Lumbar segmental rigidity: Can its identification with facet injections and stretching exercises be useful? Tom G. Mayer, MD, Richard Robinson, PhD,

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Lumbar segmental rigidity: Can its identification with facet injections and stretching exercises be useful? Tom G. Mayer, MD, Richard Robinson, PhD, Pauline Pegues, RN, Sheri Kohles, PT, Robert J. Gatchel, PhD Archives of Physical Medicine and Rehabilitation Volume 81, Issue 9, Pages 1143-1150 (September 2000) DOI: 10.1053/apmr.2000.9170 Copyright © 2000 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 1 A normal unoperated 34-year-old woman: (A) erect position, (B) right lateral bend. Note the smooth curve of the lumbar spine from T12 to S1, with the upper sacrum anatomically well below the iliac crest. The L4-L5 interspace is at the iliac crest level in the erect position. The apparent movement of the iliac crest skin mark with coronal motion is an artifact of skin motion overlying the iliac crest and is seen on all figures. Midline skin and bony structures correspond more precisely. Archives of Physical Medicine and Rehabilitation 2000 81, 1143-1150DOI: (10.1053/apmr.2000.9170) Copyright © 2000 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 2 A recently rehabilitated, chronically disabled 29-year-old man after an L4 to S1 2-level, 360° spine fusion: (A) erect position, (B) right lateral bend. The immobility involves 2 segments, with the patient having regained motion above the fusion. The complete immobility of segments L4 to S1 is easily noted; motion is only from T12 to L4. Archives of Physical Medicine and Rehabilitation 2000 81, 1143-1150DOI: (10.1053/apmr.2000.9170) Copyright © 2000 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 3 A chronically disabled 29-year-old woman with observable limitation of lumbar motion involving 3 segments from L3 to S1: (A) erect position, (B) right lateral bend. She had no surgery, but magnetic resonance imaging shows L4 and L5 degenerative disc disease. The patient's pain complaint was characteristically expressed as being in the region immediately below motion cessation. Archives of Physical Medicine and Rehabilitation 2000 81, 1143-1150DOI: (10.1053/apmr.2000.9170) Copyright © 2000 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 4 A chronically disabled 42-year-old unoperated man with observable limitation of lumbar motion involving the L4 to S1 segments: (A) erect position, (B) right lateral bend. Magnetic resonance imaging identifies L4 and L5 degenerative disc disease with facet arthropathy at both levels. Pain was expressed as lumbar pain below the level of motion cessation exacerbated primarily by extension and radiating into the buttocks. Archives of Physical Medicine and Rehabilitation 2000 81, 1143-1150DOI: (10.1053/apmr.2000.9170) Copyright © 2000 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 5 Algorithmic study design documenting interventions and measurements. Abbreviations: H&P, history and physical examination; PRE, preinjection; ROM, range of motion; ADM, at admission to the program; DC, discharge. Archives of Physical Medicine and Rehabilitation 2000 81, 1143-1150DOI: (10.1053/apmr.2000.9170) Copyright © 2000 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions