PREFERRED PRACTICE PATTERN
Pattern 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated with Spinal Disorders1
A 35-year-old man presents with a sudden onset of low back pain (LBP) 5 days ago, following bending over to pick up an item from the floor. The pain is located along the right side of the lumbar spine, sometimes radiating to the buttock region. Muscle guarding is present along the right side of the lumbar spine. Pain and loss of active range of motion is noted with forward bending, left side bending, and right rotation. Passive intervertebral motion (PIVM) testing revealed significant loss of passive mobility in the same directions. Neurologic examination was unremarkable.
LBP with primary involvement of the lumbar facet joint
Lower limb symptoms might be present in a nondermatomal pattern as a result of referred pain
Neurologic findings, minimal
Diagnosis made by clinical examination
Use of treatment- (impairment) based classification system is useful to determine evidence-based practice (EBP) treatment plan
Reproduction of symptoms when putting joint in a closed packed position (combination of extension, side-bending toward involved side, rotation away from involved site)
The fifth lumbar vertebra viewed from above (A) and from the side (B). (From Ropper AH, Samuels AH. Adams & Victor’s Principles of Neurology. 9th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Lumbar medial branch nerve and facet blocks. (A) Posterior view. (B) 30-degree oblique posterior view. (From Morgan GE, Mikhail MS, Murray MJ. Clinical Anesthesiology. 4th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
SIGNS AND SYMPTOMS
Pain in the lumbar or sacral area that can be mechanically reproduced
Possible unilateral or bilateral referred pain, or pain in lower extremities
ROM limited in a capsular pattern: rotation and side-bending limited in opposite direction
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