Lumbar Extension Syndrome

Lumbar Extension Syndrome – 2nd most common diagnosis

Common Medical Diagnoses:

  • Spinal Stenosis
  • Degenerative Disk Disease
  • Spondylolisthesis
  • Herniated Disk
  • Osteoarthritis of the Spine

Description:

Low back pain that may or may not radiate into both legs (sometimes only 1 leg).  This pain is aggravated when the spine is straighter or bent backwards (increased lordosis).

Diagnostic Tests:

  • Forward Bend: may relieve symptoms
  • Return from Forward Bend: may increase symptoms
    • Secondary Test with Return from Forward Bend: reduced symptoms
  • Supine Aligment: Lying flat with the legs extended is painful (also note increased lordosis)
    • Secondary Test: lying flat with the knees bent or pulled to the chest is less painful
  • Prone Alignment: Lying flat on your stomach is painful and increased lordosis is noted.
    • Secondary Test: pelvic tilt reduces symptoms
  • Prone knee flexion: Increased lumbar lordosis and possibly pain.
    • Secondary Test: passively stabilizing pelvis reduces lordosis and possibly pain
  • Prone hip extension: Increased lumbar lordosis and possibly pain.
    • Secondary Test: passively stabilizing pelvis reduces lordosis and possibly pain
  • Quadruped Posterior Rocking: possibly improves symptoms
  • Quadruped Anterior Rocking: possibly increases symptoms (also increased lumbar lordosis)
    • Secondary Test: correcting form reduces pain
  • Sitting Posture: increased lordosis associated with pain
    • Secondary Test: slumping the low back or moving to neutral reduces symptoms
  • Flattening the back against a wall in standing decreases symptoms.
  • Thomas Test: early anterior pelvic tilt prior to hip flexors reaching full length (hip flexors may or may not be overly lengthened)

Comerford Tests from Kinetic Control:

  • Standing: Thoracic Extension (sway)
  • Standing: Thoracic Extension (tilt)
  • Sitting: Chest Lift (tilt)
  • Sitting: Forward Lean
  • 4 Point: Forward Rocking
  • Crook Lying: Double Bent Leg Lower
  • Prone: Double Knee Bend
  • Prone (table): Hip Extension Lift
  • Standing: Hip Extension Toe Slide

SFMA: Multi-Segmental Extension + Breakouts

Treatment:

  • Reduce the relative flexibility of the lumbar spine and reduce the relative stiffness of the hip flexors
    • 1/2 or tall kneeling hip flexor stretch
    • bretzel or similar stretches
  • Reduce the relative flexibility of the lumbar spine and reduce the relative stiffness of the lats
    • Pilates ribcage arms
  • Improve the activation and strength of the gluteus maximus and abdominals
    • lower abdominal progressions
    • bridges, especially leg lock bridge
    • hip hinge > deadlift and squat
  • Change postures in sitting, standing, and walking to attempt to decrease lumbar extension.

These are primarily sourced from work by the great Shirley Sahrmann PhD. I use these pages as a personal reference for this type of information.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s