Back Pain

Question 1

Acute low back pain

Answer 1

Less than 6 weeks

Question 2

Subacute low back pain

Answer 2

Between 6-12 weeks

Question 3

Chronic low back pain

Answer 3

More than 12 weeks

Question 4

Prognosis of acute low back pain

Answer 4

70% of patients feel better in 1 week; 90% feel better in 1 month; only about 10% go on to chronic back pain

Question 5

Causes of mechanical low back pain

Answer 5

Somatic dysfunction

Question 6

Causes of non-mechanical low back pain

Answer 6

Neoplasia, infection, inflammatory arthritis, viscerosomatic

Question 7

Red flags of potentially serious spinal pathology

Answer 7

Possible fracture (trauma, pain axial, nonradiating, and severe and disabling)
Possible infection or tumor (cancer, spinal infection - pain that worsens when supine)
Possible cauda equina syndrome (surgical emergency)

Question 8

Cancer risk factors

Answer 8

Hx, unexplained weight loss, age <20 or >50, failure to improve after 4-6 weeks of therapy

Question 9

Risk factors for possible spinal infection

Answer 9

Fever and/or chills
IV drug use
Immunosuppression

Question 10

In the absence of red flags, imaging studies and further testing are not usually helpful during the first…..of low back symptoms

Answer 10

4 weeks (waiting allows 90% of patients to recover)

Question 11

Common H&P findings of pt with LBP

Answer 11

Trauma, continuous muscle stress (i.e. postural strain), poor lifting mechanics, pain localized to lumbar or lumbosacral area (no radiation to legs, but may involve butt), pain increased with activity, any motion contracting injured muscle reproduces back pain; palpating muscle spasms

Question 12

Sprain

Answer 12

Ligamentous injury caused by sudden violent contraction, sudden torsion, severe direct blows, or a forceful straightening from a crouched position

Question 13

Strain

Answer 13

Tears (partial or complete) of muscle-tendon unit

Question 14

Lumbar sprains/strains

Answer 14

Typical symptoms: pain and muscle spasm localized over posterior lumbar spinal muscle, worsens with movement

Question 15

Lumbosacral radiculopathy

Answer 15

Cause: nerve root impingement and/or inflammation that has progressed enough to cause neurologic symptoms in the areas supplied by affected nerve roots

Question 16

Iliolumbar ligament syndrome

Answer 16

Pain in multifidus triangle, pain radiates around iliac crest and possibly into groin on ipsilateral side; mimic inguinal hernia

Question 17

Degenerative disc disease

Answer 17

Cause: natural aging, poor nutrition, smoking, atherosclerosis, job-related activities, and genetics
Gradual onset of stiffness with or without pain

Question 18

Discogenic pain without nerve root involvement typically is…

Answer 18

vague, diffuse, and distributed axially

Question 19

Risk factors for LBP

Answer 19

Preexisting structural deformities (scoliosis, spondylolysis, spinal fusions)

Question 20

Causes of nerve root impingement in lumbosacral radiculopathy

Answer 20

Herniated disc, spinal stenosis, tumor, hematoma

Question 21

Piriformis syndrome

Answer 21

Due to pressure on sciatic nerve causing pressure, usually causes impairment or loss of sensory conduction (usually no motor neurological deficitis); symptoms due to combination of nerve entrapment and inflammatory response
Counterstrain tender points (lower pole L5, piriformis, midpole sacroiliac)

Question 22

Treatments for acute LBP

Answer 22

Pain meds/analgesics, muscle relaxants, exercise, PT, heat, spinal manipulative therapy, surgery

Question 23

Psoas syndrome

Answer 23

Contraction of psoas major muscle on one side; pt presents with LBP, new, sudden onset scoliosis, inability to stand straight; pelvic shift to opposite side of psoas spasm; piriformis muscle spasm on opposite side (can cause sciatic pain not past the knee)

Question 24

L4 herniated disc

Answer 24

Motor: tibialis anterior
Reflex: patellar tendon
Sensation: medial foot

Question 25

L5 herniated disc

Answer 25

Motor: extensor digitorum longus
Reflex: none
Sensation: top of foot

Question 26

S1 herniated disc

Answer 26

Motor: peroneus longus
Reflex: achilles tendon
Sensation: lateral foot

Question 27

Spinal stenosis

Answer 27

Spinal canal narrowing with possible neural compression; severe lower extremity pain weakness, numbness in legs while walking; pain worse with extension, better with flexion; physical exam can be normal (straight leg negative, DTRs diminished or not, muscle strength maintained); diagnosed via MRI or CT

Question 28

Pseudo-sciatica

Answer 28

Normal neurologic exam (about muscles not nerves)