Bony Configuration LUMBAR

Lumbar spine is a single functional unit composed of 5 vertebras forming a motion segment connected in series each motion segment consist of 2 adjacent vertebral bodies and connected by Intervertebral disc, Ligaments and muscles^1,4,6.

Bony Configuration

Vertebra consists of anterior block of bone – The body.

Posterior bony ring consist of Neural arch – containing articular, transverse and spinous processes.

Neural arch consist of two pedicles and two lamina from which arises the seven processes – one spinous processes, Two Transverse processes and four articular facet^.

Adjacent Vertebra is connected together by Intervertebral disc, contributing 20 – 30 % of the spinal length^.

Ligaments

Six Ligaments

Anterior longitudinal Ligament, Posterior longitudinal Ligament, Capsular Ligament, Ligamentum Flavum, Interspinous Ligament, Supraspinous Ligament.

CAUSE OF LOW BACK PAIN

Physical work factor

Heavy manual work

Lifting and twisting

Postural stress – sitting and driving

Whole body vibration

Psychosocial work factors

Societal influences

Monotonous work

Lack of personal control – Tension, Stress, Anxiety, fear and depression.

Low job satisfaction

Physiological factors

Low physical fitness

Inadequate trunk strength

Personal risk factors

Heredity, sex, age, body built, smoking, social class.

Patellofemoral pain syndrome (PFPS)

Patellofemoral pain syndrome (PFPS) is one of the prevalent musculoskeletal injuries seen by physiotherapist and sports medicine practitioners. (Clement et al., 1981). The etiology of PFPS is not clearly understood. It may occur due to variety of factors including lower leg and foot mal alignment. Abnormal position of the Rear foot tends to cause abnormal movement in the associated joints like Knee, Hip, Pelvic & SI joint.

Patellofemoral pain may affect as many as 25 % of athletic population.( Mcconnell. 1986). Patellar problems are common in adolescents and distance athletes (runners, cyclists). (Christopher Hess,2003). Patient usually active and Young complain of retropatellar or peripatellar Pain. It results from physical and biochemical changes in the patellofemoral joint. (Rothbart BA, Estabrook 1998).

Excessive Pronation of the Subtalar Joint leads to Patellofemoral Pain. (Buchbinder 1979).The Excessive subtalar joint Pronation may delay External rotation of leg, and therefore inhibit supination of Foot. (Donatelli, 1987). Excessive Rear foot Pronation leads to Tibial Internal rotation which translates abnormal stress in Knee cause pain in anterior area of knee. (Buchbinder et al., 1979, Donatelli 1987, Kaufman et al., 1999).

Patients with patellofemoral pain syndrome have anterior knee pain that typically occurs with activity and often worsens when they are descending steps or hills. It can also be triggered by prolonged sitting.( Cutbill JW 1997.) It is precipitated by sitting for prolonged periods (Movie – goer sign).One or both knees can be affected. Consensus is lacking regarding the cause and treatment of the syndrome.