2. Low Back Neurological Assessment

Question 1

What are examples of somatic tissues that can cause deep scleratogenous referred pain?

Answer 1

Disc
Cartilage
Ligament
Joint capsule
Bone

Question 2

Describe a scleratogenous referred pain field

Answer 2

• spreads out over time (radiates)
• referral territory grows
• may not be contiguous and may skip to more distal region

Question 3

What is the most common type of spine related extremity pain seen in practice?

Answer 3

Scleratogenous referred pain

Question 4

What is the convergence-projection phenomenon?

Answer 4

Neurological pathways from two different areas share a nerve in the spinal cord and conduct to the brain. Pain can then be perceived in both areas even though only one may be experiencing noxious stimuli

Question 5

What is central sensitization?

Answer 5

Pain signals from an injured tissue can activate spinal WDRs making them hyperactive. This can result in spontaneous pain and hyperalgesia to any stimulation

Question 6

What are the 5 clues from the H&P that help distinguish between the the 5 different causes of back and leg pain?

Answer 6

• leg pain (territory/location, quality, severity, affect of spine position)
• leg paresthesia (territory/location)
• lumbar tension tests
• Neuro deficits/abnormalities on SMR testing
• lumbar joint loading procedures

Question 7

What are the 5 possible causes of simultaneous back and leg pain?

Answer 7

• cord lesion (myelopathy)
• nerve root lesion (radiculopathy)
• peripheral nerve lesion (neuropathy)
• deep referred pain
• separate lesions

Question 8

Describe the symptoms associated with radiculopathy.

Answer 8

• may go past knee
• may follow a dermatomal pattern
• more superficial
• often sharp, stabbing, electrical, sharp, painful cold, lancinating
• leg pain often worse than back pain
• sometimes affected by spine position
• SMRs with have defects
• Nerve tension tests will reduce the leg symptoms

Question 9

What is the difference between pain centralization and central sensitization?

Answer 9

Pain centralization is the ability to narrow the field of involved tissues by repetitive loading and does not involve the cord. Central sensitization is a cord miscommunication of where the stimuli is coming from

Question 10

Describe the symptoms associated with myelopathy

Answer 10

-There may not be pain in the leg but if there it is non dermatomal and a burning sensation.
-Back worse than the leg
-paraesthesia will be described as numbness most often
-may have UMNL signs and sensory deficits
- negative nerve tension tests
Spinal loading will be negative

Question 11

Describe the symptoms associated with deep referred pain.

Answer 11

• deep and why pain that is non dermatomal
• back> leg
• position can effect the leg pain
• negative nerve tension tests
• negative spinal loading procedures

Question 12

Describe the peripheral neuropathy symptoms.

Answer 12

• a stocking pattern (follows a peripheral nerve)
• burning/ sharp/electrical quality
• no effected by spinal position
• paresthesia is usually present in the same pattern as the pain
• may have deficients in SMRs in the peripheral nerve
• positive nerve tension test
• negative spinal loading

Question 13

What Dxs result in positive nerve tension tests?

Answer 13

Radicular and peripheral nerve

Question 14

What Dxs result in positive spinal loading tests?

Answer 14

Radicular

Question 15

What Dxs have the leg pain greater than the back pain?

Answer 15

Radicular

Question 16

What Dxs have the back pain greater than the leg pain?

Answer 16

Peripheral, myelopathy, deep referred pain

Question 17

What Dxs have a burning quality?

Answer 17

Myelopathy and peripheral neuropathy

Question 18

What Dxs have a sharp quality?

Answer 18

Radicular or peripheral neuropathy