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Lumbar osteopathy

Last updated: November 10, 2021

Summarytoggle arrow icon

Chronic lower back pain is one of the most common complaints in primary care medicine. Since the majority of these complaints cannot be attributed to a pathological cause, assessment in this region remains difficult. However, osteopathic treatment, which mainly focuses on the functional capacity of the musculoskeletal system in the lumbar spine, has been shown to be clinically effective.

Anatomytoggle arrow icon

Lumbar spine

Bones

Osteopathic landmarks

Special Teststoggle arrow icon

Hip drop test

Lasegue sign (straight leg raise test)

Bragard sign

Diagnosticstoggle arrow icon

Lumbar dysfunctions

Static examination

Treatmenttoggle arrow icon

Type 1 lumbar neutral curve dysfunction

Muscle energy

  • Position: lateral recumbent (posterior transverse processes pointing upward)
  • Procedure
    1. Monitor curvature at apex.
    2. Flex hip until movement is felt at the apex.
    3. Lift feet upward until motion is felt at the apex.
    4. Ask patient to push feet downward against equal resistance for 3–5 seconds.
    5. Relax for 5 seconds.
    6. Re-engage barrier and repeat.
    7. Reassess.

High-velocity low-amplitude

  • Position: lateral recumbent (posterior transverse processes pointing upward)
  • Procedure
    1. Perform myofascial release.
    2. Monitor curvature at apex.
    3. Flex hip until movement is felt at the apex.
    4. Extend the inferior leg and hook the superior foot into the popliteal fossa.
    5. Rotate the upper torso upward.
    6. Place the superior arm in the axilla and the inferior arm on the iliac crest.
    7. Have patient take a deep breath.
    8. At the end of exhalation, apply a thrust on the iliac crest forward.
    9. Reassess.

Type 2 lumbar flexion dysfunction

Muscle energy

  • Position: lateral recumbent (posterior transverse processes pointing down)
  • Procedure
    • Monitor lumbar segment with posterior transverse process.
    • Flex legs until movement is felt at vertebral segment.
    • Ask patient to straighten and extend lower leg until motion is felt.
    • Switch monitoring finger.
    • Rotate top half of the patient into supine position.
    • Switch monitoring finger again.
    • Lift feet upward until motion is felt at the monitoring hand.
    • Ask patient to push feet downward against equal resistance for 3–5 seconds.
    • Relax for 5 seconds.
    • Re-engage barrier and repeat.
    • Reassess.

FDDR: Flexion dysfunction, patient pushes feet Down, posterior transverse process Down, lateral Recumbent position

Facilitated positional release

  • Position: prone
  • Procedure
    1. Monitor lumbar segment with posterior transverse process and segment below.
    2. Flex knee off table until motion is felt at the segment below the affected segment and adduct the hip.
    3. Internally rotate the hip until motion is felt at the monitoring finger.
    4. Optional: upward compression.
    5. Hold for 3–5 seconds.
    6. Reassess.

High-velocity low-amplitude

  • Same as lumbar type 1 dysfunction

Type 2 lumbar extension dysfunction

Muscle energy

SUUE: Sims position, posterior transverse process Up, patient lifts feet Upward, Extension dysfunction

Facilitated positional release

High-velocity low-amplitude

  • Same as lumbar type 1 dysfunction

Referencestoggle arrow icon

  1. Seffinger M. Foundations of Osteopathic Medicine. LWW ; 2018
  2. Dvořák J, Gilliar W. Musculoskeletal Manual Medicine. Thieme ; 2008
  3. Chila AG. Foundations of Osteopathic Medicine. Lippincott Williams & Wilkins ; 2010

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 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer