OMT Lumbar Somatic Dysfunction

The OMT Lumbar Somatic Dysfunction provides High Yield information that is needed for the COMLEX Level 1, 2, and 3, Medical School, Residency, and as practicing Physician.

OMT Lumbar Somatic Dysfunction

Degenerative joint disease

• Presentation:
  • – risk factors for osteoarthritis
  • – better w/ rest, worse w/ activity
• Diagnosis:
  • – x-ray shows joint space narrowing, osteophytes
• Management:
  • NSAIDs and acetaminophen
  • OMT

Osteoarthritis – affects hands, neck, lower back, hips and knees
US federal government / Public domain

Disc herniation

• Presentation:
  • – positive straight leg raise
  • – most common at L5/S1 (affecting S1 nerve root)
  • – sciatica
• Diagnosis:
  • MRI
• Management:
  • conservative early (surgery if refractory)

BruceBlaus. / CC BY

Herniated disc on MRI
Mjorter at Dutch Wikipedia / Public domain

Musculoskeletal strain

• Presentation:
  • – point tenderness on palpation
  • – overuse injury
  • – Pain in the lumbar spine may be referred into buttocks
    
  • – may increase with extension (muscle contraction) or flexion (stretch)
• Physical Exam:
  • – negative straight leg raise
• Diagnosis:
  • – NO MRI until 4-6 wks
• Treatment:
  • – NSAIDs and acetaminophen, OMT

Spinal stenosis

• Presentation:
  • – Due to foramina narrowing
  • – Back pain worse with extension and better with flexion

BruceBlaus. / CC BY

Philmarin / CC BY-SA

Spondylopathy

Scoliosis

functional scoliosis	corrects w/ side bending
structural scoliosis	does NOT correct w/ side bending
dextroscoliosis	right scoliosis apex at the right (sidebent left)
levoscoliosis	left scoliosis apex to the left (sidebent right)
Rotoscoliosis	lateral deviation of the spine from the normally straight vertical line

BruceBlaus. / CC BY

Cobb Angle

Def. – angles formed by perpendicular lines from top and bottom most segments of scoliosis

Cobb Angle	Severity	Treatment
< 20 degrees	mild scoliosis	OMT
20 – 45 degrees	moderate scoliosis	OMT and Bracing
> 50 degrees	severe scoliosis	Surgery
> 75 degrees	scoliosis w/ CV involvement	Surgery

Skoliose-Info-Forum.de,
Skoliose-Info-Forum.de / CC BY-SA

OMT Lumbar Somatic Dysfunction Techniques

Counterstrain (Lumbar)

Anterior Lumbar Tender Points

AL1	– Location: medial aspect of ASIS – Muscle: Iliopsoas – Vector: M–>L -Treatment position: F STRA
AL2	– Location: medial side of AIIS – Vector: M–>L -Treatment position: F SART
AL3	– Location: Lateral side of AIIS – Vector: L–>M -Treatment position: F SART
AL4	– Location: Inferior side of AIIS – Vector: I–>S -Treatment position: F SART
AL5	– Location: ANTERIOR aspect of pubic ramus – inferior to the pubic tubercle – 1 cm lateral from symphysis – Muscle: adductor longus – Vector: A–>P -Treatment position: F SARA

Powellle / CC BY-SA

Posterior Lumbar Tender Points

PL1-5 sp	– Location: spinous processes of L1-L5- lateralize to a side – Vector: P–>A (PL–>AM) -Treatment position: E SARA
PL1-3	– Location: transverse processes of L1-3 – Vector: PL–>AM -Treatment position: E SART

Reference

• Blausen.com staff (2014). “Disc Herniation” "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.
• Blausen.com staff (2014). “Spinal Stenosis” "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.
• Blausen.com staff (2014). “Scoliosis” "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.