The Lumbar Spine

1. The Lumbar Spine

2. Anatomy

3. 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 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 strengthening

5. 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 pain Care: RICE initially, brace, stretching, strengthening, NSAIDs

6. 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

7. 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

8. 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 extension Care: goal = reduce protrusion and restore normal posture, rest and ice, manual traction, back extensor and abdominal strengthening

9. 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

10. 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”

11. 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

12. 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

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

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