Despite these well-known biomechanical changes, it is still unclear whether altered motion at the SIJ is the source of pain.
This dysfunction commonly originates through asymmetric force transmission, as well as degenerative changes. SIJ dysfunction occurs when there is an alteration of the structural or positional relationship of the sacrum on the ilium. The pelvis also adapts to injuries of the spine and the lower extremities, which may lead to maladaptive syndromes. High forces and repetitive loads can lead to ligamentous, muscle, and bone injuries or overuse syndromes. The joints of the pelvis are intrinsically stable, and proper functioning is essential for normal biomechanics about the pelvis. The examiner must also keep in mind the importance of the sacroiliac joint (SIJ) and the hip joint within the differential diagnosis of LBP the description of hip joint pain and examination is addressed in Chapter 8. Pain-relieving and pain-exacerbating activities should be identified through history because they may provide clues toward potential mechanical relief of the back pain with physical therapy and/or increased general physical activity.
#Levels of the spine skin
History collection should include traumatic events, personal and family histories of cancer diagnoses, rheumatologic disorders, bowel inflammatory disorders, and skin disorders, and the review of systems should be sensitive enough to identify potential systemic symptoms. Nonspecific or incorrect diagnoses can lead to ineffective treatment plans that prolong morbidity and result in suboptimal utilization of community health resources. Because of the multifactorial nature of the complaint of low back pain (LBP), patients presenting with LBP necessitate a detailed history and physical examination.
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