237. Back Pain Flashcards
Pain Generators of Back Pain
Vertebral Body Intervertebral Disc Zygoapophyseal (Facet) Joints Ligaments Nerves Muscles Sacroiliac Joints (Pelvic area mimics LBP)
Where does greatest back motion occur? What movements increase/decrease canal size and facet load?
Greatest motion L4-L5 and L5-S1 (most common sites of disc herniation, Z-joint damage)
Canal size increases with flexion
Facet load increases with extension
What position has greatest disc pressures?
SITTING WITH POOR POSTURE (worse than standing with poor posture)
Key Sign of Spinal Stenosis
Neurogenic Claudication (leg pain with walking, downhill walking, prolonged standing)
Shopping Cart Sign: relieved with sitting, bending forward, walking uphill (flexion based activity)
Discogenic Pain is worse with flexion or extension?
FLEXION
What does the seated slump test and straight leg raise test for?
Nerve root problems
Seated slump: positive if sx improve by picking up head
Why don’t we do Imaging as often for LBP?
Usually acute
Images do not always coordinate with clinical severity and outcome
When do we consider LBP imaging?
Pain unresponding to tx suspected fracture nerve deficits Suspected infection/cancer considering spinal injection/surgery
Passive tx of LBP
Analgesics; NSAIDs, Opioids etc for acute + chronic
Epidural steroids for acute/subacute radicular pain
Cryotherapy for acute pain
Hot Packs for subacute/chronic pain
Active tx of LBP
P.T.!!! (Activity modification, lumbar stabilization exercises, core/posture strengthening)
LBP DOES NOT IMPROVE WITH BEDREST
McKenzie PT
Restore pain free movement
“centralization of pain” - bring to center
Individualized program
When to refer LBP to surgery?
- Cauda-Equina Syndrome: emergency, saddle distribution of numbness, bilateral leg weakness, incontinence
- Progressive Neurologic Deficit: foot drop/spinal stenosis
- Suspected spinal cord compression
- Failed all non-surgical tx
