Decision Tree

Question 1

Components of Decision tree for LBP

Answer 1

Initial observation, concerns problems and stories
Determine irritability levels
Physical exam to r/o or rule in most relevant conditions
Most relevant physical impairment
PT/pt mutually agreed upon intervention strategies

Question 2

Red Flags of Serious Pathology
- Malignancy

Answer 2

Onset of LBP >50
Continuous pain
Nocturnal pain
Malaise
Hx Malignancy
Unexplained weight loss
Elevated ESR

Question 3

Red Flags of Serious Pathology
- Osteoporotic Fracture

Answer 3

Recent fracture
Previous fracture
>60
Low body weight
Prolonged steroid use
Local percussion pain
Tenderness/axial pressure pain
Marked height reduction
Increase thoracic kyphosis

Question 4

Red Flags of Serious Pathology
- Ankylosing Spondylitis

Answer 4

<20
Male
Night Pain
Morning Stiffness
Elevated ESR
Inflammatory bowel

Question 5

Red Flags of Serious Pathology
- Cauda Equina

Answer 5

Saddle anesthesia
Bowel and bladder
Progressive weakness

Question 6

Red Flags of Serious Pathology
- Back related infection

Answer 6

Deep pain increase w/ WB
Recent infection
Immunosuppressive disoder

Question 7

Red Flags of Serious Pathology
- Aortic anesurysm

Answer 7

HTN
Smoker
CAD
>50

Question 8

Red Flags of Serious Pathology
- Vertebral fracture

Answer 8

Hx trauma with severe pain

Question 9

Red Flags of Serious Pathology
- Sponylolisthesis

Answer 9

> 20
Palpable stepoff L45

Question 10

ICF Categories for Lumbar Spine/Pelvis
LBP with..

Answer 10

Mobility deficits
Mvmt coordination impairments
Referred pain
Radiating pain
SIJ/PG pain with mvmt impariments
Cognitive or affective tendencies
General pain

Question 11

Condition: LBP with Radiating Pain
- Presentation

Answer 11

Radiating narrow band of lancinating leg pain
Paresthesias, numbness, and weakness may be reported
Symptoms often worsened with END RANGE forward bending or extension/rotation

Question 12

Condition: LBP with Radiating Pain
- Common Impairments

Answer 12

Radiating leg pain
paresthesias
sensation loss
Segmental motor loss
Nerve mobility deficits
+ Neural tension
Restrictions of involved NR elements/entrapments (inflammation, connective tissue, bone and lateral foraminal canal)
Restrictions of sciatic or femoral nerve muscular entrapment sites

Question 13

Condition: LBP with mobility deficits
- Presentation

Answer 13

Recent (<6 weeks) onset of LBP, Buttock or thigh pain
Unilateral pain
Often linked to a recent unguarded/awkward movement or position from a misstep, fall, bending, twisting or lifting activity

Question 14

Condition: LBP with mobility deficits
- Common Impairments

Answer 14

Lower thoracic, lumbopelvic, buttock and/or thigh pain
Lower thoracic lumbar and hip stiffness
Segmental and/or general motion limitations in the lower thoracic and lumbar spine (articular or muscular)
Thoraco-lumbar muscle flexibility deficits

Question 15

Condition: LBP with movmt coordination impairments
- Presentation

Answer 15

Acute exacerbation of recurring LBP commonly associated with referred LE pain; could include numerous episodes
Symptoms worsen with prolonged postures
Difficulty with maintain pain free mid-range positions while performing ADL
Often precipitated by mild trauma, lifting or athletic activity

Question 16

Condition: LBP with movmt coordination impairments
- Common impairments

Answer 16

Recurring LBP/SIJ pain or back-related buttock, thigh or leg pain
Insufficient strength, endurance, and coordination of core and hip MM for WB and loaded activities
Excessive intersegmental mobility (+ PIT) resulting in excess strain on CT of LS
PG positional asymmetries
Limitations in thoracic/hip mobility associated with excessive mvmt LS
Associated mm flexibility deficits and compensatory mm recruitment impairments in trunk and hip myofascia