Case discussion

Deep Back
Case: A 55 year old male came with a chief complaint
of dull aching pain at the low back associated with
radiating pain towards the lateral aspect of the left leg
and foot. MRI of the lumbosacral region revealed a
Herniated Nucleus Pulposus on the level of L5-S1. The
patient works as a laborer and states that symptoms
are being experienced for three months already and
medications do not offer relief of symptoms. PT also
noted that pain increases with trunk flexion , heavy
lifting , twisting, prolonged standing and sitting but is
relieved by extension maneuvers.

Questions

1. Discuss the anatomy of the deep back.

Focus on structures that are possibly affected.

2.The patient has radiating pain towards the

lateral aspect of the leg. Explain the possible
cause/s of radiating pain.

Questions

3. What group of muscles will likely have

weakness in this condition?

4. Additional points:

How to get the ROM of the LS region

Give 3 special tests appropriate for this

condition.

Anatomy of the deep back

Anatomy of the deep back

Muscles of the Back

The superficial muscles connected with

the shoulder girdle.

The intermediate muscles involved with

movements of the thoracic cage

The deep muscles or postvertebral

muscles belonging to the vertebral
column
.

Anatomy

Movement of Vertebral Column

The following movements are possible:
Flexion
Extension
Lateral flexion
Rotation
Circumduction

Anatomy

Nerve Supply of the Back

supplied in a segmental manner by the
posterior rami

31 pairs of spinal nerves

first, sixth, seventh, and eighth cervical nerves

and the fourth and fifth lumbar nerves supply
the deep muscles of the back

Anatomy

Possible structures affected

Spinal nerve roots exit from the vertebral canal

through the intervertebral foramina.
In the lubar region, the smallest one is between
the fifth lumbar and first sacral vertebra.

Possible structures affected

The list is to the side

opposite the sciatica
because a list to the
same side would elicit
pain. Conversely, when
the herniation is medial
to the nerve root . The
list is toward the side of
the sciatica because
tilting away would irritate
the root and cause pain

What group of muscles will likely

have weakness in this condition?

L5 nerve root affects the

EHL, EDL
-Weakness in toe
extension and ankle
dorsiflexion
S1 nerve root affects the
Gastrocnemius and
soleus
-Weakness in Ankle
plantar flexion

How to get the ROM of the LS

region

LUMBAR FLEXION:MODIFIED SCHOBER TEST

Procedure :
1. Place the rst mark at the lumbosacral junction
with a skin marking pencil. Place a second mark 10
cm above the rst mark. Place a third mark 5 cm
below the rst mark at the lumbosacral junction.
2. Align the tape measure between the most superior
and the most inferior marks. Ask the subject to bend
forward as far as possible while keeping the knees
straight.

How to get the ROM of the LS

region

3. Maintain the tape measure

against the

subjects back during the movement, and note

the distance between the most superior and the
most inferior marks at the end of the ROM. The
ROM is the difference between 15 cm and the
length measured at the end of the motion.

How to get the ROM of the LS

region

LUMBAR EXTENSION:
MODIFIED SCHOBER
TEST

Procedure:
1. Use a skin-marking pencil to place a rst
mark at the lumbosacral junction. Place a
second mark 10 cm above the rst mark. Place
a third mark 5 cm below the rst mark
(lumbosacral junction).
2. Align the tape measure between the most
superior and the most inferior marks.

How to get the ROM of the LS

region

3. Ask the subject to put

the hands on the
buttocks and to bend backward as far as
possible. 4. Note the distance between the
most superior and the most inferior marks at
the end of the ROM, and subtract the final
measurement from the initial 15 cm. The ROM
is the difference between 15 cm and the length
measured at the end of the motion.

Give 3 special tests appropriate for

this condition

Slump test 1
Straight leg raise Basic (Sciatic nerve )
Straight leg raise 3 (Sural nerve)
-foot inverted w/o hip adduction