Lumbar Spine Flashcards
Some epidemiology of low back pain for clinical reasoning
60-80% of adults will at some points of their lives experience LBP
What are the 3 main diagnostics from lower back pain
Non-specific lower back pain is 95%
Radicular pain from nerve root compressions cause nueropathic pain like sciatica is 5%
Serious pathology from red flags
What is non-specific low back pain
Tension, soreness or stiffness in lower back region which isn’t possible to identify a specific cause of pain
What are potential generators of lower back pain
Muscle or ligaments
Dura mater
Nerve roots
Zygapophyseal joints
Annulus fibrosus
Thoracolumbar fascia
Vertebrae
What is radicular / nerve root pain
Sharp, shooting, superficial or deep pain into the leg
Unilateral leg pain worse than LBP
Radiates to foot or toes
What is the difference between radicular pain, radiculopathy and somatic pain
Radicular pain = definitive sharp shooting pain
Radiculopathy = no pain but numbness down back or front of leg
Somatic pain = aching pain and poorly localised
What are red flags for patients coming in with lower back pain
Bilateral pain
For patients with new episode, take consideration for
Malignancy in old people with past history of tumours
Infection in those who have impaired immune function
Osteoporotic fractures
Cauda equina specific questions
What are some other specific causes of lower back pain - to build knowledge base of clinical patterns
Inflammatory conditions
Bony trauma
Spondylolysthesis
Osteoporosis
Metabolic disorders
Infections like TB
Who are the vulnerable populations for lower back pain
Serious pathology
Occupations
Psycho-social issues
Posture
SP = those under 20, those over 50
Occupations = heavy physical work, prolonged static postures, repetitive bending and heavy lifting
PSI = anxiety, depression, mental stress at work
Posture = lordotic? Kyoholordotic, sway or flat back?
What are common aggs and eases for low back pain
Sitting activities
Standing from sitting
Coughing a sneezing
Lying with hips and knee flexed - crook lying
What are yellow flags to be aware of from patients coming in with lower back pain
Belief that back pain is harmful
Avoidance behaviours
Low moods or withdrawals
Expect passive treatment is better than active participation
What night symptoms should you be aware of for low back pain
Is there a change in sleep patterns.
What symptoms keep the client awake
Type of pillow or mattress ?
What can the 24hr pattern of LBP say for patients
Initial stiffness in the morning may suggest spondylosis or OA
Stiffness that lingers for more than a few hours may suggest inflammatory pathology
What are risk factors for LBP
Weight
Smoking
Occupation
Activity
What should be observed at the start of objective examination
Curves
Bulk
Gait
Cardinal signs
Pelvic level
Lateral shift
What lower back ROM tests should be conducted in objective examination for lumbar spine
With overpressure look at
Flexion
Extension
Lateral flexion
Rotation when patient sat
Try combination or repeated movements
Schobers test for flexion
What neurological tests can be conducted for assessing low back pain
S1 myotome
Slump test
L1 - L5 myotomes and S1 to S2
Dermatomes of lower limb
Reflex test of patella and Achilles
Straight leg raise and passive neck flexion
Femoral nerve test
What special tests can be conducted for low back pain patients apart from neurodynamic test
passive physiological inter-vertebral movement tests (PPIVMS)
Passive accessory intervertebral movements (PAIVMS)
SI joint screening tests (PA tests)
What tools can be used to help decide what do to with someone with lower back pain
What are included in the nice guidelines
START back pain screening tool - help catogorise a person to what response a person will roughly have from treatment
NICE guidelines - multimodal approach =
Group exercise programme with NHS
Manual therapy is small part of trx
Consider psychological therapy as well
Pharmalogical interventions - oral NSAIDs or weak opioids
What are types of treatment options for low back pain patients
NICE guidelines
Mainlands, Mcenzies
Movement dysfunction
Soft tissue
Bio-psycho-social
Pain
What is joint mobilisation
An externally imposed small amplitude passive motion that is intended to produce gliding or traction at a joint
Used to increase joint ROM or reduce pain
How do mobilisations increase ROM
Tissue surrounding joint has elastic component so that if a force is applied to it over a sufficient time period a temptoratu length change will occur
Minimum Rx time is 30 seconds
Length change is achieved by a biomechanical force delivered to soft tissue known as Creep or hysteresis
What are passive physiological intervertebral movement tests used for
Determine the amount of segmental movement at each level
Palpated between the spinous processes to assess the motion as normal, hypomobile and hyper mobile
What are passive accessory intervertbral movements tests used to assess
Used to assess the amount and quality of movement at various intervertebral levels and to treat pain and stiffness of the spine
Known as mainlands mobilisations
Can be used to assess or treat
Treatments are graded timed and tempo may change according to symptoms
