 Be able to document accurately and appropriately in scientific language.

 Use the patient’s own words  Remember to include the functional limitation

 Type of pain e.g. burning or stabbing  Intensity out of 10 e.g. 5 / 10  Intermittent or constant  Do the different areas indicated on the body chart bear relevance to each other?

Area 1 Burning pain 6 / 10 Constant pain

 High lumbar flexion ¾ range 8 / 10 Area 1 * (indicate comparable sign with an asterisk)  Rotation L √ (clear free active)  Rotation R √√ (clear with overpressure)  Low lumbar extension 6 / 10 OP Area 1

 L = R (sensation is the same on both sides)  Sensation: L ‹ R (L4) – sensation is less on the left side L4 dermatome  Motor: R › L (L5) – could break the movement on the left side L5 miotome  Reflexes: L = R (both the same) or L < R L3,4 (the reflex on the left side was weaker)

 In: SLR (R) Did: 60° DF +  In: ULTT 2a (L) Did: Med rot +  In: mid-slump L = R

 Thoracic spine: Flex √√ Low rotation √√  Sacro-iliac joint: Compression Grade II 3 / 10 Area 3  1 st rib longitudinal caudad Grade 1 6 / 10 Area 1

 Muscle strength according to Oxford scale  Muscle length – according to ranges (0 – 60°)

 Muscles must be given where muscle spasm occurs or where trigger points occur.  e.g. m quadriceps

↓Unilat ↓ (right) Unilat ↓ (left) →← L1Gr I 3 / 10 √√√√ L2√√Gr II 6 / 10 Gr III- 4 / 10 Gr I 1 / 10 L3 √Gr IV 1 / 10 √√√ L4Gr II 6 / 10 √√√√

 L2 ↓ Gr II 6 / 10  L4 Unilat ↓ R Gr III- 1 / 10  L5 Unilat ↓ L Gr I 8 / 10

 Main problems of the patient as indicated on the body chart  List everything that tested positive (not the same as normal)  Prioritize for the specific patient  In other words – what was affected the most  Impairment must be determined objectively (what can be tested)

 Lower lumbar pain due to: painful intervertebral joint movements of L2 – L5 or hypomobile and painful intervertebral facet joint movements of L2 – L5 L muscle spasm of m erector spinae L trigger points in m quadratus lumborum L  Referred pain in L leg (L4) due to: ↓ neural mobility of n isciadicus L trigger points in m quadratus lumborum Referred pain down the leg could be due to nerve root irritation but this is a hypothesis and not a problem – can this be tested objectively

 Decreased mobility of n iskiadicus due to: painful intervertebral facet joint movements of L2 – L4 L muscle spasm of m erector spinae L poor posture  Use your clinical reasoning skills to determine the true cause of the problem  What came first (chicken – egg senario)

 Weak abdominal stabilisers due to: painful intervertebral facet joint movements of L2 – L4 L muscle spasm in m erector spinae L poor posture  Muscle spasm in m erector spinae due to: painful intervertebral facet joint movements of L2 – L4 L poor posture poor kinetic handling / ergonomics

 Activity: Can not sit for prolonged periods of time  Participation: Can not go to church Can not play bingo

 Decrease pain in the lumbar area b.m.o: mobilisation of the intervertebral joints / mobilisation of intervertebral facet joints  Decrease muscle spasm of m erector spinae L b.m.o. massage, specific soft tissue mobilisation, electrotherapy modalities  Decrease triggerpoints in m quadratus lumborum b.m.o triggerpoint therapy, hotpack

 Increase the mobility of n isciadicus L b.m.o neural mobilisation techniques  Activation of abdominal stabilisers b.m.o activation exercises  Re-education op posture b.m.o. corrective excercices  Home advice