Position 3

name text

Origin

Insertion

Major Action

Spinal level

Referral

What is a Facet Joint Sprain?

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Hip Labral Tear

What is a Labral Tear?

The hip joint socket is lined with a fibrocartilage rim called the labrum. The function of the labrum is to deepen and cushion the hip joint to prevent the thigh bone (femur) from dislocating. A labral tear usually results from trauma or overuse of the hip joint.

Symptoms – Often labral tears of the hip are asymptomatic (without symptom).

  • Generalised pain deep in the front of the hip and/or groin
  • Reduced range of motion and fluidity of the hip
  • ‘Pinching/catching’ sensation when the hip is flexed (knee is lifted to the chest)

Causes –

  • Repetitive stress of the hip joint, particularly in sports which require twisting and pivoting movements on a weight bearing leg i.e. netball, aerobics, soccer
  • Secondary to a another condition i.e. arthritis
  • Forceful direct impact to the hip or leg i.e. fall

Ilippsoas Tendonitis/Bersitis

What is Iliopsoas Tendonitis?

Tendonitis is a medical term used to describe inflammation of a tendon.

The iliopsoas is a strong muscle group which flexes the hip.

The tendon of the iliopsoas can become inflamed from repetitive overuse or trauma to the hip.

Directly underneath the iliopsoas is a bursa, which reduces frictional forces between the iliopsoas muscle and underlying bone.

Iliopsoas bursitis usually occurs simultaneously with iliopsoas tendonitis.

Symptoms –

  • Pain when the hip is flexed (knee is lifted to the chest)
  • Swelling in and around the groin
  • Reduced range of movement at the hip, particularly hip flexion

Causes –

  • Repetitive overuse, particularly in athletes who participate in kicking sports
  • Forceful direct impact to the anterior (front) hip

Lumbar Strain

What is a Lumbar Strain?

A lower back strains occurs when the muscles in the lower back are torn or stretched beyond their normal range.

Tearing and stretching of the muscle often results from a sudden muscle exertion or through heavy lifting.

A lower back sprain refers to the tearing of the ligaments (bands of tissue) which connect the vertebrae in the spine.

The ligaments of the spine can become torn through extreme twisting or forceful stretching.

Prevalence – Muscle strains and sprains of the lower back are the second most common complaint to health care professionals.

Symptoms –

  • Pain generalized in the back
  • Muscle spasms or cramping can occur
  • Swelling can be present
  • Reduction in flexibility and range of movement of the spine

Causes –

  • Biomechanical errors in lifting and poor posture (carrying the load away from the body, or twisting and bending whilst carrying a load)
  • Repetitive overuse of the lower back muscles
  • Obesity
  • Smoking

Osteitis Pubis

What is Osteitis Pubis?

Osteitis Pubis is painful overuse condition of the groin in which the pubic symphysis becomes inflamed.

The pubic symphysis is a cartilage joint, reinforced with strong ligaments connecting the two ends of the public bone together, allowing only limited movement.

Osteitis Pubis occurs when this junction ‘loosens’ causing the pelvis to become unstable, usually as a result of repeated trauma to this area.

Prevalence – Osteitis Pubis is a common condition seen in footballers and distance runners[i].

Symptoms –

  • Pain radiating from the groin and lower abdomen and down the inside of each thigh
  • Exacerbation of pain following activity, especially during sit-ups, squats and running
  • Localised tenderness of the pubic symphysis
  • Pain with weight bearing in severe cases
  • Gradual worsening of symptoms

Causes –

  • Repetitive overuse i.e. running and jumping
  • Limited internal rotation of the hip joint
  • Training errors
  • Dramatic differences in leg length

[i] Smith, M.V. (2001). Groin injuries in athletes. American Family Physician, 64, 83-84.

Osteoarthritis

What is Osteoarthritis?

Osteoarthritis (OA) is a degenerative arthritis that causes the breakdown of articular cartilage of joints. Articular cartilage is a low friction surface which allows fluid motion between the two bones of a joint and has a primary function to absorb and distribute load.

The loss of articular cartilage causes friction between the bones, making movement difficult and painful.

Prevalence – OA is the most common type of arthritis and is most frequently seen in individuals over 60 years of age.

Symptoms –

  • Discomfort and pain in the joint with activity, often relieved with rest
  • Stiffness and reduced mobility of the joint, particularly after prolonged rest
  • Swelling and redness around the joint

Causes –

  • Cumulative wear and tear of joint surfaces
  • Genetic predisposition which affects cartilage formation or joint structure[i]
  • Obesity
  • Secondary to another condition or disease

[i] Martini, F.H, Ober, C.W., Welch, K., & Hutchings, R.T. (2001). Fundamentals of Anatomy and Physiology (5th ed.). Prentice Hall: New Jersey.

Piriformis Syndrome

What is Piriformis Syndrome

Piriformis syndrome is a condition in which the piriformis muscle irritates or compresses the sciatic nerve.

The piriformis muscle lies deep within the gluteal muscles (buttocks). It originates from the base of the spine and inserts onto the top of the femur (thigh bone).

The sciatic nerve runs beneath the piriformis muscle, and in some cases through it.

Piriformis syndrome is a consequence of the piriformis muscle becoming tight or inflammed and compressing the sciatic nerve.

Prevalence – Piriformis syndrome is a common cause of low back pain and sciatica (leg pain).

Symptoms –

  • Pain, tingling or numbness deep within the buttocks
  • Pain and tingling can radiate into the lower back and down the back of the thighs
  • Exacerbation of pain when sitting, squatting or walking up-hill/stairs

Causes –

  • Anatomical variation where the sciatic nerve passes through the piriformis muscle
  • Overuse strain of the piriformis muscle
  • Muscular imbalance i.e. weak gluteal muscle
  • Overpronation (rolling inwards) of the foot

Protruded/Herniated Disc

What is a Herniated Disc?

Each vertebrae of the spine is separated and cushioned by a circular, cartilaginous intervertebral disc. Intervertebral discs are made up of an annulus fibrosus (tough, fibrous outer layer) which surrounds the nucleus pulposus (elastic, soft jellylike core) 1. These discs provide flexibility, absorb shock and cushion movements of the body between the vertebrae. A disc protrusion/herniation occurs when the disc is compressed beyond its limits causing the nucleus pulposus to break through a weakened part of the annulus fibrosis and protrude into the spinal canal or vertebral foramen (exit points). The spinal canal is the tunnel, formed by the vertebrae, which encases the spinal cord. The protrusion of the annulus fibrosus is usually unilateral (on one side) into the vertebral foramen.

Prevalence – Disc herniation is most commonly seen in older men, who participate in strenuous physical activity. Whilst a herniated disc can occur in any intervertebral disc along the spine, it occurs more frequently in the lumbar region (lower back)[i].

Symptoms –

  • Exacerbation of pain when coughing or sneezing
  • Progressively worsening pain throughout the day

Lower back Herniated Disc

  • Sciatica (radiating pain from the lower back into the buttocks and sometimes down into the leg and feet)

Upper back Herniated Disc

  • Radiating pain from the upper back into the shoulders and upper arms
  • Exacerbation of neck pain when bending or turning the head

Causes

  • Biomechanical errors in lifting and poor posture (carrying the load away from the body, or twisting and bending whilst carrying with or without load)
  • Trauma to the spine i.e. fall
  • Obesity
  • Disc degeneration associated with aging
  • Congenital spinal abnormality

1] Martini, F.H. (2001). Fundamentals of anatomy & physiology. (5th ed.). Upper Saddle River, N.J: Prentice Hall
[i]
Galeotti, S. (2005). Disc Herniation. In Gale Encyclopedia of Neurological Disorders. The Gale Group Inc: Detroit.

Sacroiliac Joint Sprain

What is a Sacroiliac Joint Sprain?

The sacroiliac joint is a strong, tight articulation between the pelvis and the sacrum (base of the spine). This junction allows only limited movement, but is vital for transferring forces between the upper and lower body. Inflammation to the sacroiliac joint can occur if the joint becomes locked (immobile) or unstable (hypermobile).


Symptoms –

  • Pain in the lower back, can be either side or both sides
  • Pain can radiate into the buttocks, groin and thighs
  • Exacerbation of pain when bending forward from the lower back (i.e. tying shoelaces) or with prolonged periods of sitting and standing

Causes –

  • Ligament laxity of the pelvis due to the release of the hormone relaxin during pregnancy, or hypermobility syndrome
  • Secondary symptom to a disease i.e. arthritis
  • Forceful contraction of the hamstrings or abdominals which exceeds the strength of the sacroiliac joint[i]
  • Shear force injuries to the sacroiliac joint i.e. a fall onto the buttocks or a jolt through the lower limb

[i] Peterson, L., & Renstrom. P. (2001). Sports Injuries: Their prevention and treatment (3rded.). London: Martin Dunitz

Sciatica

What is Sciatica?

Nerves are the communication pathways of the body, carrying messages from the brain to the body and information from the body back to the brain.

Sciatica is a medical term used to describe symptoms caused by the compression or pinching of the sciatic nerve.

The sciatic nerve runs from each side of the pelvis through the hip into the buttocks and down the back of the leg.

The compression of the sciatic nerve is generally at the nerve root where it exits the spine.

Symptoms –

  • Shooting or dull pain from the buttocks radiating into the legs
  • Exacerbation of pain when sitting for long periods of time
  • Weakness, tingling or numbness radiating from the buttocks into the legs
  • Exacerbation of pain by minor movements i.e. bending over

Causes –

  • Piriformis syndrome
  • Active trigger points of the muscles of the lumbar spine and buttock
  • Disc herniation/protrusion
  • Osteophytes (bony arthritic growths)
  • Spinal stenosis
  • Spondylolisthesis
  • Tumor
  • Infection

Spinal Canal Stenosis

What is Spinal Canal Stenosis

Spinal Stenosis is a neurological condition which narrows the spaces within the spinal canal and foramen producing lower back pain. The spinal canal is the tunnel, formed by the vertebrae, which encases the spinal cord.

If something causes the narrowing of this canal, or the vertebral foramen (exit points) where the nerves leave then spine, then the nerves can become irritated and compressed.

Sufferers of spinal cord stenosis often adopt a hunched posture, because flexion (bending forward) of the lower back helps reduce symptoms.

Prevalence – It has been estimated that 75% of spinal stenosis cases are located in the lumbar spine (lower back) and the other 25% affect the cervical spine (neck).[i]

Symptoms –

Lumbar spinal stenosis

  • Pain in the lower back
  • Sciatic symptoms (shooting pain from the buttocks down the leg)
  • Pain, cramping and/or tingling radiating from the lower back into the buttocks and sometimes down the legs
  • Exacerbation of the pain when standing
  • Decrease in endurance
  • Feelings of heaviness in the legs

Cervical spinal stenosis

  • Pain radiating into the neck, shoulders and arms
  • Numbness, cramping and/or tingling radiating into the arms

Causes –

  • Congenital abnormality
  • Herniated or prolapsed disc (disc bulge)
  • Tumor
  • Trauma to the spine i.e. motor vehicle accident
  • Degeneration associated with aging or from disease (arthritis)
  • Obesity

[i] Hsiang, J. (2007). Spinal stenosis [website]. Retrieved on the 14 January, 2008 from www.emidicine.com

Nerve Root Compression

Nerve Root Compression

Spinal Stenosis is a neurological condition which narrows the spaces within the spinal canal and foramen producing lower back pain. The spinal canal is the tunnel, formed by the vertebrae, which encases the spinal cord.

If something causes the narrowing of this canal, or the vertebral foramen (exit points) where the nerves leave then spine, then the nerves can become irritated and compressed.

Sufferers of spinal cord stenosis often adopt a hunched posture, because flexion (bending forward) of the lower back helps reduce symptoms.

Prevalence – It has been estimated that 75% of spinal stenosis cases are located in the lumbar spine (lower back) and the other 25% affect the cervical spine (neck).[i]

Symptoms –

Lumbar spinal stenosis

  • Pain in the lower back
  • Sciatic symptoms (shooting pain from the buttocks down the leg)
  • Pain, cramping and/or tingling radiating from the lower back into the buttocks and sometimes down the legs
  • Exacerbation of the pain when standing
  • Decrease in endurance
  • Feelings of heaviness in the legs

Cervical spinal stenosis

  • Pain radiating into the neck, shoulders and arms
  • Numbness, cramping and/or tingling radiating into the arms

Causes –

  • Congenital abnormality
  • Herniated or prolapsed disc (disc bulge)
  • Tumor
  • Trauma to the spine i.e. motor vehicle accident
  • Degeneration associated with aging or from disease (arthritis)
  • Obesity

[i] Hsiang, J. (2007). Spinal stenosis [website]. Retrieved on the 14 January, 2008 from www.emidicine.com

Spondyloysis

What is Spondyloysis

Spondyloysis is a common overuse injury in sport which causes a stress fracture to the pars interarticularis of the spine. The pars interarticularis is the section of the bone which connects superior and inferior articular facet joints of each vertebrae.

The pars interarticularis is the weakest section of the vertebrae, and if it is repetitively overloaded, a stress fracture may occur – spondyloysis. Whilst spondyloysis can occur to any vertebra, the majority of cases occur at the bottom lumbar vertebrae. Spondyloysis can occur on one side of the vertebra (unilateral) or to both sides (bilateral).

If spondyloysis occurs to both sides of the vertebra, it can slip forward, causing spondylolisthesis. In severe cases, this forward slip can compress the spinal cord, leading to the development of spinal canal stenosis.

Prevalence –  Spondyloysis is estimated to occur in 3-6% of the population[i]. Although, spondyloysis can affect people of all ages, it is most frequently seen in athletes and children between the ages of 9-14 while the spine is still developing6.

Symptoms – Symptoms vary according to the severity of the condition.

  • Pain in the lower back which may radiate into the legs, however in some cases there is no pain or discomfort
  • Exacerbation of pain when leaning backwards (extension of the spine)[ii]
  • Reduction in the flexibility of the spine
  • Prominent buttocks (swayed back)

Causes –

  • Participation in sports which involve repetitive loading movements of the spineck i.e weight-lifting, gymnastics, ballet, cricket etc.
  • Acute trauma to the spine
  • Congenital abnormality of the pars interarticularis

i] Standaert CJ, Herring SA (2000). Spondylolysis: a critical review. British journal of sports medicine,34, 415-22.
[ii] Fritsch, E.W. (2003). Spondylolistersis. Der Orthopade, 32, 340-361.

Spondylolisthesis

What is Spondylolisthesis?

Spondyloysis is a common overuse injury in sport which causes a stress fracture to the pars interarticularis of the spine. The pars interarticularis is the section of the bone which connects superior and inferior articular facet joints of each vertebrae.

The pars interarticularis is the weakest section of the vertebrae, and if it is repetitively overloaded, a stress fracture may occur – spondyloysis. Whilst spondyloysis can occur to any vertebra, the majority of cases occur at the bottom lumbar vertebrae. Spondyloysis can occur on one side of the vertebra (unilateral) or to both sides (bilateral).

If spondyloysis occurs to both sides of the vertebra, it can slip forward, causing spondylolisthesis. In severe cases, this forward slip can compress the spinal cord, leading to the development of spinal canal stenosis.

Prevalence –  Spondyloysis is estimated to occur in 3-6% of the population[i]. Although, spondyloysis can affect people of all ages, it is most frequently seen in athletes and children between the ages of 9-14 while the spine is still developing6.

Symptoms – Symptoms vary according to the severity of the condition.

  • Pain in the lower back which may radiate into the legs, however in some cases there is no pain or discomfort
  • Exacerbation of pain when leaning backwards (extension of the spine)[ii]
  • Reduction in the flexibility of the spine
  • Prominent buttocks (swayed back)

Causes –

  • Participation in sports which involve repetitive loading movements of the spineck i.e weight-lifting, gymnastics, ballet, cricket etc.
  • Acute trauma to the spine
  • Congenital abnormality of the pars interarticularis

i] Standaert CJ, Herring SA (2000). Spondylolysis: a critical review. British journal of sports medicine,34, 415-22.
[ii] Fritsch, E.W. (2003). Spondylolistersis. Der Orthopade, 32, 340-361.

Sway Back (Hyperlordosis)

What is Hyperlordosis?

Lordosis is a medical term used to describe an exaggerated inwards curvature of the lumbar (lower) spine.

A profile view of a healthy spine shows four spinal curves. The cervical (neck) and lumbar (lower back) portions of the spine are lordotic (curve inwards). The thoracic (mid) and sacral (buttocks) portions of the spine are kyphotic (curve outwards).

These natural curves are necessary for the back to function properly[i]. The curves function to absorb shock and assist in distributing mechanical stress as the body moves.

Symptoms – The intensity of the symptoms is dependent on the extent of curvature.

  • Dull pain and discomfort in the lower back
  • Prominent buttocks
  • Lower back curves inwards more than usual

Causes –

  • Muscular imbalance due to tight trunk extensors and hip flexors
  • Poor core stability
  • Pregnancy
  • Congenital spinal abnormality i.e. hypermobility
  • Obesity
  • Secondary symptom to another condition i.e. spinal spondylolisthesis and osteoarthritis

i] Martini, F.H. (2001). Fundamentals of anatomy & physiology. (5th ed.). Upper Saddle River, N.J: Prentice Hall

Trochenteric Bursitis

What is Trochenteric Bursitis?

Bursae are fluid filled sacs found throughout the body designed to cushion, lubricate and protect bones from working muscles.

Trochanteric bursitis occurs when the bursa overlying the greater trochanter of the lateral hip becomes irritated and inflamed from repetitive overuse or direct trauma.

Trochanteric bursitis is the most common bursitis occurring in the hip.

Prevalence – Bursitis is the most common cause of hip pain in the general population.

Symptoms –

  • Diffuse pain and swelling to the outside of the hip
  • Localised tenderness of the greater trochanter
  • Radiating pain into the thigh in severe cases
  • Exacerbation of pain when running or walking upstairs

Causes –

  • Excessive pronation (rolling in) of the foot
  • Secondary to a another condition i.e. arthritis, scoliosis
  • Forceful direct impact to the lateral hip i.e. fall
  • Repetitive overuse, particularly runners
  • Dramatic differences in leg lengths
  • Muscle imbalances and poor lumbo-pelvic stability