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Pain Generators of the Lumbar Spine
Author(s) -
Sizer Phillip S.,
Phelps Valerie,
Matthijs Omer
Publication year - 2001
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/j.1533-2500.2001.01027.x
Subject(s) - medicine , provocation test , zygapophyseal joint , lumbar , low back pain , sciatica , pathophysiology , back pain , nerve root , synovitis , lumbar nerve , differential diagnosis , physical medicine and rehabilitation , physical therapy , anatomy , lumbar vertebrae , pathology , arthritis , alternative medicine , immunology
Different anatomical structures and pathophysiological functions can be responsible for lumbar pain, each producing a distinctive clinical profile. Pain can arise from the intervertebral disc, either acutely as a primary disc related disorder, or as result of the degradation associated with chronic internal disc disruption. In either case, greatest pain provocation will be associated with movements and functions in the sagittal plane. Lumbar pain can also arise from afflictions within the zygapophyseal joint mechanism, as result of synovitis or chondropathy. Either of these conditions will produce the greatest pain provocation during three‐dimensional movements, due to maximal stress to either the synovium or joint cartilage. Finally, patients can experience different symptoms associated with irritation to the dural sleeve, dorsal root ganglion, or chemically irritated lumbar nerve root. Differential diagnosis of these conditions requires a thorough examination and provides information that can assist the clinician in selecting appropriate management strategies.