Low Back Pain Flashcards
Prevalence of LBP
80% of adults will have LBP
only 25% seek care
Up to 85% of ppl w/ LBP will have recurrent LBP
T or F: There is little relationship between physical pathology & associated pain and disability
True!
only 15% of ppl w/ LBP will have a pathoanatomoical diagnosis & none have specific biomarkers
+ NOT EVERYONE IS SYMPTOMATIC desite presence of pathoanatomy
Pain Generators in Lumbar Spine
Muscles
Ligaments
Dura Mater
Nerve Roots
Zygopophyseal Joints
Sacroiliac Joint
Annulus Fibrosus
Thoracolubar Fascia
Vertebrae
Muscle Trigger Points (TrPs)
Result of trauma, repetitive strain, postural dysfunction, nerve root dysfunction (neuropathic pain)
Mechanism Behind Muscle TrPs
Evidence that TrPs pain is due to disordered spinal segmental reflex
excessive ACh release at NMJ generates sustained contraction = structural generatino of TrP
Intervertebral Disc Herniation
Most common source of compressive radiculopathy
Lumbar roots emerge BELOW vertebrae and are most vulnerable just above foraminal exit
ex: L4/5 disc = L5 root (50% most common!) & L5/S1 = S1 root (46.3% most common)
INSERT PIC
Describe the pictured limbar disc herniation
Protrusion
this is a contained herniation: nuclear pulposus material does not escape the annulus
INSERT PIC
Describe the pictured lumbar disc herniation
Extrusion
nuclear material remains attached to disc but annulus bulges into intervertebral canal
Be cautious with manipulation
INSERT PIC
Describe the pictured lumbar disc herniation
Sequestration
Nuclear material migrates and escapes contact with disc entirely to become a free fragment in the canal
What % of LBP pts present with lateral shifts?
12%
Contralateral Shift
Trunk shifts away from side of pain
MOST COMMON (96%) & BEST PROGNOSIS
Ipsilateral Shift
Trunk Shifts Toward side of pain
LEAST COMMON & WORST PROGNOSIS
sequestration common also more lateral or larger herniations
Describe Shift Correction Responses
Correcting Shift is 1st Priority
Correcting Shift Centralizes Symptoms to LB = Green Light
Correcting Shift Peripheralizes Symptoms to LE = Red Light
Resolution of HNP
Large herniations will decrease more than small esp. after 6 months
Spontaneous regression more for: Sequestration > Extrusion > Protrusion > Bulging
Facet Joint Syndrome (Zygopophyseal Joints)
Degenerative arthritis of facet joints
Pain will refer down to the patients gluteal region MAX (no leg)
Can be caused by fx, capsular tears, or damage to articular cartilage
Treatment of Facet Joint Syndrome
Reproduce “famliar” LBP
Injections can help to diagnose and releive pain
7 Factors correlated with pain relief from facet injections
Older Age
Previous History LBP
Normal Gait
Maximal pain w/ extension from fully flexed
Absence of leg pain
Absence of muscle spasm
No pain w/ Valsalva
Sacroiliac Joint Pain
SI joint is diarthrodial synovial & STABLE (movment <2mm)
More prevalent in women due to relaxin
Caused by trauma, hormone changes, overload
Can present as hyper- or hypo-mobility
Treatment: exercise, manual, SI belts, injections, fusion
Spondylosis
degenerative changes to IVD or any part of joint
OA of the spine, very common
Spondylolysis
bone defect in pars interarticularis / verterbral arch
unilateral
increased lumbar lordosis or hyperextension trauma
Spondlylolisthesis
anterior slipping / displacement of on vertebral body in relation to the vertebral body below it due to bilateral pars defects
Slippage can compress spinal canal & is Graded I - IV in 25% increments
Can cause Step Deformity
Spondylosis Treatment
exercise
NSAIDS
injections
rarely surgery
Spondylolisthesis Treatment
Exercise: Avoid end range extension
Caution with
Surgery
Step Deformity
External bony protrusion that can be caused by spondylolisthesis
