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Lumbar Movement Assessment

Improve your awareness and control of your lumbar movement systems with this comprehensive assessment of strength, stability, and mobility. Learn how to assess and improve performance in this video.

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00:04 - 00:07This is Brother The brookbush Institute and I'd like
00:07 - 00:11to go over my lumbar spine movement
00:10 - 00:13assessment. So I'm gonna have my friend a vet come out.
00:13 - 00:16She's gonna help me demonstrate. Now. If you guys have
00:16 - 00:19watched some of our videos, you know that the overhead squat assessment
00:19 - 00:22is our top tier assessment. That's what I start with. That's
00:22 - 00:25how I know what compensation pattern I'm going after
00:25 - 00:28and what segment I'm gonna address first, but there are
00:28 - 00:31a couple small problems with the overhead squat assessment one of them being
00:31 - 00:32it's kind of weak.
00:33 - 00:36On lumbar spine. So the way
00:36 - 00:39I get through a little lumbar spine movement assessment is
00:39 - 00:43this I'm going to go ahead and sit because a
00:42 - 00:45vet is just a little shorter than I am.
00:46 - 00:49I am a little bit tall. So what I'm gonna have you do with that is I'm gonna have you turn in
00:49 - 00:50face away from me.
00:51 - 00:54And bring your feet close together. All
00:54 - 00:57right, so I want I want your toes and heels
00:57 - 01:00touching. Now. The reason why I have toes and heels touching is to
01:00 - 01:03try to decrease any chance that I have has plan
01:03 - 01:06a specialty asymmetrical pest planets. Now,
01:06 - 01:09the next thing I'm going to have of it do is go ahead and cross your
01:09 - 01:12arms so that she's touching up as it shoulders but lightly
01:12 - 01:15And then with her feet facing away
01:15 - 01:18from me. I'm gonna have her turn as much of
01:18 - 01:21her body as she wants and can to face
01:21 - 01:24back towards me. So let's go
01:24 - 01:25ahead and do that event.
01:26 - 01:29All right, good faith. Turn your head all of it
01:29 - 01:32good and what ideally you would see and
01:32 - 01:36we'll show this facing the camera is her in
01:35 - 01:38this case right shoulder would get a little
01:38 - 01:41farther than her left shoulder, right? So she'd actually
01:41 - 01:44surpass right and left shoulders being in
01:44 - 01:46line. And then let's see the other side.
01:49 - 01:53And that's interesting. She's
01:52 - 01:54a little tighter on the left side.
01:55 - 01:58So this first couple of
01:58 - 02:00tests, right? So rotation right rotation left.
02:01 - 02:04Are referred to as multi-segmental rotation tests
02:04 - 02:07by gray cook and the FMS guys
02:07 - 02:11and I really happen to like these tests for
02:10 - 02:13general movement, and I'm only looking
02:13 - 02:14for three things.
02:15 - 02:19I'm looking for gross or obvious restriction.
02:19 - 02:22I'm looking for asymmetry and I'm looking
02:22 - 02:24for concordant sign.
02:24 - 02:28All right. So before anybody gets on my case about reliability and
02:27 - 02:30whether I can measure how much
02:30 - 02:33rotation that's that's not what I'm measuring here.
02:33 - 02:36All I'm seeing is can I get one shoulder past the
02:36 - 02:39other especially is one side tighter than
02:39 - 02:42the other in a vet's case. She's actually Tighter and
02:42 - 02:45left rotation then right rotation. Did
02:45 - 02:46you have any pain there?
02:47 - 02:50And she had no pain in rotation. So something for
02:50 - 02:53you guys to keep in mind in the back of my head. I'm already going so I
02:53 - 02:56can't use this as necessarily her
02:56 - 02:59her test retest because this
02:59 - 03:00doesn't bring on our symptoms.
03:01 - 03:04The Next Step I would do is go. Okay. Can you
03:04 - 03:05touch your toes?
03:06 - 03:09Alright, and she can bend her knees a little bit. And again, I'm looking
03:09 - 03:11for obvious restriction.
03:12 - 03:15I'm looking for pain and I'm looking for asymmetry. So
03:15 - 03:18does she like end up more on the right side
03:18 - 03:21or more on the left side good and you can go ahead and stand back up.
03:22 - 03:25Any pain on the way back up? Keep that in mind guys. It's not just
03:25 - 03:28pain on the way down. It's pain on the way up. It has been
03:28 - 03:31my experience that pain on the way up is usually indicative of
03:31 - 03:34more stability type problems. That
03:34 - 03:37doesn't mean that there's no Mobility restriction, but
03:37 - 03:40it does mean that stability is a big part of the issue. The last
03:40 - 03:43thing I'm going to have her do is hands up
03:43 - 03:44over her head and extend.
03:47 - 03:48good and again
03:50 - 03:53Obvious restriction asymmetry or pain.
03:53 - 03:54How does that feel?
03:55 - 03:58Good and then turn sideways for me. I want
03:58 - 04:01to see you from the side on the toe touch and
04:01 - 04:03the extension test. So you're going to face your feet towards the camera.
04:04 - 04:06All right, go ahead and touch your toes.
04:07 - 04:10And guys, I'm only taking this lateral view because now I can see if
04:10 - 04:14there's any obvious restriction I can see if there's any obvious
04:13 - 04:16weirdness or lumbar spine. Like
04:16 - 04:19maybe I noticed she hinges at one point like some of
04:19 - 04:22you guys who who've been therapists for a while. You'll notice that like flat
04:22 - 04:25lumbar spine and like a hinge at the thoracolumbar junction.
04:25 - 04:26Go ahead and
04:28 - 04:31Stand up good and he paid on the way back up. Good go ahead
04:31 - 04:32and hands up over your head.
04:33 - 04:37And lean back as far as you can right and I'm just looking, you
04:36 - 04:39know, can she get her hips kind of close to her
04:39 - 04:42toes like is she getting some curvature back
04:42 - 04:45here and she actually looks pretty stiff and her thoracic spine. If
04:45 - 04:48you guys saw from the side her thoracic spine is like straight. So
04:48 - 04:51that's just some stuff. I want to keep in mind now.
04:52 - 04:56Let's go back to uses usage
04:55 - 04:59why I've chosen these tests and
04:58 - 05:01where we're going to go next. So I
05:01 - 05:04mentioned to you guys. This is my movement assessment
05:04 - 05:07for the lumbar spine. I am not trying
05:07 - 05:11to suggest that these are diagnostic tests.
05:10 - 05:15These are tests specifically chosen or
05:14 - 05:17I should say borrowed from Gray cook and
05:17 - 05:21the functional movement screen because they help me direct
05:20 - 05:23my intervention plan
05:23 - 05:27my corrective exercises or my manual therapy techniques,
05:26 - 05:29right? So if I have asymmetry and
05:29 - 05:32rotation for example with the vets
05:32 - 05:35and she was more asymmetrical to the left, right she
05:35 - 05:38lacking some left rotation. Maybe that means when I give her
05:38 - 05:42a home exercise program I'm doing open books right to
05:41 - 05:44work on rotation with right side down
05:44 - 05:45only.
05:46 - 05:49So that she's working on left-sided rotation to get
05:49 - 05:49even again.
05:50 - 05:54Right. I find like that's really helpful to notice those asymmetries flexion
05:53 - 05:56and extension more often than not
05:56 - 06:00those are great tests for
06:00 - 06:03finding a concordant sign to latch onto right so
06:03 - 06:06you can test retest but if I saw a gross
06:06 - 06:09restriction inflection, I might start thinking okay.
06:09 - 06:12I need to do some release techniques for
06:12 - 06:15the Erectors. I could start thinking towards instrument
06:15 - 06:18assisted soft tissue mobilization of the thoracolumbar fascia,
06:18 - 06:21like all those Mobility techniques if she was
06:21 - 06:24lacking range of motion into extension,
06:24 - 06:28maybe I'm thinking about joint mobilizations, right even
06:27 - 06:30some self-administered stuff like a thoracic spine
06:30 - 06:32foam roll would probably do a vet. Very good.
06:33 - 06:37Some of you guys might be thinking who know a little bit more of the traditional lumbar
06:36 - 06:39spine exam why I don't
06:39 - 06:40do lateral flexion.
06:41 - 06:42And this is a case of pruning.
06:43 - 06:46Right. So what do I mean by pruning if the test doesn't have
06:46 - 06:48an impact on your intervention?
06:49 - 06:50Don't do it.
06:51 - 06:55Tests have two basically when we do assessment in
06:54 - 06:57our world, right? We have two types of
06:57 - 06:59tests. We have tests that help us clear a patient for
07:02 - 07:05Being under our care. So those are like our diagnostic tests.
07:05 - 07:09Is this person have you know something really?
07:11 - 07:14Serious that may not work so well with conservative physical
07:14 - 07:17therapy treatments we need to refer them out. Right so we have
07:17 - 07:20those type of tests. And then our other tests are how is this
07:20 - 07:23going to help me make a plan for her that's going to help her feel
07:23 - 07:25better. And if it doesn't fall into one of those two categories
07:27 - 07:27It's gone.
07:28 - 07:31So with lateral flexion, I just happened to notice that I don't use lateral
07:31 - 07:34reflection for anything. It's very rare that somebody has pain and
07:34 - 07:38lateral flexion and doesn't have pain and rotation flexion or extension. So
07:37 - 07:41it just got rid of it. And I think my programs
07:40 - 07:43are more efficient for it last thing.
07:43 - 07:46I'm going to have you do with that for the camera so that they can see what I was
07:46 - 07:48seeing is I want you to go ahead and face away from the camera.
07:50 - 07:53All right. Let me have you take a little step this way. So you're a little
07:53 - 07:56bit more centered good. All right guys, and what I want you to see is is
07:56 - 07:59what I was seeing. She's gonna bring her feet together. So we don't have any
07:59 - 08:02chance of having Pez planets, especially on one side
08:02 - 08:05or less chance of has planted on one side. She's gonna go
08:05 - 08:08ahead and do this, right and what she's gonna try to do is turn around
08:08 - 08:09and face the camera as far as she can.
08:11 - 08:14Good Fortune turn turn and ideally she
08:14 - 08:17would get her right shoulder past her left and she'd
08:17 - 08:20be more or less straight up and down. So you guys can even see she like leans
08:20 - 08:20a little bit.
08:21 - 08:22All right, then. Let's try the other side.
08:26 - 08:29Oh, right. You guys can see she's like a little limited and this
08:29 - 08:30side in this case.
08:31 - 08:34Is it this side go all the way let's try the
08:34 - 08:34other way.
08:35 - 08:38Maybe she's not asymmetrical. She's not looking a little bit more even she's just
08:38 - 08:41kind of looking a little restricted on both sides. Maybe you guys have
08:41 - 08:44a better view than I do now and are seeing the
08:44 - 08:47same thing I did which this side was actually rotation to the
08:47 - 08:50left was more restricted. Of course, she can then go into flexion.
08:51 - 08:52All right, so touch your toes.
08:53 - 08:56And I would look for asymmetry. Does this bring on pain and
08:56 - 08:59does she have any gross restriction so she couldn't barely touch her knees. That's
08:59 - 09:02a problem. Go ahead and stand up make sure you ask about
09:02 - 09:03pain on the way up.
09:03 - 09:06Right because those stability problems have
09:06 - 09:09a way of people are fine on the way down and then
09:09 - 09:12they try to get themselves back up and it's like that's when everything
09:12 - 09:13kind of like seizes on them.
09:14 - 09:14Hands up.
09:15 - 09:16Ben back
09:17 - 09:20Again in this position, I would look for you know
09:20 - 09:23asymmetry. Is she leaning to one side or the other
09:23 - 09:27is their pain and of course I can see if there's a little bit of extension
09:26 - 09:29here range of motion overall for flexion
09:29 - 09:31extension are probably best viewed at
09:31 - 09:34From the side. I think
09:34 - 09:37you guys putting these tests in
09:37 - 09:40we'll get some good indications of what you
09:40 - 09:43should do as far as treatment to help improve motion
09:43 - 09:46of the lumbar spine. I hope you guys enjoyed
09:46 - 09:49this little video of one of
09:49 - 09:52our little breakouts from the overhead squat
09:52 - 09:55assessment for individuals specifically with issues
09:55 - 09:58kind of in that lumbo pelvic hip complex region.
09:58 - 09:59Talk to you soon.

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