Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Low back painMechanical low back painNon-specific low back painLumbar sprain ++ 724.2 Lumbago847.2 Lumbar sprain ++ M54.5 Low back painS33.5 Sprain of ligaments of lumbar spine ++ 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated With Spinal Disorders1 +++ Description ++ Occurs in up to 80% of populationMost episodes are self-limitingLeading cause of disability for people under the age of 45 +++ Essentials of Diagnosis ++ Diagnosis made by clinical examinationUse of treatment (Impairment) based classification system is useful to determine evidence-based practice treatment planReproduction of symptoms in specific postures and activitiesRule out disease (red and yellow flags) +++ General Considerations ++ Presentation can vary significantly based on anatomical structures and psychosocial factorsOften difficult to determine patho-anatomical cause of pain +++ Demographics ++ Variable based on specific condition +++ Signs and Symptoms ++ Pain in lumbar or sacral area that can be mechanically reproducedUnilateral or bilateral referred or radiating pain in lower extremities possibleAltered sensation, motor control, reflexes in the distribution of involved nerve roots indicates nerve-root compression (see lumbar radiculopathy)Pain may centralize or become peripheralized with repeated movementLumbar segmental hypomobility may be present and indicate instabilityOften associated with poor core-muscle strength and postural deviations +++ Functional Implications ++ Leading cause of occupational disabilityMay impede ability to perform ADLs/IADLsMay impede participation in sports and other social activities +++ Possible Contributing Causes ++ Occupational factorsCongenital anomaliesPhysical conditionSmokingObesitySocio-economic factorsPsychosocial and behavioral factorsPostural changesWeakness of core musculatureTightness of hip flexors, external rotators, hamstrings +++ Differential Diagnosis ++ Vascular insufficiencyPeripheral nerve impairmentHip pathology with radiating pain patternMalignant spinal tumor or metastasisReferred pain from visceral structuresSystematic auto-immune diseases (RA, Reiter's)Ankylosing spondylitisAbdominal aortic aneurism +++ Imaging ++ Not necessary in most cases; only with persistent symptoms that do not respond to conservative management or if red/yellow flags are presentMRI helpful in diagnosis to visualize compressed or inflamed nerve root/disc pathologyX-ray/plain-film radiograph helps to assess alignment, fractures, stability (flexion/extension radiograph)CT to show herniation compressing the spinal canal or nerves or rule out abdominal pathologyElectrodiagnostic/nerve conduction testing can help determine specific impaired nerve functionDoppler ultrasound to examine vascular function ++ Physical ExaminationAlgorithm for examination of the lumbar spinePassive physiological intervertebral mobility testing (PPIVM)Lower extremity screening examPostural examinationMuscle length testing, including hamstrings, hip flexors, calf musclesQuadrant testStraight leg raise testSlump testLower limb nerve tension ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth