Lower Back Pain 2 Flashcards
What nerves contribute to iliopsoas strength?
L1 to L3
What nerves contribute to quadriceps strength?
L2 to L4
What nerves contribute to the hip adductor muscle strength?
L2 to L4
What nerve contributes to tibialis anterior strength?
L4
What nerve contributes to extensor hallucis longus strength?
L5
What never contributes to extensor digitorum longus and brevis strength?
L5
What nerve contributes to gluteus medius strength?
L5
What nerve contributes to fibularis longis and brevis strength?
S1
What nerve contributes to gluteus maximus strength?
S1
What nerves contribute to gastrocnemius and soleus strength?
S1 and S2
During the iliopsoas testing, if there is low back pain excerbaton what could that indicate?
Discogenic pain
What is psoas syndrome and what are some etiologies?
Flexion-contracture of the iliopsoas due to prolonged positioned with a shortened psoas
What is the quality of iliopsoas pain and where is it located?
Achy muscle spasm
In the lower back, radiating to the groin
What are the signs and symptoms of ilipsoas syndrome?
Increase pain standing or walking Positive thomas test Positive tp medical to ASIS Positive pelvic shift test Nerve weakness in L1 and L2 Contralateral periformis spasm
How would you treat ilipsoas syndrome?
Acute - ice and no use of heat initially
Indirect followed by direct OMM
Chronic - stretch
What is tested for L1, L2 and L3 for sensation?
Anterior thigh
What is tested for L4 for sensation?
Medial side of the foot
What is tested for L5 for sensation?
Web space between great toe and second toe
What is tested for S1 for sensation?
Lateral side of the foot
What is tested for S2, S3, S4 and S5 for sensation?
Perianal skin
What kind of tests can you do for sensation
Pin prick for pain
Light touch with a wisp
Vibration with a tuning fork
If there is an abdominal source of lower back pain where is a likely location?
Retroperitoneal viscera
When palpating the abdomen what should you been palpating and testing?
Palpate for guarding response, masses and presence of abdominal aneurysm
What does the Valsalva exam test for?
It will exacerbate the symptoms of any space occupying lesion in the spinal canal
Positive test for pain reproduction
How is the Valsalva test performed?
Patient is supine
Place hand or fist on mid-abdominal area
Gently inc pressure and have patient press back with abdominal wall
How would the Soto Hall test be performed?
Patient is supine
Restrain the sternum
Passively flex the neck
What does it mean when pain is elicited in the Soto Hall test?
Spinal disorder
What tests can be done for scaroiliac joint pain?
Pelvic Rock test (grabs AIIS and wiggle) Gaenslen test (grab one knee, drop the other) Patrick test (scottish dancing)
What does the Patrick test look for?
Tests for sacroiliitis
Also tests for joint disease
What type of test is a Patrick test and what are the motions?
Pain reproduction test
FABERE
Flexion, Abduction, External Rotation and Extension
What will a positive Nachalas test produce?
Pain radiation down the anterior though which implies femoral nerve entrapment/disease
How is the Nachalas test performed?
Patient is prone
Leg flexed at the knee
What are the two ways to test trunk strength?
Raise shoulders prone and hold 10 seconds
Raise legs prone and hold 10 seconds
What is the pathogenesis for spinal stenosis?
Degenerative changes in the L-spine:
Hypertrophy of facet joints
Ca++ deposits in lig lavum/post long lig
Loss of intervertebral disc height
What is the quality and location of pain in spinal stenosis?
Lower back to lower legs
Achy, shooting pain with paresthesias
What are the signs and symptoms of spinal stenosis?
Worsened by extension (standing, walking, lying supine)
Osteophytes and decreased intervertebral space on imaging
What is the treatment for spinal stenosis?
OMT : decrease restriction, inc ROM
PT, NSAIDs, low dose steroids
Epidural steroid injection
Surgical laminectomy with decompression
What is the pathogensis of a herniated nucleus propulsus
Narrowing of posterior long lig
95% at L4-L5 or L5-S1
Exterts pressure on nerve root of vertebra below
Where is the location and quality of pain in a herniated nucleus propulsus?
Low back and lower leg
Numbness, tingling, sharp burning, shooting pain worsens with flexion
What are the signs and symptoms of a herniated nucleus propulsus?
Weakness and decreased reflexes
Sensory deficit in corresponding dermatome
Positive straight leg test
What test is a the gold standard for herniated nucleus propulsus?
MRI
What is the treatment for a herniated nucleus propulsus?
Less than 5% are surgical candidates
Bed rest for max 2 days
Indirect OMM follow by gentle direct
