L7 FINAL Flashcards
pain assessment tools of the low back
oswestry
rolland morris
back bournemouth
VAS
NPRS
pain diagram
___% of people experience low back pain in their lifetime
80%
back pain can be a result of
obesity
age
discogenic
spondy
muscle/ligament
congenital
congenital causes of back pain
facet tropism
spina bifida
transitional vertebrae
clasp knife deformity is exacerbated in what condition
extension
type ii A transitional vertebrae increases
chance of herniation above and at level
management of congenital conditions chiropractically
understand underlying pain generator to treat effectively
strengthen
MSTM
core stability
avoid painful motions
lumbar strain most likely due to
lifting or sudden twisting
30% of people cannot recall a precipitating event
lumbar sprain is due to
sudden traumatic injury or overuse to ligamentous structures
(chronic poor posture)
clinical evaluation of lumbar sprain/strain
ROM
Kemps localized back pain
rule out SI
FABER cause LBP
joint restrictions
chiropractic management of the lumbar spine sprain/strain
MSTM
E stim
Acupuncture
Stretching
manipulation (if not in spasm)
taping
ergonomics
causes of facet syndrome can be due to these three pathologies:
degeneration
microtrauma
extension activities
hypertonic muscles try to protect joint but only exacerbate pain
symptoms of facet syndrome of lumbar spine
forward antalgia
localized facet pain
pain worse with extension, rot, LF and prolonged standing
better with walking flexing and knee ben
medical management of facet syndrome
radiofrequency ablation
facet injections
nerve blocks
NSAIDS
lumbar facet syndrome chiropractic management
pain relief with continued activity
supine knee to chest
MSTM
shockwave
mobilization
once out of acute phase, strengthen surrounding muscles
what are some characteristics of spondylolisthesis
slippage of vertebrae
most common at L5
50% have no symptoms
causes of spondylolisthesis
isthmic
degenerative
pathological
developmental
isthmic spondylolisthesis
mc at L5 and common in children in sports
concern is for stability
symptoms of spondylolisthesis
LBP worse after exercise/extension/rotation
tight hamstrings
increased lordosis
one leg extension test is used to help diagnose
Spondylolisthesis
chiropractic management of spondylolisthesis
control pain
stabilize core
E-stim for pain
do not adjust at the level of the defect
most common disc herniation locations
L4/L5
L5/S1
lumbar disc derangement steps
annular fissure (radial)
migration of nucleus
lumbar disc derangement symptoms
back pain
leg pain
valsalvas
worse with flexion
better laying on back
antalgic lean
chiropractic management of lumbar disc derangement
mckenzie
F/D
traction
soft tissue
rehab to core, glutes
may adjust if patient can tolerate it
standing radiculopathy tests
neri
lewin standing
advancement tests
chiropractic management of lumbar radiculopathy
ST
traction
F/D
mckenzie
nerve flossing
rehab
may adjust with symptomatic side up
spinal stenosis
central canal, lateral recess stenosis
15-27mm in diameter
<12mm results in stenosis
<10mm diagnostic
spinal stenosis is not a contraindication for treatment unless
signs of myelopathy or cauda equina syndrome
symptoms of spinal stenosis
variable pain
radiating down legs
extension exacerbates the symptoms
easier to upstairs
clinical evaluation of spinal stenosis
red flags: wide based gait, bowel/bladder dysfunction, saddle anesthesia, bilateral lower extremity weakness
ROM
MRS
nerve tension tests are negative unless specific nerve root is involved
kemps
SI
claudications
chiropractic management of spinal stenosis
Do not adjust into extension
rehab
flexion and distraction
traction
flossing
ergonomic
cauda equina syndrome
usually follows a large lower lumbar herniation
can occur with congenital stenosis and bulge
3 variations of cauda equina syndrome
rapid onset without previous history
acute bladder dysfunction with a history of LBP
chronic LBP with sciatica and gradually progressing CES
four S’s of CES red flags
bilateral Sciatica, saddle anesthesia, sphincter dysfunction, sexual dysfunction
evaluation of CES
positive SLR, WLR
weakness of lower extrem
loss sensation
decreased DTR
lower motor neuron symptoms
mc cause vascular claudication
atherosclerosis
chiropractors can only manage ____ claudication
neurogenic claudication
management of neurogenic claudication
flexion based exercises
F/D
traction
do not adjust into extension
rehab
flossing
