Low Back Pain: Piriformis, Psoas Syndrome, Short-leg Syndrome, Lumbosacral Pathology Flashcards
Type I spinal mechanics is maintained by ____ restrictors, whille type II mechanics are maintained by _____ restrictors
Long; short
In type I spinal mechanics, _____ occurs first, while type II mechanics ____ occurs first
SB; R
Pathophysiology of a muscle spasm
Stretch of muscle activates Ia afferent fibers —> stimulates alpha motoneurons in the SC —> extrafusal fibers contract
Gamma motoneurons are co-activated with alpha motoneurons ensuring muscle spindle will remain sensitive to changes in muscle length
Even if muscle goes back to neutral or to shortened position, the abnormal gamma motor neuron stim elicits the stretch reflex and maintains the spasm
Nociception theory for facilitation
Once an impulse from the Sc reaches the motor neuron, there is release of peptides in peripheral tissues
The peptides are of inflammatory cascade and initiate release of prostaglandins and bradykinins, etc
Results in lowering nociceptor thresholds thus increasing input to SC
Once stimulus is strong enough to activate nociceptive pathways, impulses travel tot he cord then branch to multiple sites
______ = the enhancement of the response of a neuron to stimulus following stimulation
Facilitation
Right sided piriformis syndrome causes what sacral SD?
L/L ST
[and L5 would be rotated R; also leads to ipsilateral short leg]
Special tests for piriformis syndrome
SLR Freiburg sign Pace sign FAIR test Beatty test
What test can help differentiate piriformis syndrome from intervertebral disc herniation
EMG
What ortho test helps distinguish between piriformis syndrome and herniated disc?
FAIR test
T/F: heat works well for psoas syndrome
False — don’t use heat with this dysfunction!
Shoud you do direct stretching or MET in acute psoas syndrome?
NO — may make it worse
What is legg-calve-perthes
Idiopathic avascular necrosis of femoral head — causes short leg syndrome
L5-S1 ambulatory compensation in short leg syndrome
L5 SB towards axis, rotates opposite (toward deep sulcus)
Heilig lift formula for short leg syndrome
Total lift needed = sacral base unleveling/[Duration + compensation]
[duration <10 years = 1, 10-30 years = 2, >30 years = 3; no compensation = 0, L spine rotation/SB = 1, wedging of vertebrae = 2. If acute changes, full amount is recommended]
