Lumbar spine pathologies

Question 1

Axial spondyloarthropathy definition

Answer 1

chronic inflammatory disease that effects the vertebral joints and other peripheral joints causing stiffness and pain

Question 2

etiology and epidemiology of Axial spondyloarthropathy

Answer 2

• 2:1 male to female

- HLAB 27 gene linked

Question 3

Pathology of Axial spondyloarthropathy

Answer 3

Caused by inflammation which destroys the bones of the discs of the vertebrae causing new collagen to be laid down which turns into bone (ossification)

This can cause joint fusion and compression of nearby nerves

Question 4

Symptoms of Axial spondyloarthropathy

Answer 4

• Loss of ROM in spine
• Pain in lower back radiating down to buttock
• inflammation of achilles tendon
• ## fatigue

Question 5

Outcome measures Axial spondyloarthropathy

Answer 5

• schober’s test
• visual analogue scale
• disability index

Question 6

cautions/contraindications for Axial spondyloarthropathy

Answer 6

• quickly fatigue

- watch for flare ups

Question 7

Definition of lumbar disc prolapse

Answer 7

nucleus pulposus is displaced from the intervertebral space causing lower back pain

Question 8

Epidemiology of lumbar disc prolapse

Answer 8

• 2:1 male to female
• most common in middle age adults
• caused by excessive lifting (flexion

Question 9

Pathology of lumbar disc prolapse

Answer 9

• soft inner core of nucleus pulposus is surrounded by hard annulus fibrosis
• nucleus protrudes through annulus
• this causes pressure to spinal nerves and increases inflammatory cytokines
• discs become dehydrated

Question 10

Outcome measures for disc prolapse

Answer 10

• straight leg raise and reflex testing

Question 11

cautions/contraindications for disc prolapse

Answer 11

• cauda equina syndrome
• chronic pain
• permanent nerve injury
• paralysis

Question 12

Treatment for disc prolapse

Answer 12

• strengthening exercises
• mckenzie approach
• proprioception and balance training

Question 13

Mckenzie approach

Answer 13

Posture syndrome (>30 years old)

• pain occuring due to mechanical deformation of soft tissue
• pain arises during static position
• treated by correcting posture and avoiding provocative postures
• no loss of movement

Dysfunction syndrome (30+ years old)

• pain occurs due to mechanical deformation of structurally impaired tissues
• pain arises at end range of specific movement
• treatment by mobilising exercises in the direction that reproduces the pain ( aim to remodel tissue)

Derangement syndrome (20 to 55 years old)

• pain caused by the disturbance of the normal resting position of affected joint surfaces
• pain may be local or referred
• gross loss of movement

Question 14

Main mckenzie principles of treatment

Answer 14

Postural - postural correction and back care advice

Dysfunction - movement that produces pain is selected
(stretch and elongate contracted structures)

Derangement - movement that eases pain is selected
(reducing derangement)

Question 15

Lumbar spondylosis

Answer 15

degenerative condition affecting the lumbar vertebrae causing back pain (non inflammatory)

Question 16

Lumbar spondylosis epidemiology

Answer 16

• sex ratios the same

Question 17

Lumbar spondylosis symptoms

Answer 17

• lower back pain (can refer)
• muscle weakness in legs and back
• stiffness in lower back

Question 18

Lumbar spondylosis pathology

Answer 18

• degeneration of cartilage over time
• discs become dehydrated causing collapse and possible prolapse of nucleus
• dehydration of the discs decreases their ability to shock absorb
• ligaments become weaker (lose their tension)
• push into the area of spinal nerves - causes pain
• osteophytes can occur

Question 19

Lumbar spondylosis treatment

Answer 19

• strengthening - glutes, back muscles and abdominals

- mobilising - joints of spine and the hip/knee