HNP and Low Back Pain 1/21 Flashcards
1
Q
Spondylosis
A
bone spurs
2
Q
spondylolysis
A
pars fracture
3
Q
spondylolisthesis
A
anterior deviation
4
Q
what are most often cause of lower back pain?
A
Psoas/Illiacus muscle
5
Q
osteomyelitis
A
infection of vertebrae
6
Q
MI
A
can have referred pain to lower back
7
Q
Aortic Abdominal Aneurism
A
pulsatile mass can be detected in periumbilical/epigastric region
8
Q
Major causes of pain from GI system?
A
constipation
flatus = gas
necrotizing enterocolitis
perforation
9
Q
L4/L5 herniation
A
Would affect L5 nerve root
10
Q
If pain is above knee
A
primarily direct injury to a specific area:
- Most likely a non-specific muscular or ligamentous injury
- Somatic Dysfunction
- Degenerative Disease
- Fracture
- Spondylolysis
11
Q
pain radiates below the knee
A
- normally due to nervous innervation Pain radiates below the knee: 1. Radiculopathy 2. Spinal Stenosis 3. ***Cauda Equina Syndrome (medical emergency) 4. Associated Piriformis Syndrome
12
Q
Cauda Equina syndrome
A
- compression of nerves from L1-S5 normally due to massive disc protrusion, fracture, or tumor that causes bowel or bladder dysfunction
- Medical Management and Surgical decompression required within 48 hours to prevent permanent neurological damage
- Check for saddle/perineum anesthesia and decreased anal sphincter tone (loss of bowel and bladder control) in suspected cases
13
Q
Radiculopathy
A
nervous like symptoms due to : Herniated Nucleus Pulposus Tumor Exostoses Spinal stenosis Infection Conditions that compromise intervertebral foramen, canal, disc
14
Q
What can lead to decrease in the size of the intervertebral foramen?
A
Arthritis Ligament hypertrophy Disc degeneration Muscle imbalance Tissue quality SD
15
Q
What do GAG’s do?
A
- Negatively charged glycosaminoglycan molecules on proteoglycan chains attract fluid into the extracellular space
- help vertebral disc maintain water (the more negative the space, the more inhibitory pressure is created within the disk)
- Anulus fibrosis can adapt, but does not deform very much
16
Q
Aging and vertebral disc degeneration:
A
- age-related changes in discs begin in adolescence:
- Diminished blood flow to the disc
- Nucleus Pulposus gets smaller and more fibrotic during adult years and blood vessels disappear, cracks appear in the lamellae and annulus
- in the elderly, the annulus becomes stiff fibrocartilage and the nucleus pulposus has few viable cells
17
Q
Protruded disc
A
type of disc herniation where the annulus remains intact
18
Q
Extruded disc
A
disc herniation through the annulus but posterior longitudinal ligament maintains disc within vertebral space
19
Q
sequestered disc
A
- disc herniation where annulus is free to roam the spinal canal
- can cause AI disorder
20
Q
Where do most disc herniations occur?
A
- Most herniations occur in the Lumbar Spine
- More stress in the lumbar region compared to other regions of the spine
- Thoracic spine is protected from extreme motion by the thoracic cage, meanwhile the lumbar spine is left without boney connections to stabilize it.
- most commonly affected is S1 due to disc herniation from L5, and second most common is hernation from L4
21
Q
Where does L4 go?
A
- herniation of disk L3,4
- dermatome crosses over knee medially, and the medial side of the leg
- patellar tendon reflex lost
- medial portion of foot
- motor affected: tibialis anterior - INVERSION
22
Q
Where does L5 go?
A
- herniation of L4/5 disc
- lateral side of the leg
(higher up in the spine starts anterior and superior, and then will rotate down.) - there is no reflex
- extensors affected
- anterior portion of leg: extensor digitorum longus: flexion of foot
23
Q
S1?
A
- herniation at L5/S1
- peroneal/ fibular muscles: eversion
- Achilles reflex
- lateral side of foot parasthesia
24
Q
where do disc herniations normally occur?
A
- most often occur posteriorly, because the anterior long. ligament is thicker and stronger
- the post. long. lig. is at its narrowest in the lower portion of the spine
- results in the herniation occurring posteriorly or off to the side (paracentrally)
- keeps herniation from occurring anteriorly
25
causes of pain in HNP?
1. mechanical compression of nerve root
2. chemical mediators: such as inflammatory agents
3. irritation of highly innervated posterior longitudinal ligament
26
Why do we do OMT to treat HNP?
- SDs pre-dispose or aggravate radiculopathy when chronic processes are present within a disc
- SDs alter mechanical relationships which can change the forces directed toward the disc
OMT goals:
- Stabilize and decrease impingement locally
- Address any SD contributing to mechanical instability in the area
- Treat SDs that may have been created by the HNP
- Reduce viscerosomatic and Chapman’s reflexes
- Reduce sympathetic tone
- Improve lymphatic and venous drainage
27
Acute HNP
- Indirect techniques (HVLA & MUSCLE ENERGY ARE CONTRAINDICATED, as is any technique that exacerbates symptoms)
- Patient may not tolerate much
- May need to treat areas distal to the herniation first
28
Subacute/Chronic HNP
- May use direct treatments with care (Personally I would still shy away from direct techniques if at all possible)
- Patient normally tolerates more
29
Treatment for HNP
treat affected extremities and sacrum/pelvis:
- Type II/Type I mechanics
- ribs and diaphragm (L1-L3)
- latissimus dorsi (seen in cases with low back pain associated with shoulder pain)
- quadratus lumborum: becomes hip stabilizer with weak gluteus medius, results in LBP
- Iliopsoas: results in majority of back pain coming in - due to people seated at most times, results in constant stretch of muscle and increased gamma gain.
30
paracentral disk herniation
- will result in posterior herniation to the side
| - causes unilateral symptoms
