LBP management and lumbar issues and directional pref

Question 1

Acute low back pain

Answer 1

Less than four weeks
24% of US adults in a three month window

13.7% receive opioids.
33% get imaging
Unlikely to get PT referral

Overmedicalization of the condition
Underutilization of the best evidence for care
Inappropriate care, waiting surgery leads to chronicity

Question 2

role of imaging for low back pain

Answer 2

Assess trauma
Presence of red flags or neurodeficits
Nonresponse to care

Question 3

Risk of low back pain imaging

Answer 3

patient and provider or overreliant on imaging
decision making an absence of imaging correlation to clinical exam
Radiation exposure

Question 4

Reality of image usage for low back pain

Answer 4

increases risk for surgery
Results change management
Useful when:
Clinical exam correlation is warranted
Lack of progress, despite care
Trauma evaluation
Non-musculoskeletal source considered

Question 5

Influences of chronic low back pain

Answer 5

ages, 50 to 69
Less than high school education level
Lower household income
Receipt of disability income
Depression
Sleep disturbances
Comorbid medical conditions

Question 6

What percentage of patients with back pain have concurrent leg pain

Answer 6

60%

25% stays above the knee
38% extends below the knee

Question 7

somatic pain

Answer 7

Poorly localized
Diffuse
achy

Question 8

Referred pain

Answer 8

Presenting in a non-local area

Question 9

radicular pain

Answer 9

Sharp shooting generally narrow, band like pain in a defined area
Dermatomal pattern

Damaged nerve root being compressed
Unilateral

Question 10

Radiculopathy

Answer 10

myotome weakness
Decreased to absent muscle stretch reflex
Decreased to absent sensation
Less than 5% of patients with low back pain and lower extremity symptoms

Question 11

nerve root compression, but root itself is not damaged causes…

Answer 11

Radiculopathy, but not pain

radicular pain and radiculopathy do not always present together

Question 12

Causes of lower extremity radicular pain and radiculopathy signs

Answer 12

Degenerative changes
Disc herniation
Space occupying lesion
Trauma

Question 13

degenerative changes

Answer 13

Decreased space
Disc desiccation
-IVD space Narrows

Fibrosis
osteophytes - bone growth do to increase bone stress
Associated inflammation
Plate changes

Question 14

disc herniation

Answer 14

Focal or localized displacement of disc material outside of the intravertebral disc space margins

protrusion, extrusion, sequestration

Question 15

Space occupied lesion

Answer 15

Cancer infection other

constitutional signs
Red flags
Medical history
Family history

Question 16

Thoracic and lumbar nerve exit

Answer 16

below the numbered vertebra

Question 17

if lumbar disc is involved it is most commonly the disc

Answer 17

Above the numbered vertebra

Question 18

lesion at L4, L5 would effect?

Answer 18

L5 nerve root

Question 19

traction

Answer 19

Not recommended for patients with chronic low back pain with leg pain

peripheralization with extension and positive SLR may benefit

Question 20

normal neural exam for myotomes reflexes and sensation

negative straight leg, raise test for nerve root and disc

Answer 20

non-radicular pain
No radiculopathy signs

Question 21

neural mechanicosensitivity

Answer 21

no radiculopathy signs non-radicular pain

slump for nerve root would be back and leg pain

Positive findings on slump test that are not nerve root are most likely more distal symptoms present with sensitizing movements, not basic slump position with knee extended

Question 22

treatment for low back pain with lower extremity neural Mechanicosensitivity

Answer 22

slump stretch- low severity, irritability, prolonged holds

Tensioners - low irritability, more persistent symptoms

Sliders- higher irritability, more acuity

Question 23

LBP classification- manipulation

Answer 23

no symptoms below knee
Onset less than 16 days
low FABQ
Hypomobility
Hip internal rotation, greater than 35

Question 24

LBP classification- directional preference

Answer 24

centralization phenomenon With movement exam

Postural preference

Question 25

LBP class- stabilization

Answer 25

Prone instability test
Aberrant motions
Hyper mobility
Age is less than 40
Straight leg raise greater than 91

Question 26

LBP class- traction

Answer 26

neurological signs
Leg symptoms
peripheralization with movement exam
Crossed SLR

Question 27

first thing to do with directional preference

Answer 27

Correct the lateral shift

Question 28

lateral shift patient has no pain

Answer 28

educate with mirror, tactile queuing visualization
Improve body awareness and general proprioception about where the body is in space

Question 29

lateral shift patient has pain

Answer 29

Active correction, in standing
Passive correction in sidelying
Manuel treatment based on assessment

Question 30

extension treatment in directional preference

Answer 30

Prone lying static
Prone lying extension static
Extension in lying
Extension in lying with clinician overpressure
Extension mobilization
Extension in standing

Question 31

flexion treatment, directional preference

Answer 31

Flexion in lying
Flexion sitting
Flexion in standing
Flexion in lying with clinician overpressure