limb
left – right
where exactly
with or without
lumbar pain

Symptoms distal border :

Pain quality:

VAS 0-10
constant-intermittent
at rest
Worse with:

lying – sitting – standing – on the move – bending


In the morning
As the day progresses
At evening – at night

Better with:

lying – sitting – standing – on the move – bending


In the morning
As the day progresses
At evening – at night

Pain on coughing/sneezing:
where:

PARAESTHESIA
Where:
With or without pain:
When:
constant-intermittent
at rest-during the day-
at night-on activity (which)

General history

Description of typical exertion during professional or leisure activities:

Off work Previous treatments


since:
when:
what kind of treatment:
results:

Are there any other joints affected ? Incontinence problem since the beginning of the
which: complaints:

Medical imaging findings :

First time back problems ? Medication


which:
Yes - no
When was the last episode :
How are you feeling inbetween episodes:
Did you get any treatment : Surgery:

General state of health: good – moderate – bad Sudden unexplained loss of weight:
Inspection

How is the patient sitting during history taking: Wasting


Slouched ? where:

Particularities during undressing:

Equal weight-bearing on both feet: Angular kyphosis or shelf felt on palpation

Deviation: Remarks:
• in flexion: trunk – hip

• lateral: left – right


with or without pain

Basic functional examination

Variables: pain (where and when), ROM (normal, limited; in what degree), end-feel (normal, muscle
spasm, hard) and weakness.

Not painful / limited: - Painful / limited: +


Slightly painful / limited: +/- Very painful / limited: ++

Pain ROM End-feel Weakness


Pre-test pain at rest
A extension
A side flexion left
A side flexion right
A flexion

neck flexion more or


less pain
where
Standing on tip toe:
l –r
SI distraction test

with or without
lumbar support
SLR: l - r

neck flexion more or


less pain
where
P hip flexion
P hip lateral rot
P hip medial rot
R hip flexion
R dorsiflexion foot
R ext. big to
R eversion foot
Sensory deficit: l – r Knee jerk: l – r
where normal – weak – absent

Babinski + or - ; l – r Ankle jerk: l – r


normal – weak – absent
R knee flexion
R knee extension
P knee flexion
Gluteal contraction wasting: + or -

Extension pressure on spinous processes: pain (high lumbar or low lumbar) – end-feel elastic or
harder

Remarks:

Outcome of repeated test movements:

Accessory functional examination

Not necessarily all tests have to be carried out; the variables are mentioned between brackets.
We use the following quotation: test is positive = +; test is negative = -

R trunk side flexion in standing: l - r (pain) R trunk side flexion in standing: l - r (weakness)

Prone lying: active – passive – resisted extension (pain)

SI-appendix

The only variable we assess is pain:


can we provoke unilateral gluteal pain? We need minimum 5 positive tests!

Pain provocation tests: anterior ligaments: Pain provocation tests: anterior and posterior
• Distraction test via pressure on ASIS ligaments
• Forced hip lateral rotation Prone-lying
• Patrick’s test • Extension pressure on sacrum
• Resisted hip adduction • Yeoman’s test
Supine-lying
Pain provocation tests: posterior ligaments • Gaenslen’s test
• Pressure on anterolateral aspect crista
iliaca
• Forced hip medial rotation
• Axial pressure on the knee (from 90° hip
flexion-add.)
• Resisted hip abduction
Conclusion

Mechanical disorders Non-mechanical disorders

Disco-dural conflict: Red flags:


big derangement – small derangement • Pain in the “forbidden area”
annular – nuclear – mixed • Constantly increasing pain
reducible – irreducible – selfreducing • Expanding pain
• Constant pain, not influenced by positions
or movements
Disco-radicular conflict (lateral derangement) : • Chronology other than spontaneous cure
primary – secondary sciatica • Bilateral sciatica
annular – nuclear – mixed – roott • Combination of gross articular signs,
reducible – irreducible absence of dural signs
• Gross limitation of both side flexions
• Side flexion away from the painful side is
Postural – dysfunction syndrome the only painful and limited movement
• Discrepancy between pain and
SI-joint arthritis or postural syndrome neurological deficit (d >> p)
• Deficit of more than two nerve roots
Visceral cause • L1- or L2-deficit
• A positive sign of the buttock
Symptomatic structural deformity • S4 symptoms and signs
(osteophyte – stenosis)

Other / undecided

Non-mechanical : symptoms related to central sensitisation

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