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MSK Exam 1 - Spring > Low Back Pain > Flashcards

Low Back Pain Flashcards

1
Q

Nearly all cases of LBP have what?

A

aka non-specific LBP- nearly all cases have an unidentified nociceptive source hence the term non-specific LBP

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2
Q

What are some functional questionnaires for LBP?

A
  • Numeric Pain Rating Scale- 2 pts.
  • Visual Analog Scale- 1.5 pts
  • Oswestry Disability Questionnaire- 6 pts or 12%
  • Roland Morris Disability Questionnaire- 2-3 pts
  • STarT Back Tool- determines the risk of persistent disabling pain and matches treatments
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3
Q

What is the thoracic prevalence of LBP?

A

The smallest amount of spine-related pathology

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4
Q

What is the lumbar prevalence of LBP?

A

The leading cause of:
- Worldwide disability
- Activity limitation and work absence
- 80% will experience LBP in their lifetime

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5
Q

What is the prevalence of LBP in men compared to women and age?

A
  • Biological women > men
  • Older (half > 65 yrs. of age21) > younger ages
  • Lower educational status: think access
  • Higher physical work demands
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6
Q

What are risk factors of LBP?

A
  • Previous LBP
  • Co-morbidities (ex: diabetes, asthma, obesity, etc)
  • Poor mental health: think coping
  • Smoking and low activity levels
  • Awkward postures, heavy lifting, and fatigue
  • Genetics with age-related disc changes only, otherwise questionable
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7
Q

What structures are involved in LBP?

A

Variable innervated structures

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8
Q

What might you see on an MRI with LBP?

A

~ 1/3 of asymptomatic individuals had “abnormal” findings such as:
- IDD
- Age-related disc changes
- Nerve compression
- Facet hypertrophy
- ~ 1/2 of symptomatic individuals had an abnormality

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9
Q

What might you see with both MRI and CT with LBP?

A
  • ~2/3 of asymptomatic 30-80 yr. old individuals had disc changes
  • Normal asymptomatic age-related changes MUCH > symptomatic structural changes
  • Imaging changes significantly increase with age
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10
Q

Are most scans for LBP helpful or not?

A

59% of outpatient lumbar scans were inappropriate in 2012

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11
Q

Who should get Imaging with LBP?

A
  • > 50 yrs. of age with a hx of cancer
  • Saddle paresthesias
  • Bowel and bladder dysfunction
  • Specific neurological deficits (spinal n., brain, spinal cord)
  • Progressive/disabling symptoms
  • No improvement after 6 weeks of conservative Rx
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12
Q

How many LBP cases have an unidentified nociceptive source

A

Nearly all

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13
Q

What kind of gap is present between evidence and practice?

A

Substantial

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14
Q

Over utilization of unsupported and ineffective Rx causes what?

A
  • Fear-avoidance behaviors promoted with passive interventions like modalities and even some manual therapies
  • Leads to higher costs
  • Contributes to greater opioid addiction
  • Greater imaging and radiation exposure
  • More likely to have invasive procedures, side effects, and missed work
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15
Q

What kind of prevention is available for LBP?

A
  • Inadequate research
  • Most promoted preventions lack evidence
  • Exercise is largely effective in adults
  • For children ergonomic furniture is effective
  • For children, exercise has not been evaluated
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16
Q

What percentage of patients that had early PT developed LBP?

A

2% developed persistent LBP

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17
Q

What happens to work time in pts with LBP that have early PT?

A

Significant reductions in lost work time

18
Q

Is early PT supported in studies for LBP?

A

Yes, Supported by numerous studies

19
Q

What is the first line Rx for LBP that has moderate to strong evidence behind it?

A

Education and advice

20
Q

What kind of “against” education and advice should you give?

A
  • Bed rest
  • In-depth explanations
21
Q

What kind of “for” education and advice should you give?

A
  • Spinal anatomical and structural strength
  • Overall favorable prognosis
  • Active P! coping mechanisms that ↓ fear/catastrophizing
  • Stay active with early resumption of ADLs
  • Biopsychosocial contributors and basics of nociplastic pain
  • Emphasis on function with back protection techniques
22
Q

What kind of benefit does dry needling have for LBP?

A

Weak evidence of short term benefit

23
Q

What kind of benefits do modalities like heat, US, electrical stimulation, LASER, etc. have for LBP?

A
  • Generally ineffective and not recommended
  • Short-term results at best; often no better than placebo
24
Q

What kind of benefit does soft tissue mobilization/massage have for LBP?

A

Moderate evidence of short-term benefit

25
Q

What barriers should we overcome to achieve best practices?

A
  • Increase consultation time and follow-up
  • Better incentives to return to work
  • Reward quality and NOT volume with reimbursement
  • Public service announcements
  • Increased provider knowledge of evidence and guidelines for use in clinical reasoning and decision-making
26
Q

What kind of evidence does Rx in general have for LBP?

A
  • Moderate evidence with acute LBP
  • Weaker evidence with chronic LBP due to greater contributing variables
27
Q

What are the 4 subgroups of Rx for LBP?

A
  • Mechanical Traction
  • Directional Preference
  • Mobilization/Manipulation
  • Stabilization
28
Q

What kind of LBP benefits from traction?

A
  • Intermittent tx for LBP with LE P!
  • Acute and subacute LBP with LE P! that doesn’t centralize
29
Q

What kind of LBP does not benefit from traction?

A
  • No benefit with static tx
  • Should not use with persistent LBP with LE P!
30
Q

There is moderate evidence against all types of tx when used alone in patients with what?

A
  • Acute, sub-acute, and persistent LBP
  • Non-radicular LBP
  • Varying symptom patterns
31
Q

How should mechanical traction be best used?

A
32
Q

What is a directional preference?

A

A position and/or motion that alleviates symptoms

33
Q

What repreated motions do people with LBP usually make?

A
  • Most commonly extension/hyperextension, may centralize LE symptoms to LB
34
Q

What is centralization?

A

Centralization- abolition of distal and/or spinal P! in a distal to proximal direction in response to repetitive motion(s) or sustained position(s)

35
Q

What can directional prefernces help with?

A

Can help to choose positions and motions to avoid symptoms and promote exercise and activity

36
Q

How should directional preference be best used?

A
37
Q

What kind of evidence does manipulation have?

A
  • Strong patient preference/belief in short term effectiveness
  • Strong evidence for thrust and non-thrust mobilizations for LBP and disability
38
Q

What LBP group is manipulation most beneficial for?

A

Manipulation most effective for sub-groups with acute and sub-acute LBP

39
Q

What kind of predictors helped justify the used of manipulation with LBP?

A

≥ 4 of 5 predictors improved success from 45 to 95% with a 13.2 LR+ by using lumbar rotation or SI distraction manipulation:
1. NO symptoms distal to knee
2. Symptoms < 16 days
3. Lumbar joint hypomobility
4. Fear Avoidance Behavior Questionnaire at Work < 19
5. ≥ 1 hip with MORE than 35° IR
Added benefit when used with exercise

40
Q

Mobilizations/ manipulations have strong evidence to improve what?

A

Strong evidence to improve hip mobility with subacute and persistent LBP

41
Q

Mobilizations/ manipulations have moderate evidence to improve what?

A

Moderate to strong evidence to improve LBP and disability with back related LE P!

42
Q

Mobilizations/ manipulations are short course at most; what does this mean?

A

MSK Exam 1 - Spring (9 decks)

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