Lumbar Pathology

Question 1

lumbar strain or sprain s/s and treatment

Answer 1

movement impairments and restrictions
normal neurologic exam
any referred symptoms dont extend below knee

manual therapy and exercise
easing modalities
dry needling or soft tissue techniques

Question 2

facet joint dysfunction acute

Answer 2

sudden onset
twisting mechanism common
spontaneous locked back

Question 3

facet joint dysfunction chronic

Answer 3

degen changes
loading stress
facet hypertrophy

Question 4

signs of facet joint dysfunction

Answer 4

difficulty standing upright
protected posture
muscle spasm guarding
limited motions
-unidirectional (typically closing restriction)
-multidirectional (both opening and closing restrictions due to severity of sxs)

check neuro status
normal- mobility TBC Category
abnormal- centralization DP TBC category

local tenderness- joint hypomobility

Question 5

degen changes

Answer 5

affect entire motion segment

DDD- degenerative disc disease
circumferential and radial tears
disc disruption
herniation
desiccation/ narrowing
end plate injuries , schmorls nodes

Question 6

most common degenerative changes sites

Answer 6

L4 -5
L5-S1

Potential neural foramina and or central canal compromise

Question 7

degenerative changes risk factors

Answer 7

age
environment
trauma
genetics

Question 8

degenerative changes factors

Answer 8

aggravated with loading activities: sit, stand, or periods of immobility
eased with movement, directional preference, morning stiffness

Question 9

disc and facet pain

Answer 9

often nondermatomal
can refer distally, typically not past butt
symptoms- central, deep, diffuse, ache

Question 10

central stenosis- congenital

Answer 10

usually shortened pedicles; onset 20s-40s
pars defect may advance as in acquired

Question 11

central stenosis acquired

Answer 11

degenerative- onset 60s-90s
spondylolysis to spondylolisthesis typical teens to 20s

Question 12

central stenosis- iatrogenic

Answer 12

post- laminectomy from adjacent level degeneration

Question 13

Lumbar spinal stenosis is worse in… (what might you find)

Answer 13

worse in extension, unsupported walking
better in flexion, sitting down, pushing grocery cart

often tight hip flexion/illiopsoas, rectus femoris, often weak glut max, TrA, basic postural adaptations to lower activity can compound problem

possible LMN UMN findings

Question 14

neurogenic description

Answer 14

bilateral, may be unilateral
burning and paresthesias in back, buttock and or legs

Question 15

vascular claudication description

Answer 15

bilateral
usually cramping in calves and legs

Question 16

neurogenic signs and symptoms

Answer 16

normal pulses
good skin nutrition
diminished reflexes
SLR test may be positive
often have LE weakness

Question 17

vascular claudication symptoms

Answer 17

dec pulses
color skin changes
normal reflexes
usually no LE weakness

Question 18

neurogenic location

Answer 18

low back, buttock thighs, calves and feet

Question 19

AGG factors for neurogenic

Answer 19

inc in spinal extension
inc with walking, less painful with uphill

Question 20

AGG factors for vascular

Answer 20

pain consistent in all spinal positions
onset with physical activities
inc by stair climbing or uphill

Question 21

EASE factors neurogenic

Answer 21

dec pain with sitting, lying down, flexion
may persist for hours

Question 22

ease factors vascular

Answer 22

relieved promptly by standing still, sitting down or resting
eased in 1-5 minutes

Question 23

2 Stage treadmill

Answer 23

tolerance to level walking vs walking 15% incline self selected speed
earlier onset level, more prolonged time to onset incline more specific for LSS Dx

Question 24

bike test

Answer 24

pedal upright bike sitting upright to symptom onset
continue pedaling, but with trunk flexed
symptoms better- neurogenic eases with opening central canal
symptoms worse- vascular (inability to meet metabolic demand of muscle load)

Question 25

identify impairments for central LSS

Answer 25

gait
muscle length deficits
muscle power deficits
mobility deficits

Question 26

central LSS goals

Answer 26

centralize
monitor neuro status
retore function and conditioning

Question 27

treatment considerations for central LSS

Answer 27

stretching- hip flexors, anterior hip mobs, lumbar opening

motor control- trunk stabilization

body weight supported treadmill
deweight
restore gait mechanics
improve muscle function and conditioning

Question 28

SIJ dysfunction history

Answer 28

step off curb or fall on buttocks
rotational injury
pain with stairs, unilateral loading

Question 29

SIJ dysfunction pain

Answer 29

doesnt go higher than L5
unilateral
absence of central lumbar pain

Question 30

SIJ exam

Answer 30

3 or more positive provocation tests
impairments
hypo v hypermobile
stiffness or instability

anterior v posterior dysfunction

Question 31

rules out Disc degeneration

Answer 31

pain not above L5
Pain unilateral, and not central
No centralization or peipheralization

Question 32

rules in SIJ

Answer 32

Pain not above L5
Pain unilateral, and not central
No centralization, or peripherilazation
Three of six positive provocation tests (positive LR equals 6.97)

Question 33

SIJ dysfunction management considerations- instability

Answer 33

postpartum
Generalized laxity

consider
Motor control exercises for lumbar and hip region
SIJ stabilization belt
Other impairments identified

Question 34

SI dysfunction management-hypomobility

Answer 34

Differentiate between ankylosing spondylitis

consider lumbar and hip mobilizations
Consider self mobilization exercise