Lumbar Spine & SI Injuries Flashcards
What are the MOIs for low back pain?
Mechanical (i.e. posture, obesity, body mechanics, etc.)
Trauma
Recurrent/Chronic low back pain
True or false:
Mechanical back pain will remain in only the back. It won’t refer down past the butt.
True…it will only stay in the back region.
Where does mechanical low back pain come from?
Chronic overuse, posture, body mechanics, obesity, etc.
What are some signs and symptoms of low back pain? How should you treat this?
Antalgic gait, pain, weaknesss, etc.; correcting any malalignments or body mechanics, strengthening and stretching. Also focus on proper segmental mechanics
For lower cross syndrome, what muscles are tight? (x9)
Iliopsoas Rectus femoris Hamstrings Erector spinae Tensor Fascia Latae Thigh adductors Piriformis Quadratus lumborum Gastroc/Soleus
For lower cross syndrome, what muscles are weak? (x9)
Rectus abdominis Transverse abdominis Obliques Gluteus maximus Gluteus medius Gluteus minimis Vastus lateralis Vastus medialis Tibialis
What is the MOI for a low back muscle strain?
Sudden extension/contraction overload with some type of rotation
What are the signs and symptoms of a low back muscle strain?
Localized pain, no radiating pain distal to the butt, and no neurological involvement
What is myofascial pain syndrome? What is this often associated with?
Regional pain with referred pain to a specific area that occurs with pressure or palpation of a tender spot or trigger point within a muscle. Often associated with the thoracolumbar fascia
What is the MOI for a lumbar vertebrae fracture?
Compression fracture– trunk hyperflexion/falling from a height
Spinous/Transverse process fracture– direct blow
True or false:
Transverse and spinous process fractures are generally unstable fractures.
False–they are generally stable because of all the muscles and soft tissues that would surround the fracture.
True or false:
Vertebreal dislocations are rare.
True
What are some signs and swellings associated with a lumbar vertebrae fracture?
Point tenderness along the spinous/transverse processes, localized swelling, muscle guarding, palpable deformity of the spinous/transverse processes
What is the MOI for sciatica? (x6)
Nerve root compression IVD protrusion Tight piriformis Joint inflammation Structural irregularities within the intervertebrael foramen Bone spurs
What are the signs and symptoms of sciatica? Do they appear gradually or abruptly?
Sharp shooting radicular pain Tingling/numbness/burning Altered reflexes Weakness Symptoms can arise either gradually or abruptly
Why is it important to discover if sciatica is affecting a more general area or a specific (dermatome) area?
It can help pinpoint the cause of the sciatic..For example if it is general then the piriformis is probably tight because it is affecting the whole lower leg (after the nerves have converged to innervate that area). If it is more dermatome specific, then the problem is probably a nerve root or disc problem.
What is the most common discs to herniate?
L5 and S1
What is the management for sciatica?
Rest acutely and treat whatever is causing the sciatica
What is the MOI for a herniated disc?
Abnormal stress (i.e. forward bending and twisting) or degeneration of the discs
What are the signs and symptoms of a herniated disc? (x6) Is there a sudden or gradual onset?
Centrally localted pain
Unilateral radiculopathy pain in a dermatome pattern
Worse in the morning
Pain after sitting and then resuming activity (very painful)
Pain increase with bending and sitting
Pain decrease with back extension
These symptoms have a sudden or gradual onset
How do herniated discs present neurologically?
Unilaterally and dermatome specific
Where is the pain located with a herniated disc?
Centrally in the center of the spine
True or false:
There may be secondary muscle spasms associated with herniated discs.
True
What should initial treatment of a herniated disc be?
Pain-reducinng modalities (i.e. ice, heat, e-stim)
What other treatment could be used for a herniated disc?
Traction
Core strengthening
Surgery may be required
What position may help to slip a herniated disc back into place?
Supine with the back extended (pushing up on the arms)
For a herniated disc, when would surgery probably be required?
If the symptoms continue to worsen or the patient is continuing to have motor issued for longer than 12 weeks (3-6 months)
What is piriformis syndrome?
Hypertrophy or spasm of the piriformis muscle that results in generalized radiculopathy
What may be some signs and symptoms of piriformis syndrome? (x5)
Generalized radiculopathy Dull ache in the buttock Pain going up stairs or inclines Pain while sitting/walking/running Reduced hip ROM
What is the treatment for piriformis syndrome?
Stretching of the piroformis/ massage release (elbow)
Breaking up the spasm
What is a spondylolysis?
Degeneration of the pars interarticularis due to contenital weakness (results in a stress fracture)
What is a spondylolisthesis?
A slipping of one vertebrae above or below another
What are the signs and symptoms of a spondy?
Pain that begins unilaterally Persistant pain and aching, Low back stiffness with increased pain after activity Frequent need to change position Localized tenderness Some possible segmental hypermobility Step off deformity
What type of fracture is a spondy?
Scottie dog fracture
How are spondylolisthesis graded?
Grades 1-4 depending upon the measurement of an x-ray of how far the vertebrae has slipped forward
The seated 3 F’s are testing for what?
IS dysfunction
The standing 3 F’s are testing for what?
SI dysfunction
What are the MOIs of a SI sprain? (x4)
Twisting with both feet on the ground
Stumbles, falls backwards
Heavy landing on one leg
Bending forward with knees locked during lifting
What occurs in an SI sprain?
Irritation and stretching of the SI ligaments
What are the 3 major signs and symptoms of a SI sprain?
Palpable pain and tenderness over joint
Increased pain with unilateral stance
Pain when moving from sitting to standing
True or false:
Having a anterior or posterior rotated pelvis could lead to a SI sprain?
True because they could block normal movement during trunk flexion
Where could SI pain radiate?
Posteriorly, laterally, or anterior down the thigh
may also refer to the groin
Where should you always start treatment for an SI sprain?
On the affected side
True or false:
A pt may have pain in the pubic symphysis when they have an SI sprain.
True…this is because of shearing forces placed on it (idk that’s what Sue said :p)
When the ilium is anteriorly rotated, what is the orientation of the ASIS and PSIS as compared to normal?
ASIS= lower PSIS= higher
When the ilium is posterior rotated, what is the orientation of the ASIS and PSIS as compared to normal?
ASIS= higher PSIS= lower
When thinking there may be a pelvic outflare vs inflare, what two anatomical structures should you look at?
ASIS to umbilius
How are all the anatomical structures in relation to the bilateral side in a pelvis upslip?
Higher
What is a nutated sacrum? Counter-nutated sacrum?
Nutated= flexed
Counter nutated= extended
How are sacral torsions named?
Based on the torsion on the axis
How should we treat SI and IS dysfunctions? (x5)
Acutely= try to encourage healing
Chronic= treat the signs and symptoms, restrict from activity as needed
Focus on exercises to stabilized the hypermoble segments
Muscle energy
Core strengthening
True or false:
People dealing with an SI or IS dysfunction are at a higher risk of developing a lumbar strain or sprain.
True…so vigorous activity may need to be limited with these people until the dysfunction is under control to avoid the lumbar problems.
