Lumbar Pathology Flashcards
Lumbar Spine Fracture Prediction Rule (spinal compression fracture)
- Significant Trauma
- Female
- Over 70 years old
- Prolonged use of corticosteroids
Prognostic Factors for LBP
- Depression and fear avoidance
- High chance of developing recurrent low back pain with history of previous episodes, excessive spine mobility, excessive mobility at other joints
- High chance of having chronic LBP if symptoms present below the knee, depression and other stress, fear of pain with movement/ activity, low expectation of recovery, high pain intensity
Lumbosacral Segmental/somatic dysfunction
- Facet dysfunction
- Lumbar strain
LBP with mobility deficit
- Acute symptoms of low back; unilateral pain, buttock pain, thigh pain
- Restricted lumbar ROM and segmental mobility
- End range spinal motion produces the pain and LE symptoms
- MOI = awkward, sudden twisting or bending motion or incorrect healing
Flexion (opening) impairment
Facet dysfunction
- active ROM causes pain specifically with movements into sitting flexion
- Palpation tenderness and issues with transverse process movement when performing sitting flexion
Extension (closing) impairment
Similar facet dysfunction with flexion impairment but issue of pain and hypo mobility occurs in prone extension
Lumbar Muscle Strains
Injury to muscles of the low back: usually quadratus lomborum, psoas major, iliocostasis, multifidi, erector spinae muscles
- Trauma of low back that results in contusion, stretching or tearing of muscles in low back
- Micro tears may also contribute to this
- pain with stretching lumbar muscles effected or with lumbar extension from flexion
Spinal Instabilities
- spondylosis and spondylolisthesis
Degeneration
Low back pain with movement coordination deficits
- Acute exacerbation of recurring low back pain that is also associated with referred LE pain
- symptoms occur at initial to mid range movements
- lumbopelvic coordination impairments with flexion and extension movements
- lumbar segmental hypermobility
- additional mobility deficits at pelvis/ hip and thorax
- decreased strength and endurance
- repetitive movements or trauma related pain
- relief with posture changes
Lumbar instability or ligament sprain
Pain is worse with sustained postures, especially flexion at end range
- segmental hyper mobility (central PA, lumbar extension)
- muscle guarding and spasms
- proprioceptive deficits
- poor trunk control and endurance
- lower cross syndrome
- special test = passive lumbar extension test lifting legs off the table brings on pain and also patient describes heavy feeling or pain in low back
Lumbago with referred LE pain due to IV disc displacement
- low back pain worse with flexion activities and sitting
- pain with cough and sneeze
- positive SLR test possible if the nerve root is being compressed
- low back pain can be centralized or diminished with position change
- lateral trunk shift with limited lumbar extension mobility
- recurrent pain over 1 year
- symptoms worse with prolonged sitting or repetitive forward bending
- central PA will reproduce pain at affected segment
Lumbago with sciatica/ radiculopathy
- Acute low back pain other radiating pain into involved LE
- parasthesia or numbness/ weakness reported
- symptoms reproduced with slump test or SLR at initial to mid rage spinal mobility (different than with disc issues and referred pain)
- nerve root involvement present
- shooting pain usually below the knee
- strength and sensation deficits associated with ankle and foot movements
- lateral position shift present for pain relief
Chronic Low Back Pain
Low back pain lasting for longer than 3 months
- generalized low back pain not associated with other impairments
- worst prognosis due to depression, fear avoidance beliefs, and/ or pain castrophizing
Spinal Stenosis
Patient prefers flexion or hunched over position because extension hurts
