low back pain

Question 1

how common is LBP

Answer 1

4th cause MD visits. 33% of pop. 20% have activity limit.

Question 2

risk factors for LBP

Answer 2

work (heavy lifting, bending, twisting, vibration), obesity, arthritis or osteoporosis, physical inactivity, pregnancy, >30 yrs old, bad posture, stress or depression. smoking.

Question 3

PMH and FH are important

Answer 3

trauma, surgery, illness, deformities. family important for congenital, scoliosis, arthritis, genetics.

Question 4

classification acute

Answer 4

<6 weeks

Question 5

subacute

Answer 5

6-12 weeks

Question 6

chronic/persistent/recurrent

Answer 6

> 12 weeks.

Question 7

moderately serious things to watch out

Answer 7

risk for chronicity, psychological factors, neurological, intractable pain that is refractory.

Question 8

serious things to watch out for

Answer 8

age (55), significant trauma, unexplained weight loss, widespread neurological changes. massive paresis, bowel/bladder dysfunction, excruciating pain, UMN signs.

Question 9

what to look for on inspection

Answer 9

alignment, contour, symmetry, size, gross deformity. look at muscle size, fasciculations or spasms. posture. heat, tenderness, swelling, crepitus.

Question 10

assessing ROM and strength.

Answer 10

spinal mobility and legs (hip flexion ext rotation. thigh abduction adduction, knee flexion and extension. ankles and toes. manual muscle test. 5 = 100% 0 = no evidence of muscle contraction.

Question 11

myotome for hip flexion

Answer 11

l1/l2

Question 12

myotome for knee extenison

Answer 12

L3

Question 13

myotome for ankle dorsiflexion

Answer 13

L4

Question 14

myotome for great toe extensor

Answer 14

L5

Question 15

myotome for plantar flexion

Answer 15

s1

Question 16

ACHILLES reflex

Answer 16

gastrocnemius/soleus, S1 spinal segment, tibial peripheral nerve

Question 17

babinski reflex

Answer 17

top extensor, L4-5 and S1-2, tibial nerve

Question 18

biceps reflex

Answer 18

biceps brachii, C5, musculocutaneous

Question 19

brachioradialis reflex

Answer 19

brachioradialis, C6, radial.

Question 20

triceps reflex

Answer 20

triceps brachii, C7, radial.

Question 21

patellar reflex

Answer 21

quadriceps femoris, L4, femoral.

Question 22

balance and gait testing

Answer 22

ROMBERG! test for equilibrium (cerebellar, vestibular, sensory). check for dynamic balance -push shoulders expect quick recovery, static with one foot and eye closed. hopping on individual leg. gait: observe the anterior/posterior sides, trunk control, arm swing, rhythm, symmetric. check heel-to-toe walking.

Question 23

herbison 3 minute back exam

Answer 23

thoracic rotation, thomas test, mod gaenslens test, mod ely’s, mod femoral nerve stretch test, mod obers, hip ROM, straight leg raise, FABERE/patrick’s test.

Question 24

treatment for LBP

Answer 24

bed rest, exorcise with massage, manipulation, psychology, refer to specialist if red signs

Question 25

pharma for LBP

Answer 25

acetaminophen, NSAIDs, muscle relaxants.