Pelvis Lumbar Spine: Facet Joint Dysfunction, Spondylopathies, and Sacroiliac Joint Dysfunction

Pelvis Lumbar Spine

Facet joint dysfunction—dislocation, subluxation, or degeneration of the facet. Localized pain over the facet, decrease in symptoms with the increase in activity Treatment options—injection (steroid to reduce inflammation), facetectomy (surgical resection of a vertebral facet).

Spondylopathies

Spondylolysis—defect in the pars interarticularis. “collared scotty dog”; localized low back pain that restricts extension. Spondylolisthesis—can be progression of spondylolysis. Separation of vertebra; “decapitated Scotty dog”. S&S: spondylolysis begins unilaterally. Pain and persistent aching, low back stiffness with increased pain after activity, frequent need to change position, full rom w/ some hesitation in regards to flexion, localized tenderness and some possible segmental hypermobility, Step off deformity may be present, spinous process of one vertebra becomes prominent when the vertebra above slips on the one below (L5 on S1) Congenital weakness, more common in boys, sports movements that hyperextend the spine (gymnastics, weight lifting, volleyball, tennis, butterfly stroke).

Sacroiliac Joint Dysfunction/Sprain

—irritation and stretching of sacrotuberous or sacrospinous ligaments and possible anterior or posterior rotation of innominate bones. Athlete twist with both feet on the ground, stumbles forward, steps too far down and lands heavily on one leg or bends forward with knees locked during lifting Downhill running or repetitive unilateral activities like over-rotating a golf swing, dancing, punting, high jumping, hurdling, or gymnastics S&S: Palpable pain and tenderness over the joint, medial to the PSIS with some muscle guarding, Pelvic asymmetries, measurable leg length deformities, blocked normal movement during trunk flexion, Pain after 45 degrees during SLR, Increased pain during side-bending toward painful side, Pain may radiate posteriorly, laterally, or anteriorly down the thigh and maybe even vaguely into the groin, Increased pain with unilateral stance, Movement from sit to stand will create pain.

Coccyx Injuries

—direct impact which may be caused by forcibly sitting down, falling, kicked Common: contusion or fracture. Pain upon palpation, sitting, bearing down.