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DIAGNOSIS, PRESENTATIONS, RIB JOINT SUBLUXATION, SCIATICA image, History…

- - - - Rolling: throughout the back especially along BL meridian 5-10 minutes
        Finger/Palm pressing: BL meridian and local ashi points
        Palm press kneading: BL meridian and local ashi points
        Flick-poking: tight musculature
        
        1) Rolling along BL, 5-10 min
        2) Finger/palm press kneading, along BL and Ashi, while pushing on distal pts like BL 40
        
        Rolling: throughout the back especially along BL meridian 5-10 minutes
        Press kneading: BL meridian and local ashi points
        Flick-poking
        Scrubbing
        Rolling to finish
        
        Press-kneading: lumbar 3-5 minutes
        
        Pointing/pressing: lumbar 3-5 minutes
        
        Tapping: lumbar 2-3 minutes
        
        Press-kneading: acupuncture/ashi points
        
        Rolling
        
        Palm Pressing and Press-Kneading
        
        Finger Pressing and Press- Kneading
        
        Rolling
        
        Palm Pressing and Press-Kneading
        
        Finger Pressing and Press- Kneading
        
        Elbow pressing into BL 25, GB 30, and ashi points
        
        Knuckle pressing along limb
        
        Hold twisting of the lower limbs
  - - - Lateral Recumbant Stretch
        Weeble Wobble
        Specific Lumbar Vertebrae Stretch:patient prone, practitioner uses thumb or pisiform to press the deviated vertebra towards neutral position while simultaneously pulling the opposite side leg towards the deviated side. Hold for 30 seconds and repeat
        Patient Self-Stretch: patient supine- cross one leg over the other. Grasp the knee of the upper leg and apply stretch to low back Self Weeble Wobble
        
        Pressing 1st and 2nd rib joints
        
        Pressing for rib joint subluxation
        
        Rib pushing
        
        Lateral Recumbent Stretch
        Kicking the Leg/Kick Pull: Supine - count to 3 with extension of the leg. On 1 and 2 lightly bend/lengthen the leg and on 3 pull the leg while patient stomps through the heel. Do not perform if patient has a knee or hip replacement.
        
        Traction/Counter-Traction + Whale Shake: Prone - patient is prone, holding the edge of the table, the practitioner holds the patient’s ankles and pulls for 1 minute then releases. Repeat several times, then follow with Whale Shake
        
        Lateral Recumbent Stretch
        
        Press Lumbar, Lifting Leg: prone- press over lumbar and lift leg for 1 minute
        Bedside test stretch or “End of table” stretch
        Carrying: back to back- link arms with patient, use your hips to support patient’s lumbar, then bend forward to arch patient’s spine
        Press-kneading of the iliopsoas for 3-5 minutes
        
        Pulling Backwards- prone or side lying- apply pressure over the lumbar/sacral area, and lift the leg
        Lateral Recumbent Stretch
        Weeble Wobble
        Whale Shaking - supine- practitioner holds patient’s ankle and moves lower limbs side to side rhythmically and a small range of motion to create a wave throughout the body
        
        1 more item...
- - - - Tenderness over involved rib joint
        
        Tenderness and tight musculature over/around the rib joint
        
        With palpation, rib is posterior (feels higher) than the same rib on the other side
        
        Ask patient to take deep breath & hold it, then point out any tenderness or tightness to you
        
        Springling Test: Deep pressing along spinous processes
        (+) pain, hypermobility, and/or hypomobility
        
        Muscular spasm in lumbar region
        
        Stork Standing Lumbar Extension Test
        (+) pain in low back=possible facet syndrome or pars interarticularis fracture
        
        Differentiate from Acute Lumbar Sprain and Nerve Root Irritation
        
        Tenderness and/or ropey tissue around 3rd lumbar vertebrae
        
        Chronic = atrophy/decreased tone of the lumbar musculature
        
        Mild low back spasm, no tenderness
        
        Inability to raise both legs simultaneously
        
        Pressing/distending pain deep in abdomen and iliac fossa. This may radiate to the groin, thigh and knee.
        
        Decreased or lack of sensation in anterior thigh or knee
        
        Weak or absent patellar tendon reflex
        
        Resisted hip flexion test: supine- hip flexion against resistance
        (+) increased pain
        
        Femoral Nerve Traction test (Yeoman’s Test)
        (+) increased pain
        
        Differentiate from Acute Lumbar Sprain
        
        Lateral or decreased curvature of the spine
        Pressing pain/percussion pain
        STANDING
        
        Toe walk- If weak/unable S1 myotome involvement (walk away from me)
        
        Heel walk- if weak/unable L5 myotome involvement (walk towards me)
        
        PRONE
        
        Place pillow under chest, and palpate the spine. If tender or they have radiating pain, place the pillow under the abdomen.
        (+) if tenderness and radiation decreases
        
        Percussion test- place palm over lumbar and use other hand to strike the other hand
        
        Yeoman’s Test
        
        Knee Flexion Test- practitioner flexes the knee past 90 degrees
        (+) radicular pain - possible L2-3 disc protrusion
        
        Patellar Tendon Reflex- if decreased/absent possible L3/L4 pathology
        
        SUPINE
        
        Straight Leg Test/Lasegue’s Sign- at 30-70 deg** - watch for radiating pain
        (+) pain in the lumbar and/or radiating pain down leg
        
        Braggard’s Test (+) recreation of pain from SLT
        
        Abdominal straightening test for herniated disc (+) numbness or pain
        
        Neck Flexion Test (+) numbness or pain
        
        Dorsiflexion of the Large Toe weak= possible L5 involvement
        
        SITTING
        -Bechterew’s Test- (+) pain or weakness
        -Vasalva Maneuver- (+) radicular pain
        -Patellar Tendon Reflex test- decreased or absent reflex indicates L4 involvement
        
        STANDING
        
        Heel walk (L5 myotome), Toe walk (S1 myotome)
        
        SITTING
        
        Sensory test
        
        Patellar Tendon Reflex- decreased or absent reflex indicates L3/L4 involvement
        
        Achilles Tendon Reflex- decreased or absent indicates lesion between L5/S1
        
        Babinski Sign- splaying of toes indicates an upper motor neuron lesion. Splaying is normal in infants until 16mo
        
        Bechterew’s Test
        
        Vertex/Cervical Compression Test
        (+) peripheral pain- foraminal narrowing/SOL/sciatica
        
        Cervical Distraction Test
        (+) peripheral pain decreases- faminal narrowing/SOL/sciatica
        
        Vasalva Maneuver (+) radicular pain
        
        SUPINE
        
        Straight Leg Test/Lasegue’s Sign- (+) pain in the lumbar and/or radiating pain down leg
        
        Braggard’s Test/Reinforcing Straight Leg Test (+) recreation of pain from SLT
        
        Abdominal straightening test
        (+) numbness or pain
        
        Neck Flexion Test for herniated disc/Soto-Hall Test (+) numbness or radicular pain
        
        Dorsiflexion of the Large Toe weakness = possible L5 involvement
        
        Look for lateral or decreased curvature of the spine
        
        Pressing pain/percussion pain
        
        PRONE
        
        Place pillow under chest, and palpate the spine. If tender or they have radiating pain, place the pillow under the abdomen.
        (+) if tenderness and radiation decreases
        
        *Percussion Test on Lumbar
        - Yeoman’s Test
        
        Knee Flexion Test- practitioner flexes the knee past 90 degrees (+) radicular pain - possible L2-3 disc protrusion
- - - - Improper sleeping position
        
        Poor body mechanics
        
        Poor posture
        
        Muscular tension/imbalance
        
        Sudden extension after bending forward, causing either synovitis or muscle spasm leading to subluxation
        
        Overuse (extension) causing cartilage degeneration leading to stiffness of the joint and back
        
        Overuse and chronic strain
        
        Adhesions around 3rd lumbar vertebrae’s transverse process causing irritation of the lumbar nerves
        
        Abrupt flexion
        
        Abrupt hyperextension
        
        Overuse
        
        Aging- most likely in 30-50 year olds
        
        Overuse and repetitive motions
        
        Improper lifting
        
        Improper lifting and rotation
        
        See lumbar herniation
        
        Due to stenosis, spondylolisthesis, piriformis syndrome, SI joint dysfunction, SOL, and other inflammatory diseases.
- - - - History of LLS or flexion w sudden extension of low back
        
        Pain near HTJJ and limited ROM w extension
        
        Pain worse w coughing or sneezing
        
        Possible radiation pain down buttock and/or leg
        
        History of acute/chronic lumbar injury
        
        Unilateral lumbar and gluteal pain that is worse with bending and rotating the waist
        
        Sciatica symptoms Tender and tight around L3
        
        Chronic- atrophy of lumbar muscles
        
        X-ray may shows elongated transverse process and imbalance side to side
        
        History of injury
        
        Pain: low back, groin, and/or abdominal
        
        Weak quadriceps muscles or numbness of the anterior thigh or knee
        
        Difficulty standing erect
        
        Pain with coughing and sneezing
        
        Possible contraction of diaphragm
        
        Pain in the lumbar or legs with radiation to one side, but possibly both
        
        Pain with coughing, sneezing, abdominal contractions, or with lifting the leg
        
        Decreased sensation down the leg, foot or toes
        
        Coldness of the leg or back
        
        Leg weakness
        
        Central type- refer out
        
        Unilateral pain in the lumbar that radiates down the hip, posterior thigh, lateral posterior lower leg, and foot
        
        Burning, sharp, stabbing, or electrical sensation
        
        Intermittent/paroxysmal that is worse after activity and better with rest
        
        Chronic conditions may have constant pain and muscle atrophy
        
        Cauda Equina Syndrome
        Numbness of the saddle/sella area
        Sexual dysfunction
        Urinary dysfunction
        Bowel dysfunction
        Leg weakness