Low Back Pain LECT

Question 1

Aching pain in gluteal region increasing after sitting longer than 15-20 minutes, with “wallet” sign is indicative of what syndrome?

Answer 1

Piriformis syndrome

Question 2

How is the sacrum affected by a tight piriformis?

Answer 2

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

Question 3

How are L1 and L2 commonly affected by psoas syndrome?

Answer 3

Flexed and rotated toward side of affected psoas

Question 4

How is L5 commonly affected by psoas syndrome?

Answer 4

Extended

Question 5

Where are the tenderpoints for psoas syndrome commonly found?

Answer 5

Ipsilateral iliacus

Contralateral piriformis

Question 6

Short leg syndrome is commonly due to dysfunctions where?

Answer 6

Sacroiliac, lumbosacral joints

Question 7

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?

Answer 7

Short leg syndrome

Question 8

In short leg syndrome, what structure is the first to react to added stress in the lumbosacral area?

Answer 8

Iliolumbar ligament

TTP at attachment on iliac crest or L4/L5 TP

Question 9

What is the somatic dysfunction associated with short leg syndrome?

Answer 9

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

Question 10

What is the indication for heel lift therapy in short leg syndrome?

Answer 10

Typically only tx if leg length discrepancy is >5mm

Question 11

If there is an acute change in leg length in short leg syndrome, how quickly must you replace the discrepancy?

Answer 11

Replace the full discrepancy immediately

Question 12

What is the postural fault most implicated in spondylolysis/spondylolisthesis?

Answer 12

Hyperlordosis

Question 13

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?

Answer 13

Spondylolisthesis

Question 14

Spondylolysis is a stress fracture in the ________

Answer 14

Pars Interarticularis

Question 15

Common somatic dysfunctions in spondylolysis/spondylolisthesis

Answer 15

Psoas spasm

Iliacus dysfunction

Flexed upper lumbar dysfunction

Sacroiliac/sacral torsion

Innominate dysfunction

Question 16

What type of spinal disc herniation is most common?

Answer 16

Posterolateral herniation

Question 17

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?

Answer 17

Spinal disc herniation

Question 18

Discs most commonly affected by spinal disc herniation?

Answer 18

L4-L5

L5-S1

Question 19

Clinical test of choice for confirmation of herniation

Answer 19

MRI

Question 20

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?

Answer 20

Cauda Equina syndrome

Requires urgent surgical referral - do not tx with OMT

Question 21

What part of the spine is most affected by degenerative disc disease?

Answer 21

Lumbar spine

Due to mobility and weight-bearing responsibilities

Question 22

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?

Answer 22

Spinal stenosis

Question 23

Diagnosis of spinal stenosis is made with what test?

Answer 23

MRI

Question 24

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)?

Answer 24

HVLA