Back Flashcards
how is the spine a shock absorber along with the legs?
This occurs because the spine is flexible, and is supported by strong muscles and tendons
What happens if the spine is no longer able to absorb shocks?
we lose the ability to protect ourselves from abnormal shocks and vibrations (ankylosing spondylitis)
what are the 3 main curves in the spin?
Cervical lordosis
Thoracic kyphosis
Lumbar lordosis
what does kyphosis mean?
excessive outward curvature
what does lordosis mean?
excessive inward curvature
what part of the spine is most flexible and why?
Cervical spine is the most mobile part of the spine, due to having relatively thick discs in comparison to the size of the adjacent vertebrae
what part of the spine is least flexible and why?
Thoracic spine is the least mobile, partly due to the ribs inhibiting movement
what part of the spine is mainly shock absorbers?
the interverebral discs
at what time of day is the discs most stiff?
They are most stiff in the morning. They are swollen with water so the annulus and intervertebral ligaments resist bending strongly and are more vulnerable to injury
How does the disc become more flexible but what potential problem can this cause?
As the day progresses, discs lose up to 20% of their water and height so the spine is more supple but low back pain can increase during the day and with standing
what happens to the spine especially the intervetebral discs with increae age?
Discs lose water and lose strength and become thinner
Vertebral endplates and underlying bone structure loses strength
Repetitive loading/trauma can result in annular tears in the discs
Dryer, weaker discs result in slacker ligaments
Spine is less stable
New bone grows (osteophytes) to try to stabilise the spine
Increased load over the facet joints
what is the problem with osteophytes?
they usually grow in areas they should not
what are osteophytes?
they are new bone for compensation to the spine. To help with the added pressure in certain parts of the vertebral column
what is clinical importane does this have on the vertebral column for elderly people?
Loss of movement
Muscle weakness and wasting
Both due to ‘fear avoidance
what should people with LBP do?
Keep flexible
Keep strong
what determines back pain?
Genetics
Environment
Body weight
Muscle strength need them to support spine
Mechanical loading strengthens vertebral bodies and increases the water content within discs
OVERloading should be avoided
what occupation risk factors are there for lower back pain?
Heavy physical jobs Lifting Driving to work Previous episodes of LBP Mental health Posture- laptops, seating, desk set-up
what are the classifications of LBP?
Simple backache
Nerve root involvement
Possible serious spinal pathology
describe the the first episode of Mechanical (simple) back pain?
First episode often sudden onset while lifting/twisting/turning
With mechanical back pain what occurs with reccurent episdoes?
Recurrent episodes with decreasing inter-episode frequency
Variable pain related to position/posture
how do patients elevate mechanical back pain?
Better lying flat
where else can pain radiate to with mechanical back pain and when during the day is it worse?
May radiate to buttock and leg
Often worse at the end of the day and better with lying down/resting
what is a characteristic of sciatic pain?
pain below the knees
what was the old thinking with treatment to mechanical back pain?
How to lift
Imaging
Bed rest
Don’t return to work until 100% better
what is the current thinking with treatment to mechanical back pain?
Exercise No imaging Activity Light duty option Work to contact re welfare
with LBP how long should you rest for?
no longer than 1-3 days
when do you refer a patient with LBP to secondary care?
after 6 weeks of pain
what is LBP early management guidlelines?
Simple analgesics Physiotherapy if symptoms > few days Rest for no longer than 1-3 days Practice psychosocial management Work absence only if unavoidable Early return to work, possibly graded Consider secondary care referral if on going at 6 weeks
what is the drug treatment for LBP?
Paracetamol NSAIDs Opioids Tricyclic anti-depressants (amitriptyline) Nerve modulators
what is sciatica?
name given to any sort of pain that is caused by irritation or compression of the sciatic nerve.
what is the sciatic nerves?
– L4 to S3
where is the pain radiating in sciatica?
Pain radiating from the back to the leg below the knee
what might be assoicated with sciatica?
May be associated with pins and needles in leg
May be associated with numbness and weakness
what is the commonest neurological sign for sciatica?
loss of ankle jerk
what is the most common weakeness for people with sciatica?
foot drop?
what is red flag symptoms for possible serious spinal pathology?
Age (young or old) at first onset History of carcinoma Weight loss Constant (24h) pain > 1 month No response to treatment Pain worse at rest History of IV drug abuse or HIV positivity UTI or other infection
what is the difference between inflammatory back pain and mechanical back pain?
with inflammatory the pain gets better with movement and worse with rest but is the opposite for mechanical
what occurs with Ankylosing spondylitis?
pain and stiffness in the spine large joint oligoarthritis enthesitis iritis FH of associated diseases (IBD, psoriasis)
who are most likely affected by Ankylosing spondylitis?
young men
what does oligoarthritis mean?
is the most common type of juvenile idiopathic arthritis
what does enthesitis?
it is inflammation of the entheses, the sites where tendons or ligaments insert into the bone.
what is iritis?
inflammation of the iris
what are the risk factors of Osteoporosis?
Age Female (oestrogen) Smoking Steroids Alcohol Family history
what is Osteomalacia ?
softening of the bones, typically through a deficiency of vitamin D or calcium.
what is paget disease?
chronic disorder that can result in enlarged and misshapen bones.
when does paget disease usually occur?
Prevalence increases with age
is paget disease symptomatic or asymptomatic?
asymptomatic
what is raised with paget disease?
alkaline phosphatase
what is common site for paget disease and what can it cause?
Commonest site is pelvis
Can cause spinal stenosis
what is the history of a infection/neoplastic damage to the spin?
Insidious onset, sometimes subacute Slow deterioration 24 hr pain Weight loss Associated symptoms Sometimes fever
what occurs with spinal stenosis?
Usually a history of chronic back pain
Bilateral leg symptoms
Weakness, tingling, sometimes described as ‘cold water running down the legs’
when does symptoms of spinal stenosis usually come about?
Leg symptoms come on while standing or walking
how is symptoms of spinal stenosis relieved?
Relieved by rest (sitting) or leaning forward
how is spinal stenosis distinguised to intermittent claudication ?
by normal peripheral pulses and worse walking downhill
what is Cauda equina syndrome?
Difficulty with micturition
Loss of anal sphincter tone or faecal incontinence
Saddle anaesthesia
Low back and/or leg pain
