DEEP BACK

Group IV PT3A
CRUZ, C. ~ CRUZ, V. ~ CUYA ~ DE LEON ~ DE LOS ANGELES ~ DE LOS REYES
DISUANCO ~ DIVINA ~ DU ~ ESPENA ~ ENRIQUEZ ~ EVANGELISTA

CASE DISCUSSION
A 55 year old male came in with a chief complaint of dull,
aching pain at the low back associated with radiating pain
towards the lateral aspect of the 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 3 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 any extension
maneuvers.

Anatomy of the deep back: possibly

affected structures
Vertebral Column
Anterior Portion: Provides for weight
bearing, shock absorption, and mobility in
all direction

Posterior Portion: protection of the spinal

cord, guidance and limitation of motion, and
elongated processes to increase the leverage
of muscles of the trunk and leverage

Anatomy of the deep back: possibly

affected structures
Sacrum: fused together, concave anteriorly
Sacral Hiatus
Sacral Foramina : where anterior and
posterior sacral rami nerve passes
Typical Lumbar Vertebrae:
body: large kidney shaped
vertebral foramen: small and triangular
transvers process: long & slender
articular processes: sup & med; inferior & lat
*no articulation facets in the ribs*

Anatomy of the deep back: possibly

affected structures
Invertebral Disc
Annulus Fibrosus: collagenous, absorb and
distribute forces and limit motion
Nucleus Pulposus: water, permits one
vertebra to rock anteriorly or posteriorly on one
another
Ligaments

Anterior Longitudinal Ligament

Posterior Longitudinal Ligament

Ligamentum Flava

Interspinous Ligament

Supraspinous Ligament

Explain the possible cause/s of

the radiating pains.
Impingement of sensory roots of L5 and S1
because of Herniated Nucleus Pulposus
When the posterior part of the annulus fibrosus
ruptures and the nucleus pulposus is forced posteriorly.

What group of muscles will likely

have weakness in this condition?
Root injury

Pain dermatome

Muscle Supplied

Movement

L5

lateral part of
the lower leg
dorsum of the
foot

extensor
halluces longus
extensor
digitorum
longus

toe extension
ankle
dorsiflexion

S1

lateral part of
leg

gastrocnemius
soleus

ankle plantar
flexion

How to get the ROM of the LS

region?
Lumbar Flexion: Modified Schober Test
Procedure :
1. Place the first mark at the lumbosacral junction with a skin marking
pencil. Place a second mark 10 cm above the first mark. Place a third
mark 5 cm below the first 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.
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

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

Special tests
Straight Leg Raising Test
-

passive test

each leg is tested individually with the normal leg being tested first

Pt position: supine

hip medially rotated and adducted

knee extended

examiner flexes the hip until the Pt complains of pain or tightness in

the back or back of the leg

*If the pain is primarily back pain, it is more likely a Disc Herniation from
Pressure on the Anterior Theca of the Spinal Cord or the pathology causing
the pressure is more central

Special tests

Special tests
Compression Test
Pt position: supine

hips are flexed until the PSISs start to move backward (usually about
1000 Hip Flexion)

examiner then applies direct pressure against the Pts feet or buttocks
applying axial compression to the spine

radicular pain into posterior leg is produced

*positive for a possible Disc Herniation