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

2. Structure of the Spine

3. 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

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

5. 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

6. Other Considerations
The Nervous System
The Fascial System

7. 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.

8. Injuries & Conditions of the Spine

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

10. Disc pathologies

11. 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.

12. 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.

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

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

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

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

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

18. Management of Low Back Disorders

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