The Lumbar Spine

1
The Lumbar Spine
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Anatomy
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Prevention of Injuries to the Spine

• Lumbar spine
• Avoiding stress
• Correction of biomechanical abnormalities
• Using correct lifting techniques
• Core stabilization

4
Recognition and Management of Lumbar Spine
Injuries

• Low back muscle strains
• Cause sudden extension with trunk rotation,
  chronic strains, faulty posture
• SS diffuse or localized pain, pain with active
  extension and passive flexion
• Care cold pack initially, abdominal support,
  stretching and strengthening focus on hamstring
  flexibility core strengthening

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Recognition and Management of Lumbar Spine
Injuries

• Lumbar Sprains
• Cause forward bending and twisting while
  lifting an object, acute or chronic
• SS localized pain just lateral to the spinous
  process, pain becomes sharper with certain
  movements or postures, extension and rotational
  movements increase pain
• Care RICE initially, brace, stretching,
  strengthening, NSAIDs

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• Myofascial Pain Syndrome
• Cause mechanical stress to muscles, strains or
  postural positions regional pain with referred
  pain to a specific area that occurs with pressure
  of tender spots or trigger points
• SS point tenderness on a specific spot that
  radiates pain sharp, achy pain
• Care stretching, strengthening, deep tissue
  massage, modalities

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• Sciatica
• Cause inflammatory condition of the sciatic
  nerve that can accompany recurrent or chronic
  back pain, particularly vulnerable to torsion or
  direct blows.
• SS abruptly or gradually sharp, shooting
  pain, that follows the nerve pathway along the
  medial and posterior thigh tingling and
  numbness, sensitive to palpation
• Care rest, lumbar traction with disk
  protrusion, stretching, NSAIDs

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• Herniated lumbar disk
• Cause faulty body mechanics, trauma, or both,
  usually forward bending and twisting - most often
  L4-L5
• SS centrally localized pain that radiates
  unilaterally to buttocks and down back of leg, or
  pain that spreads across the back worse in am,
  onset is sudden or gradual, pain may increase
  after sitting, decrease with extension
• Care goal reduce protrusion and restore
  normal posture, rest and ice, manual traction,
  back extensor and abdominal strengthening

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• Spondylolysis
• Cause degeneration of the vertebrae or defect
  in the pars interarticularis of the articular
  process often attributed to a congenital
  weakness and occurs as a stress fracture

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• Spondylolisthesis
• Slippage of one vertebrae on the one below it, a
  complication of spondylolysis that often results
  in hypermobility of a vertebral segment, highest
  incidence is L5 slipping on S1, scotty dog
  deformity

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• SS persistent mild to moderate aching pain
  across the low back (LB) or stiffness in LB with
  increased pain after but not usually during
  activity the need to change positions frequently
  or the need to self manipulate the LB to reduce
  pain, localized tenderness, possible neurological
  symptoms
• Care bracing, bed rest for 1-3 days, rehab
  directed towards exercises that control or
  stabilize the hypermobility segment, abdominal
  strengthening is key

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• Sacroiliac sprain
• Cause twisting with both feet on the ground,
  stumbling forward, backwards fall, bending
  forward with knees locked, landing heavily on one
  leg
• SS palpable pain and tenderness directly over
  the joint, muscle guarding, radiating pain, pain
  increased with single leg stance
• Care bracing, mobilizations, strengthening,
  modalities

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• Coccyx injuries (tailbone contusion)
• Cause direct impact which results in sprains,
  subluxations or fractures
• SS pain in the coccygeal region is often
  prolonged and at times chronic
• Care xray to rule out fracture, analgesics,
  ring seat, padding

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• Rehabilitation
• 3 main components to work on
• Hamstring flexibility
• Abdominal strength
• Flexible and strong back musculature