Lumbar Extension Rotation Syndrome

Introduction
At the Harris Health System, many clinicians practice Shirley Sahrmann's movement impairment syndromes. Utilizing Sahrmann's principles helps guide the clinician toward movement dysfunctions often caused by prolonged postures and repetitive micro-trauma. Since Sahrmann focuses on movement impairments, her syndromes are named using pathokinesiology and kinesiopathology. For the purposes of learning, in this post I will include pathoanatomical diagnoses that relate to lumbar extension rotation syndrome (ERS).

Evaluation
 When performing a lumbar evaluation, assessing for lumbar extension rotation should be a priority. General presentation includes: >55 years old, chronic low back pain, and may be involved in a rotational sport (golf, tennis, etc). On physical examination, you will observe an exaggerated lumbar lordosis, paraspinal muscle asymmetry, excessive pelvic rotation during gait, and hinging during cardinal plane extension testing. They will often complain of unilateral lumbar pain that increases with extension and is relieved with non-weight bearing lumbar flexion.   

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Physical Examination:
-Exaggerated lumbar lordosis
-Excessive pelvic rotation during gait
-Paraspinal muscle asymmetry 
-Lumbar hinging during cardinal plane testing

Associated Pathoanatomical Diagnosis:
-Facet Syndome
-Spinal Stenosis
-DDD
-Facet OA
-HNP

Clinical Tests
In addition to my findings during my functional assessment and observation (stated above), there are many clinical tests used to diagnose lumbar ERS. A few tests I commonly perform are 1) supine bent knee fallout, 2) prone knee bend, 3) quadruped hip extension, and 4) single limb stance. With each of these tests, the examiner should be looking for lumbopelvic compensation (extension and rotation) on the involved side. This compensation generally occurs due to poor timing, coordination, and strength of the core and hip musculature. 
 

Prone knee bend: Passive knee flexion that causes the pelvis to tilt anteriorly with associated lumbar extension indicates a positive test.  This motion can also cause an increase in symptoms, a positive test is confirmed with a decrease in symptoms following pelvic stabilization

Bent knee fallout: A positive test is an increase in symptoms or opposite side pelvic rotation during the first 50% of motion. Stabilization of the pelvis should decrease symptoms

Try these tests on a few of your patients and watch how their low back compensates! Let me know if you have any questions or want more information regarding other tests you can perform.

-Jim 

Thank you to the Harris Health System Orthopedic Residency for letting me use their pictures.