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


  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 from 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 to 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.


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 The findings in the literature seem to suggest the seemingly contradictory notion that acute back conditions are self-limiting and have an excellent natural history, but there is a good chance that a problem remains. According to these studies, 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,3 leading to the assumption that most cases of LBP are benign in nature.46 However, the small percentage of people who do become disabled with chronic LBP account for 75–90% of the cost associated with LBP.7 This group of patients has been the focus of much research to determine factors associated with chronicity and the pathologic processes responsible.


Given the numerous causes and types of LBP, it is imperative that any clinician examining and treating the lower back have a sound understanding and knowledge of the anatomy and biomechanics of this region. Although this knowledge is not the sole determinant of the approach to LBP, it does provide a solid framework on which to build successful management. There have also been moves toward the design of clinical prediction rules (see Chap. 5) on how best to treat patients with LBP (see “Intervention” section).


It is worth noting that trunk strength, flexibility, aerobic conditioning, and postural education have all been found to have a significant preventative effect on the occurrence and recurrence of back injuries.815 Thus, physical therapy, with its emphasis on the restoration of functional motion, strength, and flexibility, should be the cornerstone of both the intervention and the preventative processes in LBP.


The lumbar spine (Fig. ...

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