Intermediate Lumbar Spine Post-Fracture Rehabilitation

Pain at rest less than 3/10 on VAS with verbal pain descriptors indicating fracture site stability,No neurological deficits on straight leg raise test affecting sciatic nerve tension signs,Ability to maintain neutral lumbar spine positioning during static activities,Modified Schober measurement showing less than 10% reduction in lumbar flexion compared to pre-injury,No pain reproduction with gentle palpation of lumbar vertebral processes and facet-joint lines,Tolerance to prone lying position for 10 minutes without increased symptoms

→ Advance to: Early Mobilization Phase

Independent transfers supine to sit maintaining neutral lumbar spine alignment,Straight leg raise to 45 degrees without radicular symptoms affecting nerve root mobility,Ability to activate lumbar multifidus and transversus abdominis on cue with ultrasound biofeedback,Sacroiliac joint pain less than 2/10 with FABER test positions,Lumbar extension tolerance to 10 degrees without facet-joint pain provocation,Completion of 10 repetitions of pelvic tilts in hook-lying without increased morning stiffness

→ Advance to: Intermediate Mobilization Phase

Straight leg raise to 60 degrees negative for nerve root irritation signs,Lumbar lateral flexion within 15 degrees of contralateral side symmetry,Patient demonstrates independent lumbar spine stabilization during functional tasks,Erector spinae and quadratus lumborum flexibility allowing symmetric spinal curves,Sacroiliac joint dysfunction absent on posterior pelvic tilt provocation test,Tolerance to seated activities for 30 minutes without orthostatic intervention

→ Advance to: Strengthening Phase

Lumbar flexion range 40 degrees measured with modified Schober technique,No reproduction of discogenic pain with lumbar flexion in hook-lying position,Isometric hold time of 10 seconds for lumbar extensors against gravity,Active lumbar rotation within tolerance of facet-joint loading guidelines,Patient reports less than 2/10 pain with activities of daily living involving lumbar loading,Demonstrates proper hip hinge mechanics to minimize lumbar spine flexion moments

→ Advance to: Advanced Strengthening Phase

Lumbar extension range 20 degrees without facet-joint symptom reproduction,Straight leg raise negative at 70 degrees for sciatic nerve sliding mechanics,Patient achieves 15 repetitions of bird-dog exercise maintaining neutral lumbar spine,Sacroiliac joint stability demonstrated during single-leg stance tasks,Lumbar proprioception adequate for eyes-closed single-leg balance lasting 10 seconds,Tolerance to functional simulation of work activities requiring 20 minutes standing

→ Advance to: Power and Endurance Phase

Lumbar flexion to touch fingers to tibial plateau maintaining smooth curve,Isokinetic lumbar extension endurance ratio within 20% of flexion endurance,Patient demonstrates anticipatory trunk muscle activation during rapid arm movements,No sacroiliac joint asymmetry on standing flexion test,Disc height maintained on periodic imaging with no progression ofmodic changes,Tolerance to low-demand lifting tasks under 10 pounds with proper mechanics

→ Advance to: Functional Integration Phase

Lumbar lateral flexion equal bilaterally within 5 degrees symmetry,Patient completes 5 repetitions of dead-bug exercise without lumbar hyperextension compensation,Full return to sedentary work duties with ergonomic lumbar support,Sacroiliac joint load tolerance during stair negotiation without compensatory trunk listing,Nerve root mobility sufficient for slump sit test negative,Erector spinae and abdominal muscle endurance plank hold 30 seconds each side

→ Advance to: Return to Activity Phase

Lumbar range of motion within 80% of age-matched norms in all planes,Patient tolerates 45-minute continuous activity without flare-up,No radicular symptoms with Valsalva maneuver or sustained lumbar loading,Sacroiliac joint functional stability during gait analysis,Demonstrates proper lifting mechanics for loads up to 25 pounds with lumbar stabilization,Pain catastrophizing scores reduced to less than 20 on PCS scale

→ Advance to: Advanced Functional Training

Lumbar spine demonstrates dynamic stability during perturbation-based balance tasks,Patient completes job-specific tasks requiring prolonged lumbar loading,No recurrence of fracture site pain with resisted lumbar extension in prone,Sacroiliac joint coupling mechanics normal during gait and rotational movements,Nerve root slider capacity adequate for functional nerve mobilization,Patient reports return to 70% of pre-injury recreational activity level

→ Advance to: Sport-Specific or High-Demand Conditioning

Lumbar flexion-extension coupling ratio within normal limits on functional assessment,Patient demonstrates power generation from hip hinge without excessive lumbar stress,Tolerance to high-velocity rotational movements without facet-joint impingement symptoms,Sacroiliac joint efficient force transfer during double-leg to single-leg transitions,Core endurance indices exceeding baseline pre-injury measurements,No night pain or morning stiffness greater than 15 minutes duration

→ Advance to: Return to Full Activity

Patient achieves full return to pre-injury functional capacity without restrictions,Lumbar spine demonstrates normal segmental mobility without hypermobility signs,Outcome measures at or near minimal clinically important difference thresholds,Sacroiliac joint stability confirmed with long-leg lever test negative,No neurological sequelae on comprehensive nerve root examination,Patient demonstrates confidence in lumbar spine loading during sport or occupational demands

→ Advance to: Discharge