Chronic Low Back Pain (Lab)

Question 1

What are common somatic dysfunctions that cause low back pain?

Answer 1

• -Type II at L4 or L5
• -pubic dysfunction
• -short-leg syndrome

Question 2

What are some characteristics of the quadratus lumborum?

Answer 2

–attaches at the superior border of iliac crest, TP of L1-L4, rib 12

–stabilizer for the region (often weak, easily injured)

Question 3

What is psoas syndrome?

Answer 3

• low back pain d/t hypertonicity of psoas
• overuse of lumbar extensor mm. to compensate
• Tx: stretching and frequent position changes

Question 4

What are the characteristics of the iliolumbar ligament?

Answer 4

• stabilizes
• begins just medial to the QL, consists of 2 portions

-attaches at angled portion of iliac crest, above PSIS and onto the TP’s of L4 and L5

–one of the most common sources of pain from insufficiently-healing ligaments

Question 5

What are common ways to injure supraspinous and interspinous ligaments?

Answer 5

• straight anterior/posterior mvmts

- MVA, slouching, lifting

Question 6

What is prolotherapy?

Answer 6

• useful if there’s weakness or enthesopathy, Tx of relaxed/incompetent tendons, ligaments, joints
• chem or mechanical irritant to induce growth of new fibroelastic CT by stimulating the inflammatory cascade resulting in natural healing response to a perceived new injury

Question 7

What are the characteristics of short leg syndrome?

Answer 7

• sacroiliac and lumbosacral joint pain
• dull aching pain worsens as day progresses
• iliolumbar ligament is 1st to react to stress in that area

-tenderness to palpation at iliac crest or L4/L5 attachment

Question 8

What are some clinical indications of an unlevel sacral base?

Answer 8

-medial malleoli imbalance when lying supine

-supine knee height inequity
femur length or hemi-pelvis inequity

Question 9

What compensations would you expect a body with Short Leg Syndrome to make?

Answer 9

• lumbar spine sidebent away from the short leg
• innominate rotated anteriorly on short leg side
• superior pelvic sheer on side opposite short leg
• innominate rotated posteriorly opposite short leg
• foot opposite of short leg pronated with IR
• strained short leg glutes and tensor fascia lata

Question 10

When doing a postural x-ray where do you measure the sacral delineation?

Answer 10

-at the line of eburnation (increased bone density or sclerosis caused by physiologic response to stress, identified in sacrum just below sacral base)

• -at width of femoral head when standing
• -at ischial tuberosity when seated

Question 11

If inserting lifts into a patient’s shoe, how do you do it?

Answer 11

• gradually increase by 2mm every 2-4 wks as tolerated

- shoe will generally hold a one-half inch lift