Back pain (Mechanical, Herniation, Spondy, Cervical) Flashcards
Signs of concern beyond complaints of back pain include?
Interruption in bowel or bladder function should be a reminder to consider more serious causes of back pain such as a tumor, infection, or fracture.
Management of mechanical low back pain include?
Management of mechanical low back pain can be outlined in the following 6 steps:
Control of pain and the inflammatory process
Restoration of joint ROM and soft tissue extensibility
Improvement of muscular strength and endurance
Coordination retraining
Improvement of general cardiovascular condition
Maintenance exercise programs
Mechanical back pain often presents with a history of:
Patients generally present with a history of an inciting event that produced immediate low back pain. The most commonly reported histories include the following:
What is the typical cause of mechanical LBP?
Mechanical low back pain (LBP) generally results from an acute traumatic event, but it may also be caused by cumulative trauma.
What position is the most risky for producing mehcanical LBP? and why?
The lumbar spine position most at risk for producing LBP is forward flexion (bent forward), rotation (trunk twisted), and attempting to lift a heavy object with out-stretched hands.
Repetitive, compressive loading of the disks in flexion (eg, lifting) puts the disks at risk for an annular tear and internal disk disruption. Likewise, torsional forces on the disks can produce shear forces that may induce annular tears.
WHat is the theory around why mech LBP causes pain?
This concept postulates the breakdown of the annular fibers allows PLA2 and glutamate, and possibly other as-yet unknown compounds, to leak into the epidural space and diffuse to the DRG. The weakened vertebra and disk segment become more susceptible to vibration and physical overload, resulting in compression of the DRG and stimulating release of substance P. Substance P, in turn, stimulates histamine and leukotriene release, leading to an altering of nerve impulse transmission. The neurons become sensitized further to mechanical stimulation, possibly causing ischemia, which attracts polymorphonuclear cells and monocytes to areas that facilitate further disk degeneration and produce more pain.
What is a major risk factor for lumbar disk herniations?
Smoking is a risk factor in the epidemiology of lumbar disk herniations and has been documented to decrease the oxygen tension in the avascular disk dramatically, presumably by vasoconstrictive and rheologic effects on blood.
How do disk herniations come about?
Dehydration results from shortening of the hyaluronic chains, deterioration of the state of aggregation, and decreases in the ratio of chondroitin sulfate to keratan sulfate, leading to the disk bulging and disk height loss.
