KIN 191AAdvanced Assessment of Lower Extremity Injuries

THE THORACIC AND LUMBAR SPINEINJURIES

INTRODUCTION

• Erector spinae (paraspinal) muscle strain• Facet joint sprains/dysfunction• Intervertebral disc injuries• Sciatica• Spondylopathies– Spondylolysis– Spondylolisthesis

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Erector Spinae Strains

• Easily the most common lumbar spine injury• Commonly, a history of heavy or repetitive

lifting and complaining of aching pain centralized to the lower back

• Pain with trunk motions (especially flex/ext), typically no neurological symptoms

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Facet Joint Injuries• Dislocation/subluxation– “Locking” of segment/s (hypomobility)– Often associated with a specific movement pattern

• Facet joint syndrome– Repetitive stress from movement and/or loading– Usually no neuro symptoms unless inflammation

impinges upon nerve roots• Degeneration– Degenerative changes may cause impingement on

nerve roots and resultant radicular symptoms– Often presents with hypomobility of unknown origin

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Intervertebral Disc Injuries

• “Bulging” or herniated disc is extrusion of nucleus pulposus through weakened area of annulus fibrosus with resultant impingement on nerve root typically at level below disc bulge

• Often, annulus weakened by accumulative repetitive stresses and one event then causes final failure to contain nucleus

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Intervertebral Disc Injuries

• Condition typically associated with radiating neuro symptoms (dermatomes/myotomes)

• Often present with lateral shift away from impacted side to alleviate nerve root compression

• Changes in body position (sitting to standing, etc.) change loads on discs and often exacerbate symptoms

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Sciatica

• General term for any cause of inflammation and/or irritation of “sciatic” nerve

• Similar symptoms to nerve root compression but originate at peripheral nerve level instead of spinal level (sensory/motor function)

• Multiple potential causes – all encompassing term when specific pathology is difficult to identify

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Spondylopathies• Most common in hyperextension activities• Most common at L4-L5 or L5-S1• Spondylolysis– Pars interarticularis defect – “collared” Scotty dog

• Spondylolisthesis– Bilateral pars defect with anterior listhesis (slippage)

of one vertebrae on segment below – decapitated Scotty dog

– Severity determined by amount of anterior displacement

– Single leg stance test may assist in assessment– May have significant neuro sx with severe

displacement 8

“Scottie Dog”

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