HNP and Low Back Pain Flashcards
possible problem to low back pain
cardiovascular referred pain renal pain respiratory pain ectopic pregnancy -trauma
cauda equina syndrome
problem with low back pain
medical emergency
straight leg test
is positive
cause of lower back pain
local vs. radiating
radiation below knee
some sort of neural involvement
cauda equina syndrome
compression L1-S5
loss of bowel and bladder control
48 hours to have it decompressed
-emergency
radiculopathy
herniated nucleus pulposus
intervertebral foramen
normally 2-3x larger
-can be decreased in size due to variety of factors
vertebral disc
mostly water
- center - nucleus propulsus
- surrounded by annulus propulsus
adaptation of discs to weight applied
annulus fibrosis - does not deform much
- become dried out as we age
- fibrotic as we age
protruded disc
annulus remains intact
extruded disc
through annulus, but stays in disc space due to long ligament
sequestered disc
free to roam spinal canal
lumbar disc herniation
most herniations here
- more stress here
- not protected by thoracic page
common disc herniation
S1 from L5 disc herniation
L5 by L4 disc herniation
discs lower in lumbar spine
more affected by hernation
radiculopathy
only severely bulging discs or herniations
risk factors for herniated nucleus propulsus
tobacco, ethanol, age, bending/lifting
L4 dermatome
crosses over knee
achilles reflex
S1
patellar tendon reflex
L4
disc herniation
occurs posteriorly
-anterior longitud is thick/strong
causes of pain with HNP
mechanical compression
chemical mediators
irritation of post long ligament
OMT for HNP?
SDs aggravate radiculopathy
SD alter mechanical relationships
musculoskeletal model
for looking at HNP in lumbar spine
connected to thorax and pelvis directly
respiratory / circulatory model
area of restricted motion
- connect two important junctional areas
- thoracolumbar and lumbosacral
- both studry structural aspects of body
acute HNP
lots of pain
-no OMT
subacute/chronic HNP
may use direct OMT
-shy away from HVLA
type II
single segment
keystone of type I
SB and rotate same
type I
large group curves
SB and rotate opposite
latissimus dorsi
upper extremity and low back pain connection
quadratus lumborum
associated with low back pain
iliopsoas
associated with low back pain
surgery with low back pain?
if neuro deficit, muscle atrophy, reflex change, parasthesia
