The recognition of mechanically induced pelvic pain and organic dysfunction in the low back pain patient.

Mechanical disorders of the lumbar spine have been identified as a cause of pelvic pain and organic dysfunction (PPOD). Categorically, the clinical features indicative of mechanically induced PPOD fall into three areas: the history of the development or onset of pelvic symptomatology attributable to lower sacral nerve root compression (LSNRC), identification of related symptomatology on presentation, and the recognition of clinical findings indicative of mechanically induced PPOD on examination. Characteristic features of each category are presented. The clinical signs that most reliably indicate the presence of PPOD secondary to a mechanical lesion of the low back are of a sensory nature, and the disappearance or lack of improvement of these signs closely parallels the patient's overall response to manipulative treatment. Without a thorough understanding of the salient features of mechanically induced PPOD, the practitioner is likely to overlook this as a diagnostic possibility. As a result, efforts to document chiropractic spinal manipulative therapy in relieving disorders of pelvic organic function may be hampered. The empirical efficacy of chiropractic spinal manipulative therapy for treating disorders of pelvic organic function would be enhanced if more chiropractors were apprised of the salient features indicating the presence of mechanically induced PPOD.