title: Lumbar segmental rigidity: can its identification with facet injections and stretching exercises be useful?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  An outpatient tertiary rehabilitation facility providing interdisciplinary functional restoration for chronic disabling work-related spinal disorders.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Changes in true 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.
authors.affiliation: Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, USA.
authors.forename: T G
authors.initials: TG
authors.lastname: Mayer
authors.forename: R
authors.initials: R
authors.lastname: Robinson
authors.forename: P
authors.initials: P
authors.lastname: Pegues
authors.forename: S
authors.initials: S
authors.lastname: Kohles
authors.forename: R J
authors.initials: RJ
authors.lastname: Gatchel
mesh_terms: D000328:Adult; D000465:Algorithms; D000704:Analysis of Variance; D002908:Chronic Disease; D015331:Cohort Studies; D004185:Disability Evaluation; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007267:Injections; D008159:Lumbar Vertebrae; D008297:Male; D009127:Muscle Rigidity / Q000175:diagnosis / Q000534:rehabilitation*; D010147:Pain Measurement; D016059:Range of Motion, Articular; D013124:Spinal Injuries / Q000175:diagnosis / Q000534:rehabilitation*