How to Assess Lumbar Function – Part II: Dean Somerset
Well, I’m back in Boston! We had a bit of a scramble to make it back – first flight was canceled, second flight (with a different airline) was delayed an hour and a half – but both Lisa and I made it home in one piece last night around 1:30 in the morning.
Needless to say, I feel like I got run over by a mack truck. And, BIG SURPRISE, it’s snowing like a bastard right now. Great. In any case, for those that might have missed it, I posted a quick blog yesterday highlighting a few things from my trip to Texas. You can check it out HERE.
Also, today I’m going to post part II of Dean Somerset’s post on assessing lumbar function. For a quick refresher on part I, click HERE.
How to Assess Lumbar Function Part II
Welcome back peeps! In part one, I discussed some of the basic things I look for when assessing clients who come to me demonstrating some form of lower back dysfunction/pain. Today I want to use a real life case study to help you better understand the entire process.
Take an example of Phil, one of my low back clients. He came in almost doubled over with back pain a few months ago. He’d trained with me a few years earlier, and for whatever reason decided to stop for a little while (kids, getting a PhD, work, all BS excuses in my opinion).
Phil plays indoor soccer quite regularly, but coupled with a full-time course load for a PhD in engineering and a job that left him in front of a computer for hours a day meant he was destined for something bad.
During one game he went for a slide tackle, and felt something give. He walked it off, kept playing (slowly), and was barely able to walk the next day. He called me up to see if there was anything I could do or any recommendations I had for him.
When I checked him out, he had a noticeable spinal hinge at L3-5, where the vertebrae were moving too much at one section and not enough at the others.
There were no tender points or spastic dysfunctions that would indicate anything seriously injured or a disc problem that would make me think me couldn’t do a little moving around that day. I figured his hips were great, except in internal rotation. His shoulders moved okay, but he was limited with left flexion and internal rotation on both sides (probably from being doubled over). He had no trouble with flexion as far as pain goes, but hey, check out the pic above.
He had pain with active extension, loved passive extension, couldn’t do rotation, and had difficulty with left lateral flexion. I had him do a prone McKenzie posture for about 5 minutes, took him through some light spinal stability work in both prone and supine to get his abs going again (think: plank variations and stability ball dead bugs), and worked on an active straight leg raise with him from a supported position to make sure he didn’t torque the lumbar spine. After about 10 minutes of work, his back looked like this.
The hinge is almost gone!!! I sent him to his doctor to get a check-up and imaging if needed. The next day he said he felt 90% comparatively. After his images came back negative, we trained for another two weeks, and his back then looked like this
No intervertebral hinge, and the presence of any pain throughout the day was limited to early mornings, and was downgraded from a 8/10 all the time to a 1-2/10 for the first hour.
The quality of movement in all assessed directions went through the roof, none presented any pain. In total it took three sessions, no “treatments,” just teaching his body how to move again.
A lot of back pain can be directly attributed to mechanical strain and dysfunctional movement qualities, or in layman’s terms, “movement stupidity.” Posture, repetitive strain and deconditioning are the biggest culprits, so correcting posture, increasing core strength, and correcting movement patterns will normally fix the majority of back pain any client will feel.
TG Note: which is why, folks, you can’t always rely on MRIs to tell you jack squat. As I’ve noted in the past, 82% of you reading this post now have a disk bulge at one level. Taking it a step further, 38% of you have a disk bulge at TWO levels. Yet, I’m sure the majority of you are asymptomatic right now. Looking at your MRI, however, it’s a wonder you’re even walking!
(steps off soap box)
Obviously get them checked out to make sure they don’t have something funky going on like a disc problem, arthritis, or something really cool I’ve never heard of before.
Hopefully this little guest post has helped clear up some thoughts on how to assess lumbar function without getting too in depth into the specific anatomical considerations, but I wanted to touch on a basic overview of a system I have used with close to a thousand individuals with back pain.
I talk a lot about back pain and ways to correct it on my blog, so if you’re ever interested, swing by and check it out HERE. And a big thanks to Tony for letting me post up my thoughts here. Next time, an extra ticket somewhere warm would be a better option though. No? Just checking. I gotta get outta here, it snowed 18 inches in 2 days and I have to shovel for another three hours. God I hate winter.