what structures and involved
- intervertebral discs
- sciatic nerve
- muscles = erector spinae, abdominals, obliques
structures involved
reasoning for intervertebral disc
- aggravated by bending/lifting, causing pain and numbness
- herniation can lead to nerve impingement and functional impairment
5 in the lumbar
cushion of fibrocartilage and principle joint between 2 vertebrae in spinal column
structres involved
reasoning for sciatic nerve
- potential compression/irritation contributing to numbness
- important for relieving symptoms and preventing further issues
major nerve extends from lower spinal cord down back of thigh and divides above knee
structures involved
reasoning for muscles
- muscles supprting lumbar spine, likely strained or injured
- should be assessed to alleviate pain and stiffness and prevent further issues
structures involved
what do the erector spinae muscles do
- allow us to stand and lift objects
- help hold up the spine
structures involved
what do the abdominal muscles do
allow us to flex, bend forward, lift and arch lower back
strcutres involved
what do the oblique muscles do
help rotate spine and maintain proper posture
what are the tissue mechanics
- muscle strain
- intervertebral disc compression
- nerve compression
tissue mechanics
muscle strain
when muscle fibers can cope with the demands placed on them by exercise overload and leads to tearing of the fibers
tissue mechanics
intervertebral disc compression
- when a disc degenerates, small bony outgrowths may form at edges of affected vertebrae
- these bone spurs may compress spinal nerves, leading to weakness or numbness in arms/legs
tissue mechanics
nerve compression
continuous compression can cause further damage in sciatic nerve
what is the dominant pain mechanism
mechanical low back pain
pain mechanism
what is mechanical low back pain
source of pain may be in spinal joints, discs, vertebrae, soft tissues
MUST tests
- gait
- ROM of legs and spine
- myotomes - L4-S3
- straight leg raise
MUST tests
gait
- limp?
- overcompensation on opposite side
MUST tests
myotomes
L4 = ankle DF
L5 = big toe extension
S1 = ankle eversion
S2 = ankle PF
MUST tests
legs/spine ROM
leg = hip flex, ext, abd, add, rotation
spine = flex, ext, side flex, rotation
MUST tests
straight leg raise
- supine
- knee extension
- hip flexion
positive if pain in lower back (L4/S1)
SHOULD tests
- dermatomes - L4-S2
- reflexes - L3/S1
- provocative test - SLUMP
SHOULD tests
dermatomes
L4-S2
L4 = supine, knee to big toe
L5 = supine, knee to middle 3 toes
S1 = prone, middle of calf to pinky toe
S2 = prone, top of thigh to middle of calf
SHOULD tests
reflexes
L3/S1
L3/4 = supine, leg over therapist thigh, slight knee flexion, bottom of patella
S1 = foot DF, achilles tendon
SHOULD tests
SLUMP
- sitting
- slumped upper body
- head flexed
- straighten one leg
- positive if pain is reproduced
