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Out there in the real world, one athletic trainer experienced the following:

During my junior year of college, I cared for an athlete who complained of back pain. He believed he had done more than simply pull a muscle at cheerleading practice, where he performed many repetitive motions into lumbar extension. My initial reaction to this injury was to simply assume he had a muscle strain. I examined him, but he was too sore to allow a full evaluation. I gave him some exercises to help stretch the lumbar musculature and relax the area where he was having pain. Several days later, the athlete returned and stated that he had pain radiating down one of his legs but only with certain motions. At this point, I knew that the exercises were clearly not the solution to his back pain. I informed the team physician of the athlete's symptoms; he referred the athlete for imaging. The results of the examination revealed that the athlete had a spondylolisthesis that required immediate attention. This situation taught me that back pain in athletes is not a condition to dismiss lightly. The athlete could have something more serious underneath the spasms and muscle soreness.

Becky Honisch, PT, AT, ATC, DPT

Brownsburg, Indiana


learning outcomes

After working through this chapter, you will be able to:

  1. Verbalize the questions to use when obtaining a thorough medical history for an assessment.

  2. Describe the principles of body movement at the lower back, sacroiliac joint, and pelvis and the various mechanisms of injury that affect the lower back, sacroiliac joint, and pelvis.

  3. Compare and contrast the findings of various special tests and the role of diagnostic tests used during a lower back, sacroiliac joint, or pelvis evaluation.

  4. Explain medical terminology associated with assessment of musculoskeletal injuries.

  5. Verbalize the standard procedures used for a clinical evaluation of the lower back, sacroiliac joint, and pelvis and interpret the findings for differential diagnoses.


Paula Saunder is a member of the volleyball team who plays all positions except the back row. Ms. Saunder has a history of tight hamstrings and weak core muscles that cause her to experience low back pain after practice. She has pain as a result of outside hitting that requires repetitive back hyperextension. She comes to the athletic training room with a complaint of low back discomfort, but she also is experiencing numbness and paraesthesia in her legs bilaterally. She has localized point tenderness over the lumbar (L5–S1) vertebrae and has a step deformity of the vertebrae at the L5–S1 level (Fig. 10-1). Special tests indicate a positive spring test of the low back at vertebrae L5–S1 and a negative straight-leg raise test result.

Figure 10-1:

Paula Saunder's deformity.

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