Exam 1 Flashcards
Early referral guideline adherent PT results in lower
-advanced imaging
-lumbar injections
-surgery
-opioid use
-60% lower total costs
Describe if the following have a risk factor for LBP
Anatomical
-amount of lumbar lordosis
-scoliosis
-leg length discrepancy
-spinal ROM
-hamstring flexibility
-strength
-better physical fitness
-body weight
-amount of lumbar lordosis: no
-scoliosis: no
-leg length discrepancy: maybe
-spinal ROM: no
-hamstring flexibility: no
-strength: no
-better physical fitness: yes
-body weight: weaak
Describe if the following environmental factors increase risk of LBP
-driving
-exposure to vibration
-smoker
-manual labor
-psychosocial factors
-job dissatisfaction
psychologically stressful work
-driving: yes
-exposure to vibration: yes
-smoker: yes
-manual labor: yes
-psychosocial factors
-job dissatisfaction: yes
psychologically stressful work: yes
What is the primary prevention of low back pain
primary or secondary that has consistently been found is exercise
Describe recurrence of low back pain
- history of previous episodes
-excessive mobility in spine
-excessive mobility in other joints
What is the development of chronic pain
-symptoms below knee
-psychological distress or depression
-fear of pain, movement, and re-injury or low expectations of recovery
-pain of high intensity
-passive coping style
Reality of diagnosis
-approx 15% of cases of LBP can be given a specific diagnosis
-85% unable to identify the cause (non-specified LBP)
-don’t know anatomical cause of LBP
-we do know nothing dangerous is causing their LBP
Why is there difficulty with diagnosis?
-numerous pain sensitive structures
-anatomical abnormalities do not correspond to clinical presentation
Misconception vs. reality of imaging of LBP
misconception:
-half of all pt presenting to a MD consider LB imaging to be necessary
reality
-need for immediate imaging only if: minimum of 4 weeks in absence of red flags or severe neuro deficits
How we discuss with patients about their LBP
-what you are experiencing is common
-we fully expect you to get better and most recover in 6-8 weeks
-we don’t know exactly what is wrong
–nothing dangerous is causing your pain
–imaging will not likely help us
-best recommendation for your pain is to continue to be active
Levels of classification for LBP
- is person appropriate for PT
–red flags for condition or system - do I need to alter my tx approach? (yellow flags)
- what is the best tx approach
Describe cauda equina syndrome
-formed by lumbar and sacral nerve roots originating from the conus medullaris at the base of the spinal cord
-provides sensory and motor innervation to the LE and B&B
-results from
–disc herniation
–post operative
–any space occupying lesion
-SURGICAL EMERGENCY
Describe LB fractures
-higher prevalence than other series spinal pathologies
-most common T8-L4
-often rapid onset related to: trauma, position change, coughing/sneezing, lifting
-clinical presentation may include: observable kyphosis, midline spine tenderness
Risk factors for fracture
-older
-female
-hx of osteoporosis
-hx of spinal fx
-drinking >3 alcoholic bev per day
-smoking >20 cig per day
-vit D deficiency
-long term corticosteroid use
-diabetes
-dietary restrictions/ eating disorders
Describe the increased suspicion of cancer in pt
-older
-night pain (if not able to get comfortable)
-unexplained WL
-non responsive to tx
-worsening
