Identification, Management, PreventionJim Norris, CAT(C)November, 2009

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

Observations, posture – feet, scapulae, jawCompensations to center of gravity

There are eight axes of rotation through the sacrum

The pelvis is the foundation. It must be balanced vertically, horizontally and diagonally

The Nervous System The Fascial System

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.

The disc itself has no nerve supply.

70% of disc pathologies are asymptomatic.

Conservative therapy cannot heal a disc injury.

D.D.D. Narrowing of the

space between vertebrae

Movement between vertebrae is diminished

May be due to arthritic spurring or disc degeneration/compression.

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.

‘scotty dog’ with collar ‘scotty dog’ decapitated

Literally – inflammation of the sciatic nerve

Referred pain down the posterior of the lower extremity

Pressure from; disc, skeleton, muscles, fascia

Very common

Joint may become fixed due to stacking or muscular force.

Uncoordinated movement of the spine

Painful to maintain static positions

Generally, rehab is poorly understood

Uncoordinated movement of the spine

Painful to maintain static positions

Generally, rehab is poorly understood

WE ARE GOING TO CHANGE THAT!!!

Localized compensating scoliosis Pain

Disc + nerve root Positive dural signs

C-spine + SLR (accurately) Slump test Walking on toes