3The Kinetic ChainConditions 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
4Forces acting on the spine Observations, posture – feet, scapulae, jawCompensations to center of gravity
5The balanced pelvisThere are eight axes of rotation through the sacrumThe pelvis is the foundation. It must be balanced vertically, horizontally and diagonally
6Other ConsiderationsThe Nervous SystemThe Fascial System
7Leg length – anatomical vs. functional Anatomical leg length is determined by measuring the femur and the tibiaFunctional 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.
11Spinal Stenosis D.D.D. Narrowing of the space between vertebrae Movement between vertebrae is diminishedMay be due to arthritic spurring or disc degeneration/compress ion.
12Muscle strainBecause 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.
13Spondylolysis / Spondylolisthesis ‘scotty dog’ with collar‘scotty dog’ decapitated
14Sciatica Literally – inflammation of the sciatic nerve Referred pain down the posterior of the lower extremityPressure from; disc, skeleton, muscles, fascia
15Facet (Z-joint) syndrome Very commonJoint may become fixed due to stacking or muscular force.
16Spinal Instability Uncoordinated movement of the spine Painful to maintain static positionsGenerally, rehab is poorly understood
17Spinal Instability Uncoordinated movement of the spine Painful to maintain static positionsGenerally, rehab is poorly understoodWE ARE GOING TO CHANGE THAT!!!