Lumbar

Question 1

What is outlook for acute LBP

Answer 1

Good. withing 8 weeks, 80% will have recovery

Question 2

What percentage of patients have pain 12 months following acute LBP

Answer 2

28%

Question 3

What is the association between work related loading, prolonged sitting, and sport participation on recovery from LBP?

Answer 3

No relationship identified

Question 4

What characteristics have been identified as having shorter recovery time from LBP? (3 items)

Answer 4

Lower initial pain
Shorter duration of pain
Fewer previous episodes

Question 5

Red flags for metastatic cancer (5 items)

Answer 5

CA history
night pain/pain at rest
unexplained weight loss
Age over 50 or under 17
failure to improve

Question 6

Red flags for disc or vertebral infection? (4 items)

Answer 6

imunosuppression
prolonged fever over 100.4
IV drug use
recent UTI, cellulitis, pneumonia

Question 7

Red flags for vertebral fx (6 items)

Answer 7

prolonged corticosteroid use
mild trauma over age of 50
over 70 years old
osteoporosis
major trauma
bruising over spine following trauma

Question 8

Red flags for AAA (4 items)

Answer 8

pulsating mass in abdomen
history of atherosclerosis
throbbing, pulsing back pain at rest or in sitting
older than 60

Question 9

What are blue flags

Answer 9

factors related to return to work

Question 10

What effect does aerobic fitness have on CLBP

Answer 10

Reduces the increased awareness of neural stimulus

Question 11

What effect does weight training have on low back pain?

Answer 11

decreased frequency of acute episodes

Question 12

3 guidelines for low back clinical practice

Answer 12

1) stay active, avoid bed rest
2) behavioral education
3) education on physiology of pain

Question 13

What is the make up of the outer-most annulus

Answer 13

dense, well oriented type-1 collagen

Question 14

Clinical importance of outer most annulus

Answer 14

virtually all neurovascular structures for IVD are typically located here.

Question 15

Inner portion of annulus make up

Answer 15

type 1 collagen, lacks organization present in outer most layer

Question 16

Transitional zone of IVD

Answer 16

thin, fibrous tissue that surround nucleus pulposus

Question 17

What area may be the “weak link” of IVD?

Answer 17

portion of end plate that is adjacent to vertebral body- hyaline cartilage which is weakly attached to bone

Question 18

Variance in fluid levels of IVD with time of day

Answer 18

higher in morning with healthy disc.

Changes not present with injured disc or healthy disc of people over 35

Question 19

What are strongest predictors of DDD

Answer 19

genetic influence on water content and spinal structures

Question 20

What incidence of DDD do weight lifters have

Answer 20

Lower than expected in absence of trauma

Question 21

Age related changes in collagen make up of disc

Answer 21

Type II becomes type 1. less permeable and decreased fluid exchange

Question 22

Which portion of IVD is typically the failure point following trauma?

Answer 22

end plate

Question 23

Are there differences in diffusion when comparing age related IVD changes and symptomatic changes?

Answer 23

yes, impaired diffusion in symptomatic

Question 24

Do annular tears have healing capacity?

Answer 24

limited, but yes. May lead to reduced pain threshold later in life.

Question 25

When may symptoms present following trauma to a degenerated disc?

Answer 25

hours following trauma due to altered response to load bearing

Question 26

Should flexion activities be performed in morning with DDD?

Answer 26

No, due to fluid changes less pain noted in those who avoid flexion stretching in morning.