LBP

Question 1

Specific Exercise (extension) cluster:

Answer 1

• symptoms extending to buttocks or legs
• decreased pain with extension
• self report preference for walking or standing

Question 2

Specific Exercise (flexion) cluster:

Answer 2

• decreased pain with flexion
• older than 50
• evidence of spinal stenosis in older patients

Question 3

Manipulation cluster:

Answer 3

• hypomobility
• FABQ score less than 19
• pain with mobility testing
• hip IR more than 35 degrees
• no symptoms below the knee***
• acute onset (less than 16 days) ***

Question 4

traction cluster:

Answer 4

• symptoms extending to buttocks or legs
• leg pain intensity greater than low back pain
• inability to centralize or decrease pain intensity with movement testing

Question 5

stabilization cluster:

Answer 5

• hypermobility
• increasing episode frequency
• 3 or more prior episodes
• generalized flexibility
• positive prone instability test
• aberrant movement
• age less than 40
• Avg SLR more than 90 degrees

Question 6

Red flags related to back-related tumors

Answer 6

-history of cancer (SP: 0.98
- unexplained weight loss
- failure to improve within 30 days
- age over 50
no relief with bed-rest (SN: 1.0)
- constant pain not effected by position

Question 7

red flags related to cauda equine syndrome

Answer 7

• urine retention (SN: 0.90, SP: 0.95)
• fecal incontinence
• saddle anesthesia
• sensory or motor deficits in feet (SN: 0.8)

Question 8

red flags related to infection

Answer 8

• recent infection
• immuno-suppressive disorder
• fever, swelling
• fever: spinal epidural abcess (SN:0.83; SP: 0.98)
• fever: tuberculosis osteomyelitis (SP: 0.98)
• fever: pyogenic osteomyelitis (SP: 0.98)

Question 9

red flags related to spinal compression fracture

Answer 9

• history of major trauma (SN: 0.85)
• age over 50 (SN: 0.79)
• age over 75 (SP: 0.84)
• long use of corticosteroids
• point tenderness
• increased pain with WB

Question 10

red flags related to abdominal aneurysm

Answer 10

• abdominal girth <100 cm (SN: 0.91)
• palpation of abnormal aortic pulse (SN: 0.88)
• aortic pulse 5 cm or greater (SN: 0.82)
• back, abdominal, or groin pain
• smoking history
• age over 70
• symptoms not related to movement stresses

Question 11

current recommendations for imaging:

Answer 11

1. imaging is only indicated for severe progressive neurological deficits or when red flags are suspected
2. routine imaging does not result in clinical benefit and may lead to harm

Question 12

minimally important change on Oswestry:

Answer 12

10 points or 30% from baseline score

Question 13

signs of aberrant movement:

Answer 13

• painful arc with flexion or return from flexion
• instability catch
• Gower sign
• reversal of lumbopelvic rhythm