Lumbar Spine: history and Interview Flashcards
1
Q
What neuromusculoskeletal structures can cause LBP
A
- Muscles or fascia strains
- nerves
- ligaments and joint capsules
- bones
- disc
- emotional overlay?
2
Q
What visceral structures can refer symptoms to the lumbar region
A
- lower GI tract
- uterus
- kidneys
- aortic aneursym
- pancreas
- prostate
- testicular dysfunction
- myocarditis
3
Q
What are some of the first questions you will want to know during the history and interview and why
A
- patient’s age: may be more suceptible to certain conditions
- patients occupation: what stresses are they undergoing
- gender: some conditions may impact them differenly or be more common in a specific gender
4
Q
Types of Pain
A
- Nociceptive
- nociplastic
- neuropathic
5
Q
Nociceptive pain
A
- due to activation of nociceptors due to acute tissue injury
- inflammation, mechanical irritant
- Pain localized to the area of injury +/- somatic referral
- clear proportionate mechanical or anatomical nature to aggravating and easing factors
- usually intermittent and sharp with movement or mechanical provocation, may be more constant dull ache or throb at rest
6
Q
Nocicplastic pain
A
- due to disturbances in central pain processes
- perception of pain is heighted and prolonged
- increased excitability
- decreased inhibition
7
Q
Nociplastic pain signs
A
- disproportionate, non-mechanical, unpredictable, pattern of pain provocation
- pain disproportionate to the nature and extent of injury or pathology
- diffuse/non-anatomic areas of pain and tenderness on palpation
- strong association with maladaptive psychological factors
- try to prevent rather than treat
8
Q
Neuropathic pain
A
- due to lesion or disease of somatosensory system
- radiculopathy, neuropathy etc
- pain referred in dermatomal or cutaneous nerve distribution
- history of nerve injury, pathology, or mechanical compromise
- pain/symptoms provocation with mechanical testing which move, load or compress neural tissue
9
Q
What questions to ask during history and interview in reguards to pain
A
- how long have you had the pain
- location of pain
- pain quality
- what makes it better worse or the same
10
Q
Centralization vs periperalization
neuropathic pain
A
- Centralization of pain is the progressive retreat from the most distal extend of referred or radicular pain toward midline
- peripheralization is pain moving toward peripheral
- centralization = getting better
11
Q
What other questions to ask with Back/spine pain
A
- increase symptoms with cough/sneeze: this increases pressure around the dura of the spine
- postures which decrease or increase pain: whats being stressed
- worse in the morning or evening: things like OA
- what movements cause your pain
- paresthesia/anesthesia
- weakness or reduced strength
- usually activities/pastimes
- aggravting activities
- activities that ease pain
- sleeping position
- difficulty with urination
- imaging: can think something on image is causing pain when its not
- general health
12
Q
Red flags with Back pain
A
- insidious and progressing
- H/O cancer
- back and abdominal pain
- LBP with saddle numbness and incontience
- pain does not vary with activity
- constant unrelived with posiiton
- unable to be still
- increase
- > 45
- LBP with nausea, vomiting fever
13
Q
Lumbar classification
A
- subgrouping patients with LBP evolution of a classification approach to physical therapy
- manipulation
- stabilization
- specific exercise
- traction
14
Q
Manipulation
requirements
A
- no symptoms distal to knee
- recent onset <16 days
- Low FABQ score
- hypomobility of the lumbar spine
- Hip IR ROM >35º
15
Q
Patient signs that they would need
Stabilization
A
- young age <40
- greater general flexibility
- instablity catch/aberrant
- +prone instability test
- post partum
