Pain can arise from stretching the anterior and posterior longitudinal ligaments.

Table 26.3 Associated motor, sensory, and reflex changes with lumbar nerve root compression.

Reflex (decreased

Nerve root

or absent)

Motor affected




Dorsiflexion (difficulty with heel walking)

Lateral thigh, medial aspect of ankle, ankle, big




Dorsiflexion (ankle, big toe)

Over sacroiliac joint, lateral thigh and leg, dorsum

of foot



Plantar flexion (difficulty walking on toes)

Over sacroiliac joint, posterior thigh and leg, heel

lateral foot

Table 26.4 "Red Flags" in medical history may be associated with serious causes of back pain.

• Cauda equina: loss of bowel or bladder control (incontinence, retention)

• Progressive neurological deficit(s)

• History of neoplasia

• Unexplained weight loss

• Severe unrelenting pain

• Intravenous drug abuse

• History of recent trauma

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