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CHAPTER OBJECTIVES

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At the completion of this chapter, the reader will be able to:

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  1. Describe the vertebrae, ligaments, muscles, and blood and nerve supply that comprise the lumbar intervertebral segment.

  2. Outline the coupled movements of the lumbar spine, the normal and abnormal joint barriers, and the reactions of the various structures to loading.

  3. Perform a detailed examination of the lumbar musculoskeletal system, including history, observation, palpation of the articular and soft-tissue structures, specific passive mobility and passive articular mobility tests for the intervertebral joints, and stability testing.

  4. Evaluate the results of the examination and establish a diagnosis.

  5. Describe the common pathologies and lesions of this region.

  6. Describe intervention strategies based on clinical findings and established goals.

  7. Design an intervention based on patient education, manual therapy, and therapeutic exercise.

  8. Apply mobilization techniques for the lumbar spine, using the correct grade, direction, and duration, and explain the mechanical and physiologic effects.

  9. Evaluate intervention effectiveness to progress or modify intervention.

  10. Plan an effective home program, including spinal care, and instruct the patient in this program.

  11. Help the patient to develop self-reliant intervention strategies.

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OVERVIEW

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Over the past few decades, low-back pain (LBP) has become increasingly problematic, placing significant burdens on health systems and social-care systems.1,2 Indeed, LBP is one of the most common disorders encountered by physical therapists.3 The clinical course of LBP can be described as acute, subacute, recurrent, or chronic. The first episode of back pain can have differing results: 80–90% will be asymptomatic in 6 weeks, 98% in 24 weeks, and 99% in 52 weeks,4 leading to the assumption that most cases of LBP are benign in nature.57 However, the small percentage of people who do become disabled with chronic LBP account for 75–90% of the cost associated with LBP.8 In addition, this population has been associated with a reduced quality of life, poor health, comorbidities, and high medical costs.9,10 A number of risk factors have been associated with LBP. However, current literature does not support a definitive cause for the initial episode of LBP.11

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ANATOMY

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The lumbar spine (Fig. 28-1) consists of five lumbar vertebrae, which, in general, increase in size from L1 to L5 to accommodate progressively increasing loads. Between each of the lumbar vertebrae are the intervertebral disks (IVDs).

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VERTEBRAL BODY

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The anterior part of each vertebra is called the vertebral body. The pedicles, which project from the posterior aspect of the vertebral body, represent the only connection between the posterior joints of the segment and the vertebral bodies, both of which deliver tensile and bending forces. Noticeably, the muscles that act on a lumbar vertebra pull downward, transmitting ...

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