Lower Back Pain Flashcards
History taking for back pain
Character/location onset course relationship to work/activity exacerbating or relieving factors prior tx litigation/work comp
mechanical LBP
most common dx in adults
Frequently multifactorial
mechanical lbp common causes
Muscle spasm
facet joint inflammation
SI joint dysfunction
PE for LBP (mechanical)
Inspection, palpation, ROM, joint/muscle provocative tests, straight leg raises, neurologic testing
Evaluation for mechanical lbp
Xray** MRI CT TPBS EMG
mechanical lbp tx
TIME AND MOVEMENT Early mobilization physical therapy core stabilization adjustment/manipulation massage (rolfing)
Mechanical LBP prognosis and recurrence
35% in 1 mo
85-90% in 3 mo
95% in 6 mo
62% recur in 1 yr
80% in 2 yr
- manage and prevent
Degenerative diseases
spinal stenosis
facet arthrosis
spondylolisthesis
sacroiliac arthrosis
DJD/SS pathophysiology
gradual narrowing of spinal canal and/or neural foramina
osteophyte formation, facet hypertrophy, bulging disks, hypertrophy of ligamentum flavum
DJD/SS Dx
low back pain radiating posteriorly to ankles and feet
symptoms worse w/ erect posture
numbness, tingling, foot drop
kip, knee, ankle, foot pain
DJD/SS tx
TIME AND MOVEMENT PT meds (steroids, NSAIDs, narcotics) Dorsal column stimulators surgery (MAJOR)
Spondylolisthesis
forward slipping of one vertebrae on another
Spondylolisthesis clinical presentation
frequently asymptomatic
may be painful (motion, sleeping)
radicular sxs w/ nerve root irritation
Spondy tx
non op - meds, PT, TENS
op only if progressive slip, uncontrolled pain
Acute disc herniation presentation
LBP identifiable precipitant radicular sxs (sciatica) sensory sxs motor sxs
Acute Disc herniation physical findings
Splinting (leaning)
+/- tenderness
straight leg raise
reflexes, motor function, sensory exam
Acute disc herniation tx
TIME AND MOVEMENT active rest oral steroids pain meds \+/- PT *not chiro MOST GET BETTER W/OUT SURGERY
Acute disc herniation indications for surgery
pain, corresponding lesion on MRI, radicular sxs, motor weakness, surgical candidate
Acute disc herniation surgery
microdiscectomy
fusion
causes of sciatica
disc disease spinal stenosis piriformis entrapment peripheral entrapment vascular claudication others
Back pain in children causes
mechanical (less common) spondylolysis/spondylolisthesis disc disease tumor infection rheum visceral psychosomation
**Usually more serious and need to follow up
What to know about child back pain (hx)?
location, precipitants/modifiers, activity, radicular sxs, constitutional sxs, associated sxs, home stressors
Back pain in children - dx
Xrays - 5 view TPBS *** MRI CT \+ lab work (less likely - CBC, CRP, ESR, rheum, LP, EMG)
spondylolysis tx in kid
activity modification
time
bones stimulator
bracing, surgery?
