1. The Lumbar Spine

2. Anatomy

3. Prevention of Injuries to the Spine Lumbar spine –Avoiding stress –Correction of biomechanical abnormalities –Using correct lifting techniques –Core stabilization

4. Recognition and Management of Lumbar Spine Injuries Low back muscle strains Cause: sudden extension with trunk rotation, chronic strains, faulty posture S&S: diffuse or localized pain, pain with active extension and passive flexion Care: cold pack initially, abdominal support, stretching and strengthening; focus on hamstring flexibility; core strengthening

5. Recognition and Management of Lumbar Spine Injuries Lumbar Sprains Cause: forward bending and twisting while lifting an object, acute or chronic S&S: localized pain just lateral to the spinous process, pain becomes sharper with certain movements or postures, extension and rotational movements increase pain Care: RICE initially, brace, stretching, strengthening, NSAIDs

6. Myofascial Pain Syndrome Cause: mechanical stress to muscles, strains or postural positions; regional pain with referred pain to a specific area that occurs with pressure of tender spots or trigger points S&S: point tenderness on a specific spot that radiates pain; sharp, achy pain Care: stretching, strengthening, deep tissue massage, modalities

7. Sciatica Cause: inflammatory condition of the sciatic nerve that can accompany recurrent or chronic back pain, particularly vulnerable to torsion or direct blows. S&S: abruptly or gradually; sharp, shooting pain, that follows the nerve pathway along the medial and posterior thigh; tingling and numbness, sensitive to palpation Care: rest, lumbar traction with disk protrusion, stretching, NSAIDs

8. Herniated lumbar disk Cause: faulty body mechanics, trauma, or both, usually forward bending and twisting - most often L4-L5 S&S: centrally localized pain that radiates unilaterally to buttocks and down back of leg, or pain that spreads across the back; worse in am, onset is sudden or gradual, pain may increase after sitting, decrease with extension Care: goal = reduce protrusion and restore normal posture, rest and ice, manual traction, back extensor and abdominal strengthening

9. Spondylolysis Cause: degeneration of the vertebrae or defect in the pars interarticularis of the articular process; often attributed to a congenital weakness and occurs as a stress fracture

10. Spondylolisthesis –Slippage of one vertebrae on the one below it, a complication of spondylolysis that often results in hypermobility of a vertebral segment, highest incidence is L5 slipping on S1, “scotty dog deformity”

11. S&S: persistent mild to moderate aching pain across the low back (LB) or stiffness in LB with increased pain after but not usually during activity; the need to change positions frequently or the need to self manipulate the LB to reduce pain, localized tenderness, possible neurological symptoms Care: bracing, bed rest for 1-3 days, rehab directed towards exercises that control or stabilize the hypermobility segment, abdominal strengthening is key

12. Sacroiliac sprain Cause: twisting with both feet on the ground, stumbling forward, backwards fall, bending forward with knees locked, landing heavily on one leg S&S: palpable pain and tenderness directly over the joint, muscle guarding, radiating pain, pain increased with single leg stance Care: bracing, mobilizations, strengthening, modalities

13. Coccyx injuries (tailbone contusion) Cause: direct impact which results in sprains, subluxations or fractures S&S: pain in the coccygeal region is often prolonged and at times chronic Care: xray to rule out fracture, analgesics, ring seat, padding

14. Rehabilitation –3 main components to work on: 1.Hamstring flexibility 2.Abdominal strength 3.Flexible and strong back musculature