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CHAPTER OBJECTIVES

CHAPTER OBJECTIVES

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 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.

OVERVIEW

OVERVIEW

Over the past few decades, low back pain (LBP) has become increasingly problematic, placing significant burdens on health systems and social-care systems. Indeed, survey studies show that the lifetime prevalence of LBP is greater than 80% in the adult population,1 making it one of the most common disorders encountered by physical therapists.2 The clinical course of LBP can be described as acute, subacute, recurrent, or chronic. Fortunately, LBP resolves in the majority of these patients within the first 6 weeks of onset.3 This had led to the assumption that most cases of LBP are benign in nature, despite the fact that between 5% and 30% of the proportion of individuals who have acute or subacute LBP episodes will develop chronic LBP,4 and it is this proportion of people who account for 75–90% of the cost associated with LBP.5 In addition, this population has been associated with a reduced quality of life, poor health, comorbidities, and high medical costs.5–7 Thus, establishing an effective approach for patients with LBP at high risk for chronicity that has a focus on addressing modifiable prognostic factors could have significant personal, financial, and societal benefits.8,9

ANATOMY

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).

FIGURE 28-1

Structures of the lumbar spine.

VERTEBRAL BODY

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 ...

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