Low Back Pain

Question 1

What is Greenman’s “Dirty 1/2 dozen” for failed back syndrome?

Answer 1

Type II lumbar SD, pubic symphysis shears, backward sacral torsions, innominate shears, short leg syndrome or pelvic tilt syndrome, and muscular imbalance of the trunk and LE

Question 2

What are the signs of psoas syndrome?

Answer 2

Difficulty sitting or standing upright, forward bent posture (lists to one side). ipsilateral short leg, and contralateral externally rotated leg.

Question 3

What is stage four (where most patients present) of psoas syndrome progression?

Answer 3

Psoas spasm with backward sacral torsion and contralateral piriformis spasm.

Question 4

What is stage five of psoas syndrome progression?

Answer 4

Onset of contralateral sciatic nerve irritation (ipsilateral to the piriformis spasm).

Question 5

What is the attachment and function of the quadratus lumborum?

Answer 5

Attaches from the 12th rib to the pelvis and iliac crest. Stabilizes the 12 rib and causes ipsilateral lumbar SB.

Question 6

What are the signs of QL dysfunction/trigger point?

Answer 6

Deep aching pain at rest, sharp pain with movement, rolling and sit standing painful, and mistaken for S1 radicular pain (Pseudo-disc syndrome)

Question 7

When the glut medius/minimus are weak stabilizers what are the overactive synergists and shortened antagonists?

Answer 7

TFL, QL, and piriformis are overactive synergists and the thigh adductors are shortened antagonists.

Question 8

When the glut maximus is a weak stabilizer what are the overactive synergists and shortened antagonists?

Answer 8

Iliocast and hanstrings are overactive synergists and iliopsoas and rectus femoris are shortened antagonists.

Question 9

When the lower trapezius is a weak stabilizer what are the overactive synergists and shortened antagonists?

Answer 9

Levator scapulae and upper trapezius are overactive synergists while the pectoralis major is a sortened antagonist.