Low Back Injuries Identification, Management, Prevention Jim Norris, CAT(C) November, 2009

Structure of the Spine

The Kinetic Chain Conditions of the low back most often result from a mechanical stress through the kinetic chain. Evaluation of conditions with no clear mechanism must include the influences of the upper and lower extremities

Forces acting on the spine Observations, posture – feet, scapulae, jaw Compensations to center of gravity

The balanced pelvis There are eight axes of rotation through the sacrum The pelvis is the foundation. It must be balanced vertically, horizontally and diagonally

Other Considerations The Nervous System The Fascial System

Leg length – anatomical vs. functional Anatomical leg length is determined by measuring the femur and the tibia Functional leg length is determined by the height of the iliac crests in weight bearing and at the medial malleoli with the iliac crests when lying supine.

Injuries & Conditions of the Spine

Disc The disc itself has no nerve supply. 70% of disc pathologies are asymptomatic. Conservative therapy cannot heal a disc injury.

Disc pathologies

Spinal Stenosis D.D.D. Narrowing of the space between vertebrae Movement between vertebrae is diminished May be due to arthritic spurring or disc degeneration/compress ion.

Muscle strain Because of power output, velocity, and range of motion, actual injury to a sarcomere of a back muscle is very difficult to achieve. Most back strain diagnoses are shearing injuries between tissue types and tissue layers.

Spondylolysis / Spondylolisthesis ‘scotty dog’ with collar ‘scotty dog’ decapitated

Sciatica Literally – inflammation of the sciatic nerve Referred pain down the posterior of the lower extremity Pressure from; disc, skeleton, muscles, fascia

Facet (Z-joint) syndrome Very common Joint may become fixed due to stacking or muscular force.

Spinal Instability Uncoordinated movement of the spine Painful to maintain static positions Generally, rehab is poorly understood

Spinal Instability Uncoordinated movement of the spine Painful to maintain static positions Generally, rehab is poorly understood WE ARE GOING TO CHANGE THAT!!!

Management of Low Back Disorders

Identification of disc pathology Localized compensating scoliosis Pain Disc + nerve root Positive dural signs C-spine + SLR (accurately) Slump test Walking on toes