Upon completion of this chapter the student should be able to demonstrate the following competencies and proficiencies concerning the lumbar spine:
Know the functional anatomy of the lumbar spine including spinal curvature
Understand normal osteokinematic and arthrokinematic motion of the lumbar spine
Design rehabilitation programs for postural-related lumbar dysfunction
Be able to apply and interpret lumbar spine endurance tests
Understand lumbar spine exercise guidelines and progressions
Understand and implement exercises for lumbar spine dysfunction including hypomobility, hypermobility, disc pathology, sprains, and strains
Implement the use of manual therapy techniques for lumbar spine dysfunction
Understand the use of clinical prediction rules in the treatment of lumbar spine dysfunction
The lumbar spine is composed of many structures that can be involved in the cause and complaint of low back pain. Many different approaches and philosophies are used by sports medicine professionals in the treatment of lumbar spine dysfunction and injury. Unfortunately, there is limited scientific evidence supporting several common approaches to treating lumbar spine dysfunction. For example, exercise is one of the primary modalities used in the management of back pain. Although various forms of exercise have been used for many years, there is little evidence to substantiate the value of any one particular form over another. Many unsubstantiated recommendations such as bending the knees while performing a sit-up, stretching the hamstrings, strengthening the abdominals, and exercising on a ball have become commonplace in rehabilitation programs for low back pain.1,2 One approach cannot be used for all lumbar injuries. Every injury is unique and should be treated as such based on the scientific evidence available and the clinician's experience with the type of exercises indicated for that injury.
Injuries to the lumbar spine can be categorized into sprains/strains, fractures, motion/movement disorders, postural abnormalities, and muscle imbalances. The sacroiliac (SI) joint is often a source of lumbar pain and is commonly treated in conjunction with the lumbar spine. This chapter will address many rehabilitation techniques that can be used in the treatment of low back pain. The health-care professional must design an appropriate rehabilitation program that will address the cause of the problem and the specific needs of the patient.
FUNCTIONAL ANATOMY OF THE LUMBAR SPINE
The lumbar spine consists of 5 vertebrae, 10 nerve roots, 10 facet joints, 6 main ligaments, and 5 intervertebral discs (Fig. 19-1). The vertebrae serve as attachment sites for many ligaments and tendons that stabilize and move the spine. The facet joints help guide motion and resist shear forces. The spinal nerves that originate in the lumbar region, together with the sacral nerves, form the lumbosacral plexus, which innervates the muscles of the pelvis and lower extremity. Ligaments are the main stabilizers of the spine while standing and help support the spine in conjunction with the muscles during movement.3