LBP part 2 Flashcards
A patient is experiencing dull, constant, non-specific pain that spreads into the groin and thigh. Which LBP diagnosis fits the best?
a. spinal stenosis
b. disc lesion
c. radiculopathy
d. bulging disc
disc lesion
This patient is middle-aged, has a history of their back going out, has a physically demanding job, their pain moves towards the extremity and its taking longer to recover. What could they be diagnosed with?
a. disc lesion
b. spinal stenosis
c. bulging disc
d. radiculopathy
disc lesion
This patient has pain AM and PM, flexed positions irritate them, sitting for awhile hurts and it is painful when they cough. What could these subjective clues suggest?
a. disc lesion
b. spinal stenosis
c. bulging disc
d. radiculopathy
disc lesion
Movement, supine position and lumbosacral support eases this patients pain. What could these subjective clues suggest?
a. disc lesion
b. spinal stenosis
c. bulging disc
d. radiculopathy
disc lesion
A patient had pain in sustained positions, movement makes it better, laying supine helps, they have more pain with a sneeze and vibration. What could these subjective clues suggest?
a. disc lesion
b. spinal stenosis
c. bulging disc
d. radiculopathy
disc lesion
A patient has a protective deformity, loss of lordosis, flexion increases pain, and hypomobile with palpation. These signs could suggest which diagnosis?
a. disc lesion
b. spinal stenosis
c. bulging disc
d. radiculopathy
disc lesion
It is important to educate patients that discs heal and movement is essential (true/false)
true
Which motion helps diffusion into the disc?
extension
What are ways to unload the spine for disc lesions?
traction
aquatic therapy
lumbosacral support
Ways to treat disc lesion
mobilization manipulation opening techniques closing techniques directional preference exercise
An opening technique should be used for which type of disc lesion?
a. posterior lateral
b. posterior medial
c. direct posterior
d. multi directional
posterior lateral
Opening techniques for posterior lateral disc lesions include
traction
rotation with painful side up
central PA in SB away
lateral glides
Closing techniques for posterior medial disc lesions include
central PA
central PA in SB towards
unilateral on the painful side
techniques into extension
What are environmental factors that could be related to disc lesions?
smoking lifting job sedenatary lifestyles food
Manipulation for a disc lesion can only be done
if symptoms are above the knee
Majority of people with low back pain have an _ problem
inflammation
could be pressing on the nerve
Various pro-inflammatory mediators and immune compounds are known to remove myelin from adjacent axons describes
radiculopathy
mechanical pressure on an exposed and unmyelined axon causes
a. somatic pain
b. referred pain
c. severe pain
d. a pain response
severe pain
The main role of neuroanatomy is:
it is designed to:
electrochemical communication
move, slide, glide
the spinal cord ends at
a. L2/L3
b. L3/L4
c. L1/L2
d. L4/L5
L1/L2
Sinuvertebral nerve includes
ventral dura
arachnoid
posterior longitudinal ligament
dural ligaments
The sacral plexus provides motor and sensory for the
posterior thigh
most of the lower leg
entire foot
part of the pelvis
Prone knee bend and side lying slump are used to test
a. L1-1/2 of L4
b. L1-L4
c. 1/2 of L4-S2
d. L4-S2
L1-1/2 of L4
The Straight leg raise and slump are used to test
a. L1-1/2 of L4
b. L1-L4
c. 1/2 of L4-S2
d. L4-S2
1/2 of L4-S2
This type of pain is a deep, burning, throbbing pain
a. somatic pain
b. referred pain
c. nociceptive
d. radiculopathy
radiculopathy
Pain in the distribution of the nerve root can be called
radicular pain
What is the cardinal sign for radiculopathy?
a. deep, burning, throbbing
b. proximal pain worse than distal pain
c. distal pain worse than proximal pain
d. pain locally in the back
distal pain worse than proximal pain
A patient demonstrates parasthesia, numbness, and longer reflex changes. This could suggest
a. referred pain
b. radiculopathy
c. somatic pain
d. nerve pain
radiculopathy
List 3 characterstics of radiculopathy
deep, burning, throbbing type pain
dermatomal patterns
distal pain > proximal pain
radiculopathy demonstrates in a _ pattern
dermatomal
What are the 4 signs of threatening nerve root pain?
dermatome, distal > proximal severe pain, latency slight movement distal PM towards PL away
A patient demonstrates dermatomal pain, more distal, latency, slight movement is irritating. What can you suggest about these characteristics?
a. it could be somatic pain
b. it could be referred from an organ
c. don’t worry about this type of pain, it will go away
d. this is threatening nerve root pain
this is threatening nerve root pain
Signs of nerve root compression
numbness in the dermatome
heavy feeling in the extremity
hypersensitivity
cramping
in later stages, what do patients experience if they have nerve root compression?
loss of sensation
motor weakness/atrophy
decreased reflexes
A patients symptoms are better when they move, unload and are shifted. Loading and staying in sustained postures irritates their symptoms. What could they be diagnosed with?
a. spinal stenosis
b. disc lesion
c. radiculopathy
d. bulging disc
radiculopathy
Eases of radiculopathy
protective deformity
movement
unloading
upright postures
Aggs of radiculopathy
positions stimulating neurodynamic tests loading sustained postures valsalva static stretches
This type of pain is common with nerve root pain
latent
Therapists should be careful with aggressive treatments on radiculopathy patients because of latent pain (true/false)
true
A shift upon movement, positive SLR and slump, compression and distraction will suggest
a. spinal stenosis
b. disc lesion
c. radiculopathy
d. bulging disc
radiculopathy
Which neurodynamic tests are positive with radiculopathy symptoms?
SLR
slump
sidelying femoral slump test
How can you manually treat radiculopathy to create more space?
lumbar rotation painful side on top
lateral flexion stretch painful side on top
Mid lumbar spine transverse and lower lumbar spine transverse towards the side of pain help
create space for radiculopathy
3 movements that help with radiculopathy
single knee to chest
double knee to chest
trunk rotation
Only do passive neural mobilization with radiculopathy patients (true/false)
false
both passive and active
A study showed that slump mobilization is beneficial for improving , and _ in patients with radiculopathy
short term disability
pain
centralization of symptoms
The lumbar facet joints are a _ joint
paired synovial
Lumbar facet joints guide _ and _ plane movement
sagittal and coronal
Lumbar facet joints restrain _ and _
axial rotation
excessive translation
What structure protects disc from torsional and shearing strains?
a. transverse process
b. facet joints
c. spinous process
d. ligamentum flavum
facet joints
Lumbar facet joint is a synovial joint, therefore it can get
stretched
strained
torn
Articular cartilage is (vascular/avascular)
avascular
What structure needs movement for adequate nutrition?
a. lumbar disc
b. articular cartilage
c. facet joint
d. nerve root
articular cartilage
Facet joint dysfunction can be due to
traumatic
aging
An athlete has a traumatic fall with back pain. What could this suggest?
a. sprain to the facet joint
b. strain to the facet joint
c. radiculopathy
d. disc fracture
sprain to the facet joint
Athletes’ movements, slip, fall, MVA, can cause this type of traumatic injury to the low back
a. sprain to the facet joint
b. strain to the facet joint
c. radiculopathy
d. disc fracture
sprain to the facet joint
Sustained postures due to work, excessive loads like pregnancy or backpacks can cause this type of traumatic injury to the low back
a. sprain to the facet joint
b. strain to the facet joint
c. radiculopathy
d. disc fracture
strain to the facet joint
What can cause radiculopathy due to inflammation and swelling?
facet joint dysfunction
This age change is when the cartilage becomes soft in the lumbar spine is in young adults in response to compressive loading
a. osteoarthrosis
b. chrondromalacia
c. bony hypertrophy of facets
d. articular cartilage loss
chrondromalacia
This facet joint change is thickening and sclerosis in the subchondral bone leading to hypertrophy of facets with osteophytes
a. osteoarthrosis
b. chrondromalacia
c. bony hypertrophy of facets
d. sprain
bony hypertrophy of facets
Cartilage loss with age
a. osteoarthrosis
b. chrondromalacia
c. bony hypertrophy of facets
d. strain to the facet joint
osteoarthrosis
What can cause pain in an older adult due to articular cartilage loss?
cartilage no longer protects the innervated subchondral bone
Characteristics of symptoms include sharp, localized, unilateral, proximal pain more
a. radiculopathy
b. lumbar facet joint dysfunction
c. stenosis
d. OA
lumbar facet joint dysfunction
How is pain distributed with facet joint dysfunction?
proximal pain > distal pain
Patient has spasms, localized sharp pain, and points to it on either side of the spine. These characteristics could suggest
a. radiculopathy
b. lumbar facet joint dysfunction
c. stenosis
d. OA
lumbar facet joint dysfunction
Gradual lumbar facet joint dysfunction can be due to
posture
loading
aging
Lumbar facet joint dysfunction can be caused by sudden trauma only (true/false)
false
A patients pain is aggravated walking a long time, laying on their stomach, when they extend and is made better when they sit or rest and lay down. What could this suggest?
a. radiculopathy
b. lumbar facet joint dysfunction
c. OA
d. stenosis
lumbar facet joint dysfunction
Facet joint dysfunction aggs
prolonged standing walking a long distance prone extension/rotation coughing progressive loading OA: AM stiffness
Facet joint dysfunction eases
rest sitting supine flexion movement
What is the facet joint dysfunction capsular pattern?
a. F > SB, Rot > extension
b. F < SB, rot < flexion
c. E > SB, rot > extension
d. E > SB, rot > flexion
E > SB, rot > flexion
Which posture does facet joint dysfunction avoid?
a. side bending
b. flexion
c. extension
d. rotation
extension
A patient avoids extension, has repeated movements and their pain to palpation is localized on one side. What could these characteristics suggest?
a. stenosis
b. radiculopathy
c. disc lesion
d. facet joint dysfunction
facet joint dysfunction
Facet joint dysfunction that is _ shows pain through the range
arthritic
Spinal mobilization for a painful facet joint should include
a. small amplitude, slow rhythm
b. smooth, slow rhythm in the painful position
c. large amplitude, smooth and slow rhythm, symptom free position
d. small amplitude, fast rhythm in pain free position
large amplitude, smooth and slow rhythm, symptom free position
Spinal mobilization for painful facet joints
PAIVM
symptom free positioning
large amplitdue
smooth, slow rhythm
Which spinal mobilization directions should be used for facet joints?
PA
unilateral PA
transverse
Spinal mobilization for painful facet joints should go into some degree of discomfort (true/false)
true
PAIVM should be the spinal mobilization technique for
a. painful facet joints
b. stiff facet joints
c. hypermobile facet joints
d. any type of facet joint dysfunction
painful facet joint
PPIVM should be the spinal mobilization technique for
a. painful facet joints
b. stiff facet joints
c. hypermobile facet joints
d. any type of facet joint dysfunction
stiff facet joints
Pain is normal with aging (true/false)
false
Aging is strongly correlated to low back pain (true/false)
false
Which low back pain problem is correlated to age?
a. ID disruption
b. facet joint pain
c. SI joint dysfunction
d. OA
OA
Which ligaments contribute to stenosis?
a. anterior and posterior longitudinal ligament
b. interspinous and supraspinous ligament
c. posterior longitudinal and ligamentum flavum
d. ligamentum flavum and anterior longitudinal ligament
posterior longitudinal and ligamentum flavum
Why is a contraction of the TA important?
pulls on thoracolumbar fascia then lifts ligamentum flavum and creates space in the canal
What happens with degenerative spinal stenosis?
space narrows, ligamentum flavum buckles
What are the types of stenosis?
degenerative spinal stenosis
vascular stenosis
postural/positional stenosis
What changes happen over time resulting in spinal stenosis?
facet joint hypertrophy thickened facet joint capsules thickening of the ligamentum flavum flattening of the VB disc bulges
What degenerative changes happen over time to the vertebral body?
loses trabeculae
traction spurs/osteophytes
What degenerative changes happen over time to the IVD?
fluid content
fissuring
What degenerative changes happen over time to the facet joints?
capsule, cartilage, ligaments
sclerosis leads to bony ankylosis
spinal stenosis
Fluid content and fissuring changes happen to what structure with age
a. vertebral body
b. IVD
c. facet joint
d. ligament function
intervertebral disc
Loss of trabeculae and traction spurs or osteophytes changes happen to what structure with age
a. vertebral body
b. IVD
c. facet joint
d. ligament function
vertebral body
Capsule, cartilage, ligaments, sclerosis, stenosis are changes that affect what structure with age
a. vertebral body
b. IVD
c. facet joint
d. ligament function
facet joints
Ligamentum flavum hypertrophy and facet cysts show
a. symptoms
b. no symptoms
no symptoms
Disc bulge, ligamentum flavum hypertrophy and facet cysts show
a. no symptoms
b. symptoms
symptoms
What are reasons for progressive changes to the spine resulting in stenosis?
aging changes in posture and function increased use of AD changes in gait decreased lordosis
A older patient with AM stiffness, decreased lordosis, and progressive pain as the day goes on could suggest which pathology
a. postural stenosis
b. facet joint dysfunction
c. OA
d. degenerative stenosis
degenerative stenosis
A patient who has a history of physical hard work, changes in gait pattern, relies on their AD, and has a change in their gait pattern could suggest
a. vascular stenosis
b. degenerative stenosis
c. OA
d. postrual stenosis
degenerative stenosis
Foraminal stenosis is (bilateral/unilateral)
unilateral
Canal stenosis is (bilateral/unilateral)
bilateral
Symptoms more in the legs, AM stiffness and a progression of increased spread of pain can suggest
a. degenerative stenosis
b. facet joint dysfunction
c. OA
d. vascular stenosis
degenerative stenosis
The early phase of degenerative stenosis is felt in the
a. legs and thighs
b. glutes and hips
c. in the feet
d. in the feet up to the glutes
in the feet
The middle phase of degnerative stenosis is felt in the
a. feet
b. glutes and hips
c. legs up to thighs
d. feet up to glutes and hips
legs up to thighs
The late phase of degenerative stenosis is felt in the
a. glutes and hips
b. feet up to the glutes and hips
c. thighs and glutes
d. feet only
feet up to the glutes and hips
A patients symptoms are made worse with extension, prolonged walking, standing and are made better with sitting and movement. What could this suggest?
a. vascular stenosis
b. facet joint dysfunction
c. OA
d. degenerative stenosis
degenerative stenosis
a patient shows progressive symptoms of stenosis including a loss of bladder control
a. continue treatment and do nothing
b. continue treatment but tell the doctor
c. do a neuro screening and continue with treatment
d. stop treatment and refer out immediately
stop treatment and refer out immediately
Physical presentation of stenosis
loss of extension
hypomobility
Symptoms are distal, bilateral, feet are cold all the time, they have trouble walking and see changes in their skin. These characteristics could suggest
a. degenerative stenosis
b. vascular stenosis
c. postural stenosis
d. any of the above
vascular stenosis
With vascular stenosis what motions make it better? What makes it worse?
walking and sitting increases pain
standing is better
Vascular stenosis can be associated with what co morbidities?
a. hypertension, diabetes, alcohol abuse
b. smoking, hypertension, type 1 diabetes, peripheral neuropathies
c. diabetes, peripheral neuropathies, peripheral vascular disease and smoking
d. smoking, diabetes, peripheral neuropathies, hypertension
diabetes, peripheral neuropathies, peripheral vascular disease and smoking
This type of stenosis is a narrowing in certain postures
postural stenosis
In postural stenosis, the canal narrows in which position?
anterior pelvic position
Postural stenosis happens over a short period of time and it doesn’t take much to produce these symptoms (true/false)
false
Which postural changes increase lumbar extension that contribute to postural stenosis
obesity
pregnancy
high heels
ligamentous laxity
A younger patient shows pain with extension, increased symptoms over time, walking eases pain. This could suggest
a. vascular stenosis
b. postural stenosis
c. degenerative stenosis
d. facet joint dysfunction
postural stenosis
Progressive neurological symptoms of stenosis include
cord compression
babinski
clonus
What speed should the patient walk at for treadmill testing for LSS?
a. 0.9 mph
b. 1.0 mph
c. 1.2 mph
d. 2.0 mph
1.2 mph
What should be measured with treadmill testing for LSS?
time to first symptoms
total ambulation time
Exercise treadmill testing has a poor test-retest reproducibility (true/false)
false
What is the best treatment for LSS?
PA hip mobs
Which diagnoses of LBP experiences the most latent pain?
a. disc lesion
b. radiculopathy
c. facet joint dysfunction
d. stenosis
radiculopathy
A patient has to move for pain to go away, loading their back is irritating and they have a deep, burning type of pain. Which diagnosis is most likely?
a. disc lesion
b. radiculopathy
c. facet joint dysfunction
d. stenosis
radiculopathy
A pt has dull, constant, nonspecific pain and climbs up their thighs when they come up from hip flexion. What could this suggest?
a. disc lesion
b. radiculopathy
c. facet joint dysfunction
d. stenosis
disc lesion
Which LBP diagnosis most likely shows aberrant motion?
a. stenosis
b. radiculopathy
c. facet joint dysfunction
d. disc lesion
disc lesion
Dull, constant, non-specific pain can suggest
a. disc lesion
b. facet joint dysfunction
c. radiculopathy
d. any of the above
disc lesion
Deep, burning, throbbing pain can suggest
a. disc lesion
b. facet joint dysfunction
c. radiculopathy
d. any of the above
radiculopathy
Sharp, stabbing, localized, unilateral pain can suggest
a. disc lesion
b. facet joint dysfunction
c. radiculopathy
d. any of the above
facet joint dysfunction
