Orthopaedic Manual Physical Therapy of the Lumbopelvic Spine
At the conclusion of this chapter, the reader will be able to:
Identify the key anatomical and biomechanical features of the lumbopelvic spine and their impact on examination and intervention.
List and perform key procedures used in the orthopaedic manual physical therapy (OMPT) examination of the lumbopelvic spine.
Demonstrate sound clinical decision-making in evaluating the results of the OMPT examination.
Use pertinent examination findings to reach a differential diagnosis and prognosis.
Discuss issues related to the safe performance of OMPT interventions for the lumbopelvic spine.
Demonstrate basic competence in the performance of a skill set of joint mobilization techniques for the lumbopelvic spine.
FUNCTIONAL ANATOMY AND KINEMATICS
The human spine is a complex, complicated, and often confounding structure composed of 33 individual vertebrae forming 25 mobile segments. During typical function, the spine must move through a wide range of multiplanar motions while simultaneously serving as a stable base from which the muscles of the appendicular skeleton must perform their important functions.
The spine is divided into the cervical (7), thoracic (12), lumbar (5), sacral (5), and coccygeal (3-5) regions, each of which possess unique movement characteristics that allow the execution of a variety of functional demands (Fig. 28–1). In total, the spine was created with a variety of inherent engineering flaws that sacrifice stability for mobility. As a result, spinal dysfunction and subsequent disability has reached epidemic proportions in our society.
The regions of the vertebral column with their degree of spinal curvature.
Lumbar Spine Arthrology and Kinematics
The spinal motion segment is considered to be the functional unit of the spine and is defined as the inferior aspect of the superior vertebra, the superior aspect of the inferior vertebra, and all of the structures in between (Fig. 28–2). Due to the interdependent nature of the spinal motion segment, impairment of any structure within the motion segment will eventually impact, to a greater or lesser degree, the other structures within the motion segment.
The spinal motion segment.
Within the spinal motion segment, the articular facet joint, sometimes referred to as the interzygapophyseal or zygapophyseal joint, plays a major role in dictating the direction and quantity of motion that occurs among adjacent vertebrae. As dictated by the sagittal plane orientation of the lumbar facet joints, the greatest extent of motion is in the sagittal plane (forward/backward bending), with less motion in the frontal plane (side bending), and the least amount of motion in the transverse plane (rotation).