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1. LUMBAR PATHOLOGIES

2. Lumbosacral spinal pathologies are common
and include trauma, malignancy, infection,
and degenerative disease!

3. SPINAL STENOSIS
• This condition narrows
the amount of space
within the spine.

4. SPINAL
STENOSIS
can cause radiating pain and numbness to the buttock,
thigh, or leg particularly during walking or standing for a
long time.The pain reduces usually when a patient is in
resting, sits down, or bends forward.
is related to aging, affecting mostly individuals
over the age of 60 years
NOTE: Not all patients with spinal narrowing develop
symptoms, so the term "spinal stenosis" refers to the
symptoms of pain and not to the narrowing itself and a
diagnosis of spinal stenosis is only made once symptoms
are present.

5. CAUSE OF
SPINAL
STENOSIS
• Degenerative Spondylosis
• Degenerative Spondylolisthesis
• Osteoarthritis
• Inflammatory spondyloarthritis
• Bulging of the disc
• Thickening of the vertebral ligament
• Tumour
• Infection

7. SPINAL STENOSIS EXAMINATION
•BICYCLE STRESSTEST
• During this test the patient first pedals on a cycle ergometer in upright position
with preservation of neutral lumbar lordosis.The distance the patient has pedaled
in a certain amount of time is recorded.The patient has to pedal a second time in a
slumped position with lumbar delordosing.The distance the patient has pedaled in
the same time is recorded again. If the patient can pedal further in slumped
position than in upright position, lumbar spinal stenosis is indicated

9. The classic presentation of Lumbar spine
stenosis is radiating leg pain associated with
walking that is relieved by rest.When patients
bend forward, the pain diminishes.

10. PHYSIOTHERAPY MANAGEMENT
• Conservative treatment
• Flexion-based exercise programs
• Lumbar isometric and stretching exercises
• Individualized muscle strengthening
• Stabilization of abdominal and back muscles to avoid excessive lumbar
extension
• Postural and ergonomic advice

11. LUMBAR
SPONDYLOSIS
• It is an age-related
degeneration of
the vertebrae and
disks of the lower
back.

14. Symptoms of Lumbar Spondylosis
• Muscle spasms in lower back
• Grinding or popping sensations when patient sit or stand up
• Numbness in the lower back and feet, and toes
• Pain in the buttocks
• Sciatica (leg pain.

15. PHYSIOTHERAPY MANAGEMENT OF
LUMBAR SPONDYLOSIS
• The physical therapy management consists of a multidisciplinary
approach, which includes lumbar traction, manipulation of the
spine, massage therapy,TENS, Lumbar back supports.

16. LUMBAR
SPONDYLOLISTHESIS
• Spondylolisthesis is the
slippage of one vertebral
body with respect to the
adjacent vertebral body
causing mechanical or
radicular symptoms or
pain.

17. CAUSE OF LUMBAR SPONDYLOLISTHESIS
• Repetitive stress on spine
• Traumatic accidental injuries
• Pathological causes - Neoplasm, connective tissue disease etc

18. Physical Examination of
Lumbar Spondylolithesis
• Step off Sign
A noticeable Step
off sign is
palpated at the
Lumbo sacral
area due to
slippage of the
vertebrae.

19. • Straight Leg Raise Test
Straight raising of the leg with the patient lying
on the back causes pain and triggers the entire
trunk.
• flattened lumbar lordosis with palpable step of
the spinous process will also be observed

21. Physiotherapy
Management of Lumbar
Spondylolisthesis
• Isometric and isotonic exercises
beneficial for strengthening of the main
muscles of the trunk, which stabilize the
spine
• Core Stability Exercises
• GaitTraining
• Strengthening and Stretching exercises
• Balance training- Hydrotherapy

22. Low Back Pain
• According to the European Guidelines
for prevention of low back pain, low
back pain is defined as “pain and
discomfort, localized below the costal
margin and above the inferior gluteal
folds, with or without leg pain

23. What causes BACK
PAIN?
• Segmental Instability
• Discogenic

24. Examination
of LOW
BACK PAIN
To look for and rule out such as fracture,
cancer, infection and ankylosing
spondylitis
specific causes of back pain with
neurological deficits (such as
radiculopathy, caudal equina syndrome)
Low back pain could be non specific as
well

26. SCIATICA
• Sciatica is a condition in which the
patient experiences pain and/or
paresthesias and/or weakness in
the distribution of the sciatic
nerve or an associated
lumbosacral nerve root.

27. Cause of SCIATICA
Mainly the injury to the sciatic nerve.
Spinal causes:
• Spinal stenosis (due to degenerative bone disorders, trauma, inflammatory
disease)
• Spondylolisthesis
• Herniated or bulging lumbar intervertebral disc
• Spinal or paraspinal mass (malignancy, epidural hematoma or abscess)

28. Clinical
Presentation
Radicular pain in the distribution of the
lumbosacral nerve root
Sensory impairment/disturbance, such as
hot and cold or tingling/ burning sensations
in the legs or numbness
Muscular weakness
Reflex impairment
Gait dysfunction

29. Physiotherapy Management of Sciatica
• Extension and flexion back exercises.
• Gentle stretching exercises
• Hot packs
• Mobilization or soft tissue technique
• Patient Education