Common MSK Conditions of the Lumbar Spine and Sacroiliac Joint

Question 1

Low Back Pain - Definition

Answer 1

Defined by location of pain, typically between lower rib and buttock crease. Commonly accompanied by pain in one or both legs.

Question 2

LBP - Risk Factors (psychological and work related) (10)

Answer 2

Genetics, smoking, prior history of MSK conditions.
Degenerative changes and muscle strength NOT related.
Psychological factors (persistent): physical distress, fear avoidance, kinesiophobia, depression.
Work related: operating heavy equipment, job satisfaction.

Question 3

Prognostic Factors - Recurrent Pain (3)

Answer 3

History of previous episodes
Excessive spine mobility
Excessive mobility in other joints.

Question 4

Prognostic Factors - Persistent Pain (7)

Answer 4

Negative prognosis
Symptoms below the knee
Psychological distress or depression
Fear of pain
Low expectations
High pain intensity
Passive coping

Question 5

Serious Pathologies (5)

Answer 5

Vertebral Fracture
Malignancy
Spinal Infection
Axial spondyloarthritis
Cauda equina syndrome

Question 6

Serious Pathology - Vertebral Fracture : Risk Factors (4)

Answer 6

> 65y
Prolonged corticosteroid use.
Severe trauma, sudden onset pain after trauma.
Contusion or abrasion.

Question 7

Serious Pathology - Malignancy : Risk Factors/symptoms (5)

Answer 7

History of malignancy
Strong clinical suspicion
Unexplained weight loss
>50y
Night pain

Question 8

Serious Pathology - Spinal Infection : Risk Factors (4)

Answer 8

Fever or chills
Immune compromised
Pain at rest or night
IV drug user
Recent injury, dental or spinal procedure.

Question 9

Serious Pathology - Axial Spondyloarthritis : Characteristics (6)

Answer 9

Persistent back pain with onset before 45y and one of the following:
- Inflammatory back pain
- Peripheral manifestation
- Extra-articular manifestation
- Positive family history
- Good response to NSAID

Question 10

Serious Pathology - Cauda Equina Syndrome : Symptoms (3)

Answer 10

Bowel or bladder dysfunction
Saddle anaesthesia
Bilateral lower limb lower motoneuron changes.

Question 11

Specific Disorders (2)

Answer 11

Stenosis
Sciatica/Lumbar radiculopathy

Question 12

Specific Disorders - Stenosis : Cause and Symptoms (agg/ease) (5)

Answer 12

Caused by narrowing of the spinal canal due to degenerative changes.
Limited walking tolerance
Older patient
Bilateral leg pain or cramping with or without LBP.
Agg: Extended posture
Ease: Flexion (sitting)

Question 13

Specific Disorders - Stenosis : Special Tests (4)

Answer 13

Neurological assessment during rest.
Antalgic posture (flexion).
Straightened posture amplifies leg pain or numbness.
Wide based gait.

Question 14

Specific Disorders - Sciatica/Lumbar Radiculopathy : Symptoms (2) Special Tests (4)

Answer 14

LBP with radiating pain.
Sign of nerve root involvement (loss of function).
Kemp’s test
Neurodynamics (SLR, Slump, PKB, Slump KB)
Neurological Examination
Mechanical Diagnosis

Question 15

Low Back Pain Classification (4)

Answer 15

LBP with Mobility Deficit
LBP with Movement coordination impairment
LBP persistent generalized pain
LBP with radiating pain (sciatica/radiculopathy)

Question 16

LBP with Mobility Deficit (Somatic Dysfunction) - Symptoms (3)

Answer 16

Acute LB/buttock pain often linked to recent unguarded/awkward movement or position.
Lumbar ROM limited.
Restricted Tx/Lx segmental mobility.

Question 17

LBP with Mobility Deficit (Somatic Dysfunction) - Special Tests (5)

Answer 17

Limited and painful end range active and passive ROM (flexion).
Fingertip to floor/Schober test
Spring test
Mechanical diagnosis (repeated direction specific movement)

Question 18

LBP with Movement Coordination Impairment (instability) - Symptoms (3)

Answer 18

Persistent, recurring LBP and referred lower extremity pain.
Pain at rest or reproduced with initial to mid-range movements.
Worsens with sustained end-range position.

Question 19

LBP with Movement Coordination Impairment (instability) - Special Tests (3)

Answer 19

Prone instability test.
Aberrant movements: painful arc flexion or return from flexion, instability catch sign, inverted lumbopelvic rhythm.
Endurance test (supine and prone).

Question 20

LBP with Persistent Generalized Pain - Symptoms (2)

Answer 20

LB and/or LB-related lower extremity pain >3 months.
Yellow Flags: influence of behavioral, cognitive and affective factors (depression, fear-avoidance beliefs, pain catastrophizing).

Question 21

LBP with Persistent Generalized Pain - Objective Examination (2)

Answer 21

Catastrophizing scale
Fear-avoidance beliefs questionnaire

Question 22

Sacroiliac Joint Pain - Symptoms (2)

Answer 22

Pain localized in Fortin area.
No response to mechanical diagnosis (repeated direction-specific movements).

Question 23

Sacroiliac Joint Pain - Special Tests (6)

Answer 23

Laslett’s Cluster (3/6):
- Distraction
- Compression
- Thigh Thrust
- Sacral Thrust
- Gaenslen’s Ipsilateral / Contralateral