Lumbar Spine Pain Considerations:
a. Occupation: Heavy Lifting or physically demanding
b. Socioeconomic: Lower education levels, Psychological distress, Work-related,
c. LBP is often recurrent: Current episode length?
d. Deconditioning Syndrome: Often associated with Chronic LBP - Compounds LBP problem as it leads to decreased muscle
strength, impaired motor control, and decreased coordination and postural control.
Category: Back pain dominant. Leg Pain Dominant
re there any postures or actions that specifically in- crease or decrease the pain or that cause
difficulty
T-Spine Patient Education: Thorax: Important region of load transfer b/w the upper body (head, cervical spine, and upper extremities)
and the lower boy (lumbopelvic region and LE). . Excessive or poorly controlled mobility of the thorax (Figure 8-3) may result in
local pain, as well as pain and dysfunction in the shoulder, neck, and low back, because many of the muscles that span the low
back and neck and control scapulohumeral movement have their origins in the thorax. Conversely, insufficient mobility of the
thorax (Figures 8-4 and 8-5) increases the movement requirements of the cervical and lumbar regions and may resuJt in neck
and/or low back pain coupled with a painless, stiff thorax.
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Effective management of thoracic pain should include techniques to reduce joint compression where necessary (i.e., joint manipulation, joint mobilization, muscle
release techniques), techniques to align tlle thorax where necessary (i.e., muscle energy techniques and postural re-education), exercises to increase joint compression
where and when necessar y (i . e., motor control and muscle capacity [strength and endurance] training), and patient education to help patients understand both tlle
mechanical and emotional components of tlleir experience.
The decreased thoracic mobiljty may be due to joint stiffuess or altered patterns ofmuscle recruitment (poor motor control); further testing is required to determine the
cause of the restriction.
The integrated model is not a pain- or structure-based model that focuses only on identifying the pain-generating structure.
This is not to say that pain is ignored; rather, the model seeks to help the clinician understand why a structure has become
painful. Often nonpainful but dysfunctional components contribute to excessive tensile, compression, and/or shear forces on
other structures. These structures then become a source of nociception (pain) and may show signs of degeneration on imaging
tests. Local treatment can temporarily address the painful structure, but an examination of all components of the model (form
closure, force closure, motor control, and emotions) can reveal why load transfer has failed, resulting in a concentration of
forces rather than load sharing among structures. For example, lumbopelvic pain can change patterns of recruitment and
activity in muscles that span the thoracic spine,29-32 and if this occurs unilaterally, the resulting asymmetrical muscle activity
creates rotation and side-bending curves in the tho rax both at rest and during loading (Figure 8-2). Excessive, repetitive
unilateral compression can result in thoracic pain and breakdown of structures over time. Excessive or poorly controlled
mobility of the thorax (Figure 8-3) may result in local pain, as well as pain and dysfunction in the shoulder, neck, and low back,
because many of the muscles that span the low back and neck and control scapulohumeral movement have their origins in the
thorax. Conversely, insufficient mobility of the thorax (Figures 8-4 and 8-5) increases the movement requirements of the
cervical and lumbar regions and may resuJt in neck and/or low back pain coupled with a painless, stiff thorax.
The goal of treatment, therefore, is to optimize load transfer and the sharing of forces throughout the thorax, the spine, and the
entire body. This requires restoration of mobility to restricted areas, restoration of muscle control and the capacity to stabilize
poorly controlled areas, and consideration of the emotional components that may alter posture and increase sensitization to
pain. Ultimately, all techniques need to be incorporated into an overall approach that increases awareness of postural habits
and movement patterns in order to change the way the patients Live and move in their bodies, so that pain-free, effortless
movement is restored. The clinician's goal is to empower patients through knowledge, movement, and awareness to help
regain control and achieve their optimum potential.