Rough examination of spinal joint range of motion does not adequately reflect the complex spinal mechanism. Range of motion studied in the clinical setting represents the sum of segmental movements. The spine has the capacity to bend forward and backward, torsion and bend sideways. The lumbar region consists of 5 vertebrae. For example, in bending forward from the waist, each joint between these vertebrae contributes to the movement to some extent. It is not possible to detect movement limitation in any of these vertebral segments by simply having the patient bend forward. The movement observed in the lumbar spine consists of the total effect of each movement segment from the back to the coccyx and the hip joint. In other words, a problem in the patient's hip joint may cause pain in the waist area. The disc, joints, ligaments and muscles contribute to the strength of the lower back. The harmony of these structures in the waist area allows the most efficient movement. However, the natural aging process, habitual posture changes, physical and psycho-social stress factors can cause changes in these structures.
There are many factors that provide durability in the lumbar spine. These are muscles, ligaments, discs and joints between the vertebrae. They are the muscles that make the most important contribution.
The disc located between the vertebrae performs load-bearing, bending and rotation functions. The disc consists of a soft core in the center and a stronger ring-shaped ligament around it. 70-90% of the core region is water. It contains collagen and proteoglycan. The water content of the core decreases with age. Postures that endanger the disc the most are bending forward, turning, and lifting a load away from the body.
From a functional point of view, the lumbar muscles and abdominal muscles are classified as local or global stabilizers. Local stabilizers help minimize shear forces by controlling waist posture and positional relationships between the lumbar vertebrae. Global stabilizers are generally more superficially located muscles that play a role in controlling gross movements of the trunk and transmitting force from the pelvic area to the back area. Functional distinctions between these groups are important in the treatment of low back pain. In the absence of muscle contraction, the lumbar vertebrae are 2 k It can bend under a load of as little as one kilogram.
Many studies investigating the roles of the waist and abdominal muscles show the dysfunction of these muscles as the most important factor related to low back pain. Strengthening the lumbar spine muscles is the most important step in treatment for patients with low back pain and dysfunction.
I tried to briefly explain the functional anatomy of the lumbar region above. It is very important to know the biomechanical connections when evaluating the patient with low back pain. Because a problem at a distant point may cause pain in the lower back. In other words, it is not necessary for the patient with lower back pain to have a problem originating from the waist area.
For a correct diagnosis, an examination by a specialist physician who can evaluate functional anatomy, biomechanics, biochemistry knowledge, imaging and electrophysiological studies as a whole is indispensable.
Read: 0
