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

During my junior year of college I began experiencing pain in my lower back along my posterior superior iliac spine (PSIS). My senior athletic training student (ATS) said it was from knots in my muscle from hitting and that they would resolve after the season. Later in the season, I suffered two disc herniations at L4–L5 and at L5–S1. This issue improved after many months of rehabilitation, but I still had the sacroiliac (SI) pain. Putting pressure on my lower back was the only thing that relieved this pain. Over the summer months, the pain got increasingly worse and the pain moved into my hips as well. I brought this to my ATS's attention and she diagnosed it as SI joint dysfunction. We began using muscle energy and I starting wearing an SI belt. The pain subsided after a couple of weeks. I learned that many things can contribute to low back pain; however, a proper diagnosis and a good rehabilitation plan bring success and reduce pain.

Chelcey Lyons, AT, ATC

Graduate Assistant Athletic Trainer

Valdosta State University

Valdosta, Georgia


learning outcomes

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

  1. Describe seven different goals of rehabilitation and the importance of each in the overall rehabilitation protocol.

  2. Verbalize indications for performing low back, sacroiliac joint, and pelvis rehabilitative techniques.

  3. Discuss modifications and progressions that are used during a rehabilitation program for the low back, sacroiliac joint, and pelvis.

  4. Discuss outcome measures used to identify activity levels and return-to-play guidelines for low back, sacroiliac joint, and pelvis injuries.

  5. Explain what modality choice is proper for rehabilitation by using indications, contraindications, and the principles and theory related to the physiological response of the intervention.


Claire Hutchins is a collegiate distance runner who participates in both cross-country and track. She has a prior history of low back, left gluteal, and lateral thigh pain that radiates to the left knee. The pain intensifies over her summer break while she participates in a summer running program. She visits her family physician, who orders a radiograph of her low back. The results show a spondylolysis at the L4–L5 vertebrae. The physician diagnoses spondylolysis and a weak core, and he refers Claire Hutchins for physical therapy. The physical therapy sessions focus on lumbar stabilization and strengthening; however, the physical therapy sessions bring no pain relief. Her physician then orders magnetic resonance imaging (MRI), which has no significant findings. The physician recommends an epidural steroid injection to help relieve any effusion that might be present between the vertebrae, which brings about only temporary relief. She is still having a moderate amount of low back and left ...

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