1) Lumbar Muscle Sprain – backache, worsen with spinal movements, worsen with maintained postures like prolonged sitting or squatting, may be preceded by an initiating trauma like lifting a heavy weight, unusual physical activities, Tx – Investigations determined by the presence of red flags, plain radiography only for fever, weight loss, past cancer, neurological deficits, drug abuse, elderly and trauma in the absence of improvement within 4-6 weeks, CT and MRI for detection of early infections and cancer, analgesics for pain, usually continuously rather than PRN basis, day to day activities within the limits of spinal pain, rapid return to normal activities, avoid exercises and physical therapy in acute phase, exercise program for chronic backache starts with stretching exercises, then strengthening exercises, finally stabilization exercises. Stretching exercises are done for hip flexors, hamstring, hip internal and external rotators, lumbar extensors, leg lifts, trunk lifts, sit-ups, and lateral pull-downs. Strengthening exercises are done for abdominal and gluteal muscles, and pelvic tilts. Stabilization exercises are carried out by bridging exercises. Abdominal muscles are strengthened by vertical leg crunch, long arm crunch, and reverse crunch.
2) Lumbosacral Facet Syndrome – backache spreading to the buttocks and the posterior thigh, worsened by twisting, stretching, lateral bending, rest, and hyperextension, relieved by repeated motions, painful spinal movements, lumbar extension, and rotation painful.
3) Herniated Disc – Tx - Exercises therapy includes neural mobilization exercises, cat and camel exercises and nerve flossing exercises, progressive leg weakness is an indication of spinal surgery (for instance toe weakness of 1 day becoming a foot drops in a few days’ time surgery is indicated)
4) Myofascial pain syndrome - buttock pain posterior as in gluteus maximus MFPS, buttock pain posterior spreading to upper posterior thigh in gluteus medius MFPS, buttock pain spreading up the lumbar region in iliocostalis lumborum and longissimus thoracis MFPS, flank pain spreading to the posterior chest wall, down to iliac crest in iliocostalis thoracis MFPS, backache lumbar paraspinal area and anterior thigh pain upper 1/3rd in iliopsoas MFPS, sacral area pain, midline in multifidi and rotators MFPS, backache upper lumbar and low lumbar regions in multifidi MFPS, buttock pain spreading down to the posterior thigh in piriformis buttock and lateral hip pain in quadratus lumborum MFPS, buttock pain, sacral pain spreading to posterior thigh in quadratus lumborum, glut maximus, levator ani and piriformis MFPS, area just below iliac crest in rectus abdominis lower end MFPS, upper buttock pain in soleus MFPS, sacral area pain spreading to the posterior thigh in sphnicter ani, levator ani, coccygeus, obturator internus ( SALACO complex) MFPS. See notes under myofascial pain syndrome for diagnosis and treatment of myofascial pain syndrome.
5) Spinal Stenosis – unilateral or bilateral leg pain with/without backache, Tx - Exercise therapy includes neural mobilization exercises, cat and camel exercises, and nerve flossing exercises.
6) Osteoporotic compression fractures
7) Spondylolisthesis
8) Traumatic fractures
9) Diskogenic low back pain
10) Postural back pain – back pain with following postural defects at the spine – frontal view shoulders slanted, space between arms and sides unequal, hips slanted, knee caps face sideways, side view head thrust forward, chin tilted up/down, shoulder not aligned with ears, low back hyperlordosis, Tx – Correct the factors maintaining the poor posture – obesity, weak muscles, high heeled shoes, tight muscles, decreased flexibility of the spine, poor work environment, poor sitting habits, poor standing habits, proper posture requires the strong set of posture muscles namely abdominal muscles, hip flexors, hip extensors, lateral trunk muscles, hip abductors, therefore exercise these muscles regularly,
11) Fibromyalgia
12) Ischial bursitis - Buttock pain radiating down the posterior thigh, mimicking sciatica, prolonged sitting on hard surfaces, point tenderness over the ischial tuberosity
13) Piriformis syndrome – unilateral pain in the hip region and low buttock spreading widely and down the sciatic distribution as well, and also to the external genitals, pain worsens with walking and squatting, bowel movement, sex, prolonged sitting, tenderness over the gluteal region, pain reproduction with flexion, adduction and internal rotation of the hip of the affected side, Lasegue sign positive (greater sciatic notch pain with extension of the knee when the hip I flexed to 90*), resisted abduction and external rotation of the thigh painful, passive internal rotation of the thigh when the leg is extended and the patient is supine – Mx – NSAIDs and piriformis exercises (See notes).