Chapter 11: Lumbar Spine

This is a Chapter 11 summary of “Clinical Neurodynamics” by Michael Shacklock.

Physical Exam

The slump is the big dog for assessing lumbar spine complaints. Deciphering which movements evoke the patient’s symptoms can tell you a lot about the nervous system’s dysfunction:

  • Neck flexion increases symptoms – Cephalid sliding dysfunction.
  • Knee extension/dorsiflexion increases symptoms – Cauded sliding dysfunction.
  • Both neck flexion and knee extension increase symptoms – Tension dysfunction.
Guaranteed he does the slump all the time.
Guaranteed he does the slump all the time.

The straight leg raise is another important test that can help determine the nervous system’s state.

Treatment

The treatment parallels similar tactics as previous body areas. For reduced closing dysfunctions We start level 1 with static openers, progress to dynamic openers, then work to close.

For opening dysfunctions, we progress toward further opening/contralateral lateral flexion.

Neural Dysfunctions

We treat these mechanisms based on which dysfunction is present. For cephalid sliding dysfunctions, we approach with distal to proximal progressions; and for caudad sliding dysfunction, we work proximal to distal

Tension dysfunctions are started with off-loading mvoements towards tensioners

Complex Dysfunctions

Sometimes you can have interface dysfunctions that simultaneously have contradictory neurodynamic dysfunction. There are several instances of the case.

Reduced closing with distal sliding dysfunction – Treat by combining closing maneuvers while perform active knee extension.

Reduced closing with proximal sliding dysfunction – Address by closing maneuver with neck flexion.

Reduced closing with tension dysfunction – This is treated with adding closing components to tensioners

Reduced opening with distal sliding dysfunction – Here we add a dynamic opener along with leg movements.

Reduced opening with proximal sliding dysfunction – Same as above, only we add neck flexion instead of leg movements

Reduced opening with tension dysfunction – Basically a combination of the last two treatments.

The same techniques can be applied to mid-lumbar dysfunctions, this time utilizing the femoral slump:

And if all else fails, just watch this video (NSFW due to language).

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