Motion Palpation of the Lumbar Spine
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This is Chapter 5 from RC’s best-selling book:
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Chapter 5: The Lumbar Spine
This chapter describes the dynamic chiropractic approach to the correction of fixations of the lumbar spine and related tissues. Emphasis is on biomechanical, fixation, and therapeutic considerations. Some significant points in differential diagnosis are also described.
According to Faye, the three most common types of low back pain are:
(1) the lumbar facet syndrome,
(2) the sacroiliac syndrome, and
(3) the lumbar radicular syndrome, which may be discogenic or biomechanical in origin.
Each of these types can be acute or chronic, traumatic or nontraumatic, and have varying degrees of concomitant pathomechanics. The syndromes are named according to the level of inflammation or pain-producing structures and more than likely not the area in need of adjustments. Their typical cause may be due to:
joint dysfunction (fixation/hypermobility),
or various combinations of these origins.
In addition, the possibility of viscerosomatic and somatosomatic reflexes should not be overlooked.
Gillet’s studies found that lumbar flexion-extension movements are similar to those of other regions of the spine but with less forward or backward gliding. Extension is, states Gillet, also a movement that takes place in two parts with the anterior interbody space opening only after backward bending has reached its limit. This opening anteriorly is, however, a smaller movement than that which occurs in other regions of the spine.
The extent of lumbar extension is primarily controlled by the tautness of the anterior longitudinal ligament, the elasticity of the posterior ligaments, and the tonicity of rectus abdominis anteriorly and the spinal extensor muscles posteriorly. See Figure 5.10. In IVD herniation posteriorly, facet inflammation,
or spondylolisthesis, pain will be increased during extension but not on flexion. This is a helpful point in differential diagnosis.
According to McKenzie, reduced lumbar extension is frequently the result of poor sitting posture and/or inadequate extension mobilization following injury in which scar tissue prevents a full range of extension.
(1) causes chronic stress on the soft tissues of the posterior motion unit and an increased intradiscal pressure during sitting;
(2) restricts a fully upright posture during relaxed standing, leading to a stooped appearance in stance and gait; and
(3) produces a premature fully stretched lumbar posture when arising from a forward flexed posture.
Keep in mind that the fibers of the posterior anulus are the weakest. The anterior and lateral aspects of the anulus are almost twice as thick as the posterior aspect. The anular fibers at the posterior aspect of the disc are less numerous, narrower, and more parallel to each other than at any other portion of a disc.
If a person must work habitually in a prolonged forward flexed position, periodic lumbar extension will relieve the stress of the posterior anulus and tend to shift a loose nucleus pulposus anteriorly; ie, away from the spinal cord and IVF. Many manual laborers do this stretching maneuver instinctively.
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