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a. Yr 2 Athletic Training & Functional Rehab > Lumbar Spine > Flashcards

Lumbar Spine Flashcards

1
Q

Some epidemiology of low back pain for clinical reasoning

A

60-80% of adults will at some points of their lives experience LBP

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2
Q

What are the 3 main diagnostics from lower back pain

A

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

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3
Q

What is non-specific low back pain

A

Tension, soreness or stiffness in lower back region which isn’t possible to identify a specific cause of pain

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4
Q

What are potential generators of lower back pain

A

Muscle or ligaments
Dura mater
Nerve roots
Zygapophyseal joints
Annulus fibrosus
Thoracolumbar fascia
Vertebrae

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5
Q

What is radicular / nerve root pain

A

Sharp, shooting, superficial or deep pain into the leg
Unilateral leg pain worse than LBP
Radiates to foot or toes

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6
Q

What is the difference between radicular pain, radiculopathy and somatic pain

A

Radicular pain = definitive sharp shooting pain
Radiculopathy = no pain but numbness down back or front of leg
Somatic pain = aching pain and poorly localised

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7
Q

What are red flags for patients coming in with lower back pain

A

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

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8
Q

What are some other specific causes of lower back pain - to build knowledge base of clinical patterns

A

Inflammatory conditions
Bony trauma
Spondylolysthesis
Osteoporosis
Metabolic disorders
Infections like TB

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9
Q

Who are the vulnerable populations for lower back pain
Serious pathology
Occupations
Psycho-social issues
Posture

A

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?

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10
Q

What are common aggs and eases for low back pain

A

Sitting activities
Standing from sitting
Coughing a sneezing

Lying with hips and knee flexed - crook lying

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11
Q

What are yellow flags to be aware of from patients coming in with lower back pain

A

Belief that back pain is harmful
Avoidance behaviours
Low moods or withdrawals
Expect passive treatment is better than active participation

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12
Q

What night symptoms should you be aware of for low back pain

A

Is there a change in sleep patterns.
What symptoms keep the client awake
Type of pillow or mattress ?

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13
Q

What can the 24hr pattern of LBP say for patients

A

Initial stiffness in the morning may suggest spondylosis or OA
Stiffness that lingers for more than a few hours may suggest inflammatory pathology

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14
Q

What are risk factors for LBP

A

Weight
Smoking
Occupation
Activity

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15
Q

What should be observed at the start of objective examination

A

Curves
Bulk
Gait
Cardinal signs
Pelvic level
Lateral shift

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16
Q

What lower back ROM tests should be conducted in objective examination for lumbar spine

A

With overpressure look at
Flexion
Extension
Lateral flexion
Rotation when patient sat
Try combination or repeated movements

Schobers test for flexion

17
Q

What neurological tests can be conducted for assessing low back pain

A

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

18
Q

What special tests can be conducted for low back pain patients apart from neurodynamic test

A

passive physiological inter-vertebral movement tests (PPIVMS)

Passive accessory intervertebral movements (PAIVMS)

SI joint screening tests (PA tests)

19
Q

What tools can be used to help decide what do to with someone with lower back pain

What are included in the nice guidelines

A

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

20
Q

What are types of treatment options for low back pain patients

A

NICE guidelines
Mainlands, Mcenzies
Movement dysfunction

Soft tissue
Bio-psycho-social
Pain

21
Q

What is joint mobilisation

A

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

22
Q

How do mobilisations increase ROM

A

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

23
Q

What are passive physiological intervertebral movement tests used for

A

Determine the amount of segmental movement at each level
Palpated between the spinous processes to assess the motion as normal, hypomobile and hyper mobile

24
Q

What are passive accessory intervertbral movements tests used to assess

A

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

25
Q

What are the maitland grades of mobilisations

A

Grade 1 = small amplitude movement at the beginning of the avaible ROM
Grade 2 = large amplitude movement at within the avaiblle ROM
Grade 3 = large amplitude movement that reaches end of ROM
Grade 4 = small amplitude movement at very end range of motion
Grade 5 = high velocity thrust of small amplitude at the end of available range and within anatomical range

26
Q

What are grades 1 and 2 used for in mainlands mobilisations

A

Treat pain prior to reaching resistance
It is a neurophysiological treatment which doesn’t use the end ROM
And don’t produce pain or discomfort

27
Q

What are grades 3 and 4 used for in mainlands mobilisations

A

Used to treat resistance and pain within the restricted area

28
Q

What are contraindications for mobilisations

A

Severe pain
Malignancy
Severe scoliosis
Active AS or RA
Bony block
Fresh fractures
Acute nerve root ittirtation

29
Q

What directions of mobilisations are there

A

A-P
P-A
Transverse
Longitudinal caudad
Longitudinal cephalad
Distraction
Compression
Medial guide
Lateral guide

30
Q

What muscle strength tests are there to assess with lower back pain

A

Hip flexor
Hip extensors
Quads
Hamstrings
Abdominal muscle control
Glut med/min clam test
Glut max strength and hamstring strength

a. Yr 2 Athletic Training & Functional Rehab (17 decks)

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