Low Back Pain LECT Flashcards
Aching pain in gluteal region increasing after sitting longer than 15-20 minutes, with “wallet” sign is indicative of what syndrome?
Piriformis syndrome
How is the sacrum affected by a tight piriformis?
Sacrum rotates anterior toward ipsilateral side on a contralateral oblique axis
(R piriformis syndrome causes L on L sacral torsion with compensatory rotation of lower lumbar vertebrae to the right)
Leads to ipsilateral physiologic short leg and ipsilateral hip external rotation
How are L1 and L2 commonly affected by psoas syndrome?
Flexed and rotated toward side of affected psoas
How is L5 commonly affected by psoas syndrome?
Extended
Where are the tenderpoints for psoas syndrome commonly found?
Ipsilateral iliacus
Contralateral piriformis
Short leg syndrome is commonly due to dysfunctions where?
Sacroiliac, lumbosacral joints
Pt with scoliosis c/o dull, midline lumbosacral aching. Pt c/o that pain gets worse as the day progresses. What syndrome might this be?
Short leg syndrome
In short leg syndrome, what structure is the first to react to added stress in the lumbosacral area?
Iliolumbar ligament
TTP at attachment on iliac crest or L4/L5 TP
What is the somatic dysfunction associated with short leg syndrome?
Lumbar spine sidebent away and rotated toward side of lower sacral base
Innominate rotated anterior on side of short leg
Foot on longer leg pronated with internal rotation
What is the indication for heel lift therapy in short leg syndrome?
Typically only tx if leg length discrepancy is >5mm
If there is an acute change in leg length in short leg syndrome, how quickly must you replace the discrepancy?
Replace the full discrepancy immediately
What is the postural fault most implicated in spondylolysis/spondylolisthesis?
Hyperlordosis
35 yo female athlete c/o pain in the buttock and posterior thigh after a motor vehicle accident. + Thomas test. On radiograph, pt appears to have a sliding vertebra at the lumbosacral joint. What is this presentation?
Spondylolisthesis
Spondylolysis is a stress fracture in the ________
Pars Interarticularis
Common somatic dysfunctions in spondylolysis/spondylolisthesis
Psoas spasm
Iliacus dysfunction
Flexed upper lumbar dysfunction
Sacroiliac/sacral torsion
Innominate dysfunction
What type of spinal disc herniation is most common?
Posterolateral herniation
Pt c/o sudden onset LBP with bending/lifting and numbness and tingling down the front and sides of the thigh after a motor vehicle accident 2 days ago (sudden or compressive force). Pt has a + Straight Leg Raise. What pathology is this?
Spinal disc herniation
Discs most commonly affected by spinal disc herniation?
L4-L5
L5-S1
Clinical test of choice for confirmation of herniation
MRI
Pt presents with bowel and bladder incontinence after motor vehicle accident yesterday which resulted in a lumbar spinal fracture. Upon examination, pt appears to have numbness and tingling in the perineal area. What pathology does this pt most likely have?
Cauda Equina syndrome
Requires urgent surgical referral - do not tx with OMT
What part of the spine is most affected by degenerative disc disease?
Lumbar spine
Due to mobility and weight-bearing responsibilities
60 yo female w/ PMH of osteoarthritis c/o low back pain exacerbated by standing and walking, relieved by sitting or lying down. Pt also complaints of numbness and tingling radiating down her thighs. What disease process is this?
Spinal stenosis
Diagnosis of spinal stenosis is made with what test?
MRI
What OMT is most contraindicated for low back pain in pts with back pain-related comorbidities (vertebral tumor, CA, osteoporosis, acute lumbar disc herniation, compression fx, Rheumatoid arthritis)?
HVLA
