Lumbar Flashcards
What is outlook for acute LBP
Good. withing 8 weeks, 80% will have recovery
What percentage of patients have pain 12 months following acute LBP
28%
What is the association between work related loading, prolonged sitting, and sport participation on recovery from LBP?
No relationship identified
What characteristics have been identified as having shorter recovery time from LBP? (3 items)
Lower initial pain
Shorter duration of pain
Fewer previous episodes
Red flags for metastatic cancer (5 items)
CA history night pain/pain at rest unexplained weight loss Age over 50 or under 17 failure to improve
Red flags for disc or vertebral infection? (4 items)
imunosuppression
prolonged fever over 100.4
IV drug use
recent UTI, cellulitis, pneumonia
Red flags for vertebral fx (6 items)
prolonged corticosteroid use mild trauma over age of 50 over 70 years old osteoporosis major trauma bruising over spine following trauma
Red flags for AAA (4 items)
pulsating mass in abdomen
history of atherosclerosis
throbbing, pulsing back pain at rest or in sitting
older than 60
What are blue flags
factors related to return to work
What effect does aerobic fitness have on CLBP
Reduces the increased awareness of neural stimulus
What effect does weight training have on low back pain?
decreased frequency of acute episodes
3 guidelines for low back clinical practice
1) stay active, avoid bed rest
2) behavioral education
3) education on physiology of pain
What is the make up of the outer-most annulus
dense, well oriented type-1 collagen
Clinical importance of outer most annulus
virtually all neurovascular structures for IVD are typically located here.
Inner portion of annulus make up
type 1 collagen, lacks organization present in outer most layer
Transitional zone of IVD
thin, fibrous tissue that surround nucleus pulposus
What area may be the “weak link” of IVD?
portion of end plate that is adjacent to vertebral body- hyaline cartilage which is weakly attached to bone
Variance in fluid levels of IVD with time of day
higher in morning with healthy disc.
Changes not present with injured disc or healthy disc of people over 35
What are strongest predictors of DDD
genetic influence on water content and spinal structures
What incidence of DDD do weight lifters have
Lower than expected in absence of trauma
Age related changes in collagen make up of disc
Type II becomes type 1. less permeable and decreased fluid exchange
Which portion of IVD is typically the failure point following trauma?
end plate
Are there differences in diffusion when comparing age related IVD changes and symptomatic changes?
yes, impaired diffusion in symptomatic
Do annular tears have healing capacity?
limited, but yes. May lead to reduced pain threshold later in life.
When may symptoms present following trauma to a degenerated disc?
hours following trauma due to altered response to load bearing
Should flexion activities be performed in morning with DDD?
No, due to fluid changes less pain noted in those who avoid flexion stretching in morning.
