The Lumbar Spine

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					The Lumbar Spine
 Prevention of Injuries to the
• Lumbar spine
  – Avoiding stress
  – Correction of biomechanical abnormalities
  – Using correct lifting techniques
  – Core stabilization
Recognition and Management
  of Lumbar Spine Injuries
Low back muscle strains
Cause: sudden extension with trunk rotation, chronic
  strains, faulty posture

S&S: 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
        Recognition and Management
          of Lumbar Spine Injuries
•   Lumbar Sprains

    Cause: forward bending and twisting while lifting an
    object, acute or chronic

    S&S: localized pain just lateral to the spinous process,
    pain becomes sharper with certain movements or
    postures, extension and rotational movements increase

    Care: RICE initially, brace, stretching, strengthening,
• 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

  S&S: point tenderness on a specific spot that
   radiates pain; sharp, achy pain

  Care: stretching, strengthening, deep tissue
   massage, modalities
• Sciatica

   Cause: inflammatory condition of the
     sciatic nerve that can accompany
     recurrent or chronic back pain,
     particularly vulnerable to torsion or
     direct blows.

   S&S: 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
•   Herniated lumbar disk

    Cause: faulty body mechanics, trauma, or both, usually forward bending
    and twisting - most often L4-L5

    S&S: 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

    Care: goal = reduce protrusion and restore normal posture, rest and ice,
    manual traction, back extensor and abdominal strengthening
• 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
• 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”
• S&S: 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
• Sacroiliac sprain

   Cause: twisting with both feet on the
     ground, stumbling forward,
     backwards fall, bending forward with
     knees locked, landing heavily on
     one leg

   S&S: palpable pain and tenderness
     directly over the joint, muscle
     guarding, radiating pain, pain
     increased with single leg stance

   Care: bracing, mobilizations,
     strengthening, modalities
• Coccyx injuries (tailbone contusion)

   Cause: direct impact which results in sprains, subluxations or

   S&S: pain in the coccygeal region is often prolonged and at
   times chronic

   Care: xray to rule out fracture, analgesics, ring seat, padding
•   Rehabilitation
    – 3 main components to work on:

      1. Hamstring flexibility
      2. Abdominal strength
      3. Flexible and strong back musculature

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