Low Back Pain

Question 1

• aching pain in the gluteal region
• parasthesias that radiate down the back of the leg
• worse after sitting > 15-20 mins
• “wallet sign”

Answer 1

piriformis syndrome

Question 2

actions of piriformis muscle

Answer 2

when hip is extended:

• external rotation

when hip is flexed:

• aBduction

Question 3

straight leg raise test

Answer 3

(+) increased pain between 30°-60°

• inicates lumbosacral radiculopathy d/t herniated disc or sciatic neuropathy

Question 4

psoas syndrome

Answer 4

• RLQ pain that radiates to the lower back
• worse with standing
• hypertonic psoas muscle

Question 5

what SDs are commonly associated with psoas syndrome? (4)

Answer 5

• L1-2 F, R towards the dysfunction (type 2)
  
  • If chronic, there may be a type 1 SD above and below the type 2 dysfunction
• L5 E
• TPs on ipsilateral iliacus
• TPs on contralateral piriforms

Question 6

• midline low back pain
• worsens as the day progresses
• surgical Hx
• difference in iliac crest heights

Answer 6

short leg syndrome

Question 7

Chapma’s point on the iliolumbar ligament

Answer 7

colon

Question 8

what SDs are commonly associated with short leg syndrome? (7)

Answer 8

• iliolumbar ligament SD
• sidebent towards the side of the high innominate
• rotated away from the side of the high innominate
• anterior innominate roation ipsilateral to short leg
• posterior innominate rotation contralateral to short leg
• pelvic side shift to the side of the longer leg
• foot pronated and IR on longer leg

Question 9

what are the reccomendations for heel lift therapy?

Answer 9

• fragile
  
  • start 1/16”
  • add 1/16” every 2 weeks
• flexible
  
  • start 1/8”
  • add 1/8” every 2 weeks

Question 10

spondylolysis

Answer 10

stress fracture in the pars interarticularis

Question 11

spondylolisthesis

Answer 11

stress fracture plus slidiung of vertebra

Question 12

what causes spondylolysis/spondylolisthesis?

Answer 12

hyperlordosis d/t hyperextension and overuse

Question 13

how does spondylolysis present in children?

Answer 13

• usually asymptomatic
• possible change in gait/posture
• possible hamstring hypertonicity

Question 14

what SDs are commonly associated with spondylolysis/spondylolisthesis? (5)

Answer 14

• psoas spasm or inhibition
• iliacus dysfunction
• flexed upper lumbar dysfunction
• sacroiliac/sacral torsion
• innominate dysfunction

Question 15

symptoms of disc herniation

Answer 15

• pain in the buttock that radiates down the posterior thigh
• • straight leg test

Question 16

causes of disc herniation

Answer 16

• compression and/or rotational force
• common with bending or lifting

Question 17

what is the most common type of spinal disc herniation?

Answer 17

posterolateral herniation at

• L4-5 or L5-S1

Question 18

what OMT treatment is particularly helpful for disc herniation?

Answer 18

FPR, especially if symptoms of radiculopathy are present

Question 19

• lower back pain radiating down bilateral posterior thighs
• urinary and bowel changes
• saddle anesthesia

Answer 19

cauda equina syndrome

Question 20

• intermittent low back pain
• worse with bending over and sitting down
• improved with lying down

Answer 20

degenerative disc disease “wear and tear”

Question 21

• low back pain
• improves with sitting down or leaning over
• worse with standing for long periods of time
• numbness and tingling in posterior thighs

Answer 21

spinal stenosis

Question 22

causes of spinal stenosis

Answer 22

narrowing of the spinal canal

• herniated or bulging disc
• abnormal mass
• osteophytes/bone spurs from OA
• scar tissue from previous surgery

Question 23

central stenosis may result in ________.

Answer 23

neurogenic claudication

Question 24

25 modifier

Answer 24

separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service

Question 25

59 modifier

Answer 25

used for a distinct procedural service to indicate that 2+ procedures were performed during the same visit to different sites on the body

• Ex. OMT + trigger point injections in the same visit