Low Back Pain Flashcards
- aching pain in the gluteal region
- parasthesias that radiate down the back of the leg
- worse after sitting > 15-20 mins
- “wallet sign”
piriformis syndrome
actions of piriformis muscle
when hip is extended:
- external rotation
when hip is flexed:
- aBduction
straight leg raise test
(+) increased pain between 30°-60°
- inicates lumbosacral radiculopathy d/t herniated disc or sciatic neuropathy
psoas syndrome
- RLQ pain that radiates to the lower back
- worse with standing
- hypertonic psoas muscle
what SDs are commonly associated with psoas syndrome? (4)
- 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
- midline low back pain
- worsens as the day progresses
- surgical Hx
- difference in iliac crest heights
short leg syndrome
Chapma’s point on the iliolumbar ligament
colon
what SDs are commonly associated with short leg syndrome? (7)
- 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
what are the reccomendations for heel lift therapy?
- fragile
- start 1/16”
- add 1/16” every 2 weeks
- flexible
- start 1/8”
- add 1/8” every 2 weeks
spondylolysis
stress fracture in the pars interarticularis
spondylolisthesis
stress fracture plus slidiung of vertebra
what causes spondylolysis/spondylolisthesis?
hyperlordosis d/t hyperextension and overuse
how does spondylolysis present in children?
- usually asymptomatic
- possible change in gait/posture
- possible hamstring hypertonicity
what SDs are commonly associated with spondylolysis/spondylolisthesis? (5)
- psoas spasm or inhibition
- iliacus dysfunction
- flexed upper lumbar dysfunction
- sacroiliac/sacral torsion
- innominate dysfunction
symptoms of disc herniation
- pain in the buttock that radiates down the posterior thigh
- straight leg test
causes of disc herniation
- compression and/or rotational force
- common with bending or lifting
what is the most common type of spinal disc herniation?
posterolateral herniation at
- L4-5 or L5-S1
what OMT treatment is particularly helpful for disc herniation?
FPR, especially if symptoms of radiculopathy are present
- lower back pain radiating down bilateral posterior thighs
- urinary and bowel changes
- saddle anesthesia
cauda equina syndrome
- intermittent low back pain
- worse with bending over and sitting down
- improved with lying down
degenerative disc disease “wear and tear”
- low back pain
- improves with sitting down or leaning over
- worse with standing for long periods of time
- numbness and tingling in posterior thighs
spinal stenosis
causes of spinal stenosis
narrowing of the spinal canal
- herniated or bulging disc
- abnormal mass
- osteophytes/bone spurs from OA
- scar tissue from previous surgery
central stenosis may result in ________.
neurogenic claudication
25 modifier
separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service
