Physical Examination 208: Lumbar Spine & Sacroiliac Joints

The examination of the lumbar spine and sacroiliac joints as a chiropractor performs and documents it: the evidence for chiropractic care in low back pain; the anatomy of the lumbar spine, its spinal nerves, dermatomes and myotomes, and the sacroiliac joints; consultation and history; palpation and the bilateral radicular evaluation; the lower extremity neurological screen — deep tendon reflexes at L4, L5 and S1 graded 0–5, muscle strength grades, myotomes L2–S2 and dermatomes L1–S5; range of motion grading; visual inspection and palpation findings; the orthopedic tests — Bechterew's, straight leg raise, Braggard's, Ely's, Yeoman's, Hibb's, Gillis', iliac compression, FABERE (Patrick's), Kemp's, the Stoop test and the one-leg hyperextension (Stork) test — each with position, procedure, positive finding and indication; and x-ray and MRI. The key tests are demonstrated on video.

Donald Ozello, DC, CCN, CCSM — sports chiropractor, founder of Championship Chiropractic in Las Vegas and CCEDseminars faculty for the Sports Injuries, Rehabilitation and Adjusting & Manual Therapy series — teaches the 2-hour course. It is written for Doctors of Chiropractic who want a repeatable, documentable low back examination: the order of the sequence, the neurological grades that belong in the chart, and each orthopedic test with what a positive result means and which structure it points to.

By letting the tests sort it, which is what the course teaches test by test. A nerve root under pressure in the lumbar spine declares itself on the straight leg raise, Braggard's and Bechterew's tests — sharp pain, numbness or burning down the leg — and on the neurological screen, where a weak myotome, a numb dermatome and a diminished reflex point to the level. Kemp's test separates the facet joint from the nerve: the patient is taken through flexion, lateral flexion and extension, and pain that stays in the low back on the tested side means facet syndrome while symptoms that radiate into the leg mean nerve impingement. The sacroiliac joint has its own set — Yeoman's for the anterior ligaments, Hibb's for the posterior ligaments, Gillis', Ely's and iliac compression — and FABERE (Patrick's) settles whether pain on the hip-opening maneuver is the hip itself or the sacroiliac joint. The Stoop test picks up the central stenosis patient who leans forward to walk, and the one-leg hyperextension test points to a pars defect. The pattern across the tests, not any one of them, makes the call.

Physical Examination 208 is online and on-demand: you start immediately after checkout and work at your own pace. When you pass the post-course assessment your completion is recorded electronically and your certificate is issued right away. CCEDseminars is PACE Provider #34015544 and the course is co-sponsored by Texas Chiropractic College; completions are reported to CE Broker for the states served. Approved states are listed at the bottom of this page, and confirming your own board's requirements remains your responsibility.

Dr. Ozello's Adjusting & Manual Therapy 209: Lumbar & Pelvic Techniques is the treatment half of the same region — 208 is the examination, that course is the adjusting. His Physical Examination 205: Cervical Spine and 207: Thoracic Spine and Rib Cage complete the spinal examination from the occiput to the sacrum on video; the three together are 6 CE hours, where the automatic 10% multi-course discount starts ($108 instead of $120). Dr. O'Hara's Physical Examination 203: Lumbar Spine and Lower Extremity approaches the same region from the injury-pattern and imaging side — spondylolysis staging, the lumbar disc, the hip and hamstring — and many clinicians take both. New Physical Examination titles are released as faculty complete them; the current list with pricing lives on the category page.