Lumbar segmental rigidity: Can its identification with facet injections and stretching exercises be useful?

Tom G. Mayer, Richard Robinson, Pauline Pegues, Sean Kohles, Robert J. Gatchel

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objectives: To describe a method for observing lumbar segmental rigidity and to show how motion measurements and pain/disability questionnaires can be used to evaluate outcomes of combined facet injections and stretching exercises. Design: Preliminary 2-part study: (1) presentation of a technique for identifying lumbar segmental rigidity based on physical observation of the spine's lateral bending; and (2) repeated measures of motion and pain/disability self-report in a chronic lumbar spinal disorder cohort, performed before and after treatment with combined facet injections and stretching exercises. Setting: An outpatient tertiary rehabilitation facility providing interdisciplinary functional restoration for chronic disabling work-related spinal disorders. Patients: Chronically disabled patients with lumbar spinal disorder (n = 39; mean age, 41yr; 82% male) with segmental rigidity at 1 or more levels on physical examination. Subjects averaged 20 months of disability, and 51% had preinjection spine surgery (average, 1.7 procedures involving up to 3 spinal segments). Thirty-nine percent of the cohort had a fusion at levels 1 or 2. Interventions: Bilateral facet injections were administered under fluoroscopy to all patients, and 2 or 3 levels were performed in 93% of cases (range, levels 1-4). Patients were instructed in an unsupervised stretching program and were reassessed 2 to 4 weeks later. After an intensive supervised resistance exercise training program as part of interdisciplinary functional restoration, a third set of motion, pain, and disability measures were collected. Main Outcome Measures: Changes in tree lumbar sagittal and coronal motion (T12-S1), measured with inclinometers, and pain/disability self-report were compared statistically. Results: Patients' mobility improved significantly (p <.01-.0001) across all 4 motions. A large majority (71%-97%) of individuals improved on motion. According to self-reports made over the postinjection period, most patients improved their disability (83%) and pain intensity (63%) ratings. Conclusions: A simple physical examination technique for assessing lumbar spine segmental rigidity was used in this preliminary study to select patients and levels for combined facet injection and stretching exercise, with resultant improvements in mobility and self-reported pain/disability that may extend beyond the pharmacologic duration of the corticosteroid. The efficacy of either the facet injection or stretching components alone in achieving objective mobility improvements cannot be determined from the present study, but warrants future investigation. (C) 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

Original languageEnglish (US)
Pages (from-to)1143-1150
Number of pages8
JournalArchives of Physical Medicine and Rehabilitation
Volume81
Issue number9
DOIs
StatePublished - 2000
Externally publishedYes

Fingerprint

Exercise
Injections
Pain
Self Report
Spine
Physical Examination
Resistance Training
Fluoroscopy
Pain Measurement
Adrenal Cortex Hormones
Outpatients
Rehabilitation
Observation
Outcome Assessment (Health Care)
Education
Therapeutics

Keywords

  • Disability
  • Injections
  • Lumbar vertebrae
  • Outcome assessment
  • Pain
  • Range of motion, articular
  • Rehabilitation.

ASJC Scopus subject areas

  • Rehabilitation

Cite this

Lumbar segmental rigidity : Can its identification with facet injections and stretching exercises be useful? / Mayer, Tom G.; Robinson, Richard; Pegues, Pauline; Kohles, Sean; Gatchel, Robert J.

In: Archives of Physical Medicine and Rehabilitation, Vol. 81, No. 9, 2000, p. 1143-1150.

Research output: Contribution to journalArticle

Mayer, Tom G. ; Robinson, Richard ; Pegues, Pauline ; Kohles, Sean ; Gatchel, Robert J. / Lumbar segmental rigidity : Can its identification with facet injections and stretching exercises be useful?. In: Archives of Physical Medicine and Rehabilitation. 2000 ; Vol. 81, No. 9. pp. 1143-1150.
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abstract = "Objectives: To describe a method for observing lumbar segmental rigidity and to show how motion measurements and pain/disability questionnaires can be used to evaluate outcomes of combined facet injections and stretching exercises. Design: Preliminary 2-part study: (1) presentation of a technique for identifying lumbar segmental rigidity based on physical observation of the spine's lateral bending; and (2) repeated measures of motion and pain/disability self-report in a chronic lumbar spinal disorder cohort, performed before and after treatment with combined facet injections and stretching exercises. Setting: An outpatient tertiary rehabilitation facility providing interdisciplinary functional restoration for chronic disabling work-related spinal disorders. Patients: Chronically disabled patients with lumbar spinal disorder (n = 39; mean age, 41yr; 82{\%} male) with segmental rigidity at 1 or more levels on physical examination. Subjects averaged 20 months of disability, and 51{\%} had preinjection spine surgery (average, 1.7 procedures involving up to 3 spinal segments). Thirty-nine percent of the cohort had a fusion at levels 1 or 2. Interventions: Bilateral facet injections were administered under fluoroscopy to all patients, and 2 or 3 levels were performed in 93{\%} of cases (range, levels 1-4). Patients were instructed in an unsupervised stretching program and were reassessed 2 to 4 weeks later. After an intensive supervised resistance exercise training program as part of interdisciplinary functional restoration, a third set of motion, pain, and disability measures were collected. Main Outcome Measures: Changes in tree lumbar sagittal and coronal motion (T12-S1), measured with inclinometers, and pain/disability self-report were compared statistically. Results: Patients' mobility improved significantly (p <.01-.0001) across all 4 motions. A large majority (71{\%}-97{\%}) of individuals improved on motion. According to self-reports made over the postinjection period, most patients improved their disability (83{\%}) and pain intensity (63{\%}) ratings. Conclusions: A simple physical examination technique for assessing lumbar spine segmental rigidity was used in this preliminary study to select patients and levels for combined facet injection and stretching exercise, with resultant improvements in mobility and self-reported pain/disability that may extend beyond the pharmacologic duration of the corticosteroid. The efficacy of either the facet injection or stretching components alone in achieving objective mobility improvements cannot be determined from the present study, but warrants future investigation. (C) 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.",
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AU - Gatchel, Robert J.

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