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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 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.



Over the last few decades, chronic nonspecific low back pain (LBP) has become increasingly problematic, placing significant burdens on health systems and social care systems, making it one of the most common disorders that physical therapists encounter. The clinical course of LBP can be described as acute, subacute, recurrent, or chronic. Fortunately, LBP resolves in the majority of acute cases within the first 6 weeks of onset, leading to the assumption that most cases of LBP are benign, even though approximately one-third of individuals who have acute or subacute LBP episodes will develop chronic LBP and become the ones who account for approximately three-quarters of the cost associated with LBP, poor health, and comorbidities. One of the reasons for the lack of a gold standard for treating chronic nonspecific LBP is the heterogeneity of its definition. Thus, establishing any effective approach for patients with LBP at high risk for chronicity must address the cause and any modifiable prognostic factors that could have significant personal, financial, and societal benefits.


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


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 connection between the posterior joints of the segment and the vertebral bodies, delivering tensile and bending forces. Noticeably, the muscles that act on a lumbar vertebra pull downward, ...

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