LBP

Question 1

If pt complains of increased pain after sitting for 15+ minutes, you might think?

Answer 1

Piriformis Syndrome

Paresthesias down posterior aspect of thigh due to proximity to sciatic nerve

Question 2

What SDs are common with piriformis syndrome?

Answer 2

Ipsilateral hip external rotation SD

sacrum is rotated anteriorly towards ipsilateral side on a contralateral oblique axis (sacral torsion)

Question 3

What SD is commonly associated with psoas syndrome?

Answer 3

L1 and L2 flexed rotated towards affected psoas

L5 extension

TPs ipsilateral iliacus and contralateral piriformis

Question 4

Short leg syndrome is associated with what SDs?

Answer 4

Lumbar spine SaRt the side of the lower sacral base

Innominate rotated anteriorly on side of short leg, or rotated posteriorly on side of long leg

Pelvic side shift to the side of the longer leg

Foot on longer leg pronated with internal rotation

Question 5

How do we treat short leg syndrome?

Answer 5

tx SD in area (first)

exercise stretching of asym muscles

heel lift therapy (if discrepancy is greater than 5mm)

Question 6

What SDs are seen in spondylolysis/spondylolisthesis?

Answer 6

Psoas spasm or inhibition

Iliacus dysfunction

Flexed upper lumbar dysfunction

Sacroiliac/sacral torsion dysfunction

Innominate dysfunction

Question 7

What OMT tx should not be done for spondylolysis/spondylolisthesis?

Answer 7

HVLA

tx with indirect and soft tissue

Question 8

How do you dx spinal stenosis?

Answer 8

MRI

Question 9

Contrainindications of OMT

Answer 9

HVLA in low back pain from vertebral tumor or cancer metastasis to spine

HVLA with history of osteoporosis

HVLA for acute lumbar disc herniation (relative contraindication)

Most types of direct treatments for compression fracture (other than direct MFR)

HVLA in acute phase of rheumatoid arthritis affecting lumbar spine