Lumbar Pathology Flashcards
lumbar strain or sprain s/s and treatment
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
facet joint dysfunction acute
sudden onset
twisting mechanism common
spontaneous locked back
facet joint dysfunction chronic
degen changes
loading stress
facet hypertrophy
signs of facet joint dysfunction
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
degen changes
affect entire motion segment
DDD- degenerative disc disease
circumferential and radial tears
disc disruption
herniation
desiccation/ narrowing
end plate injuries , schmorls nodes
most common degenerative changes sites
L4 -5
L5-S1
Potential neural foramina and or central canal compromise
degenerative changes risk factors
age
environment
trauma
genetics
degenerative changes factors
aggravated with loading activities: sit, stand, or periods of immobility
eased with movement, directional preference, morning stiffness
disc and facet pain
often nondermatomal
can refer distally, typically not past butt
symptoms- central, deep, diffuse, ache
central stenosis- congenital
usually shortened pedicles; onset 20s-40s
pars defect may advance as in acquired
central stenosis acquired
degenerative- onset 60s-90s
spondylolysis to spondylolisthesis typical teens to 20s
central stenosis- iatrogenic
post- laminectomy from adjacent level degeneration
Lumbar spinal stenosis is worse in… (what might you find)
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
neurogenic description
bilateral, may be unilateral
burning and paresthesias in back, buttock and or legs
vascular claudication description
bilateral
usually cramping in calves and legs
neurogenic signs and symptoms
normal pulses
good skin nutrition
diminished reflexes
SLR test may be positive
often have LE weakness
vascular claudication symptoms
dec pulses
color skin changes
normal reflexes
usually no LE weakness
neurogenic location
low back, buttock thighs, calves and feet
AGG factors for neurogenic
inc in spinal extension
inc with walking, less painful with uphill
AGG factors for vascular
pain consistent in all spinal positions
onset with physical activities
inc by stair climbing or uphill
EASE factors neurogenic
dec pain with sitting, lying down, flexion
may persist for hours
ease factors vascular
relieved promptly by standing still, sitting down or resting
eased in 1-5 minutes
2 Stage treadmill
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
bike test
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)
identify impairments for central LSS
gait
muscle length deficits
muscle power deficits
mobility deficits
central LSS goals
centralize
monitor neuro status
retore function and conditioning
treatment considerations for central LSS
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
SIJ dysfunction history
step off curb or fall on buttocks
rotational injury
pain with stairs, unilateral loading
SIJ dysfunction pain
doesnt go higher than L5
unilateral
absence of central lumbar pain
SIJ exam
3 or more positive provocation tests
impairments
hypo v hypermobile
stiffness or instability
anterior v posterior dysfunction
rules out Disc degeneration
pain not above L5
Pain unilateral, and not central
No centralization or peipheralization
rules in SIJ
Pain not above L5
Pain unilateral, and not central
No centralization, or peripherilazation
Three of six positive provocation tests (positive LR equals 6.97)
SIJ dysfunction management considerations- instability
postpartum
Generalized laxity
consider
Motor control exercises for lumbar and hip region
SIJ stabilization belt
Other impairments identified
SI dysfunction management-hypomobility
Differentiate between ankylosing spondylitis
consider lumbar and hip mobilizations
Consider self mobilization exercise
