Evaluation and Treatment of Vertebral Motion Segment Dysfunction

Impaired or altered function of related components of the somatic (body framework) system; skeletal, arthrodial, and myofascial structures; and related vascular, lymphatic, and neural elements is termed somatic dysfunction (International Classification of Diseases – Hospital Adaptation, ed. 2, 1973).
Somatic dysfunction can be produced by trauma or acquired as a compensation for dysfunction elsewhere in the system.

Vertebral somatic dysfunction is identified through assessment of motion quantity/quality and tissue texture at the involved vertebral segment. The quantity of motion at the dysfunctional segment can be reduced (hypomobility) or increased (hypermobility) in relation to motion at a normal vertebral segment. The end-feel during motion testing provides qualitative insight into the nature of the barrier that limits motion. Another qualitative measure of vertebral motion is its symmetry. Asymmetrical motion of the component parts of the vertebral segment, when symmetrical motion is expected, is a sign of dysfunction. Tissue texture abnormalities also signify altered function at a segment. Of particular interest is the palpable presence of hypertonus in intersegmental muscles such as multifidus. Patterns of pain referral and altered neurological function also suggest that a vertebral segment is dysfunctional.

Normalizing function involves restoring motion and enhancing neuromuscular control at the involved vertebral segment. The restoration of motion is the goal of manual therapy techniques used in the treatment of spinal dysfunction. There are many hypothesized causes of vertebral somatic dysfunction and specific manual therapy techniques have been developed to address each hypothesis. The focus of this section is to explore the concepts behind the use of muscle energy techniques in the evaluation and treatment of vertebral somatic dysfunction and lumbar spine pain.