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After completion of this chapter, the physical therapist should be able to do the following:
Discuss the functional anatomy and biomechanics of the spine.
Describe the difference between spinal segmental stabilization and core stabilization.
Explain the rationale for using the different positioning exercises for treating pain in the spine.
Conduct a thorough evaluation of the back before developing a rehabilitation plan.
Compare and contrast the importance of using either joint mobilization or core stabilization exercises for treating spine patients.
Differentiate between the acute versus reinjury versus chronic stage models for treating low back pain.
Explain the eclectic approach for rehabilitation of back pain in the athletic population.
Describe basic- and advanced-level training in the reinjury stage of treatment.
Incorporate the rehabilitation approach to specific conditions affecting the low back.
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Functional Anatomy and Biomechanics
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From a biomechanical perspective, the spine is one of the most complex regions of the body, with numerous bones, joints, ligaments, and muscles, all of which are collectively involved in spinal movement. The proximity to and relationship of the spinal cord, the nerve roots, and the peripheral nerves to the vertebral column add to the complexity of this region. Injury to the cervical spine has potentially life-threatening implications, and low back pain is one of the most common ailments known to humans.
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The 33 vertebrae of the spine are divided into 5 regions: cervical, thoracic, lumbar, sacral, and coccygeal. Between each of the cervical, thoracic, and lumbar vertebrae lie fibrocartilaginous intervertebral disks that act as important shock absorbers for the spine.
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The design of the spine allows a high degree of flexibility forward and laterally, and limited mobility backward. The movements of the vertebral column are flexion and extension, right and left lateral flexion, and rotation to the left and right. The degree of movement differs in the various regions of the vertebral column. The cervical and lumbar regions allow extension, flexion, and rotation around a central axis. Although the thoracic vertebrae have minimal movement, their combined movement between the first and twelfth thoracic vertebrae can account for 20 to 30 degrees of flexion and extension.
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As the spinal vertebrae progress downward from the cervical region, they grow increasingly larger to accommodate the upright posture of the body, as well as to contribute to weight bearing. The shape of the vertebrae is irregular, but the vertebrae possess certain characteristics that are common to all. Each vertebra consists of a neural arch through which the spinal cord passes, and several projecting processes that serve as attachments for muscles and ligaments. Each neural arch has 2 pedicles and 2 laminae. The pedicles are bony processes that project backward from the body of the vertebrae and connect with the laminae. The laminae are flat bony processes occurring on either side of the neural arch that project backward and inward from the pedicles. With the ...