Lumbopelvic Differential Diagnosis Flashcards
What are the common pain patterns for internal disc disruption?
- Gluteal pain
- Possible mid-line pain
- Pain worst in the morning
What are the risk factors for internal disc disruption?
- Age > 50 years
- Repetitive trauma/motion
- Awkward/repetitive work
- Vibration and seated positions
- Prior low back pain
What are common examination findings for internal disc disruption?
- Pain early & 2D ROM
- Pain with segmental mobilization
- (+) Positive pain over spinous processes
What manual therapy techniques are used for internal disc disruption?
- Traction
- Joint mobilization (thoracic and lumbar)
- STM/MFR of glutes, paraspinals, QL
What therapeutic exercises are recommended for internal disc disruption?
- Directional preference exercises
- Progressive loading exercises
- Motor control retraining
What are the classifications of disc herniation?
- Protrusion
- Prolapse
- Extrusion/sequestration
What is the typical pain pattern for disc herniation?
- Nerve root level pain
- Discogenic pain
- Pain worst in the morning and at night
What are the risk factors for disc herniation?
- Age 30-50 years
- Male > female
- Work-related twisting
- Smoking
- Multiple pregnancies
- Obesity
- Mental stress
- Prior history of LBP
What are common examination findings for disc herniation?
- guarded posturing
- pain early/mid 2D ROM (flexion)
- (+) positive Valsalva/sneeze/cough
- (+) positive STLR and slump test
- sensory changes
- weakness
- decreased sensation or DTR
What manual therapy techniques are used for disc herniation?
- Traction
- Joint mobilization (thoracic and pelvis),
- STM/MFR of glutes, paraspinals, QL
What therapeutic exercises are recommended for disc herniation?
- Neural flossing
- Directional preference extension-based exercises
- Piriformis stretching
- Progressive loading for deep core
- Endurance strengthening
- Body mechanics education
What are the classifications of foraminal stenosis?
- lumbar radiculopathy/itis
- lumbar spondylosis
- chronic sciatica syndrome
- degenerative disc diseases
- secondary disc disease
What is the typical pain pattern for foraminal stenosis?
- bilateral buttock or leg pain
- pain worst in the evening
What are the risk factors for foraminal stenosis?
- age > 65 years
- activity outside of norm
- previous lumbar surgeries
What are common examination findings for foraminal stenosis?
- forward lean/decreased lordosis
- wide-based gait
- Possible weakness
- sensation loss
- decreased DTR
What manual therapy techniques are used for foraminal stenosis?
- Joint mobilization (thoracic and pelvis)
- STM/MFR in flexion paraspinals, glutes, QL
What therapeutic exercises are recommended for foraminal stenosis?
- neural flossing
- postural education
- flexion-based exercises
- flexibility preservation
- thoracic mobility
- balance activities
- gait retraining
What is the classification of piriformis syndrome?
- deep gluteal syndrome,
- sciatica caused by extra pelvic entrapment
- hip/buttock pain
- leg pain without LBP
What is the typical pain pattern for piriformis syndrome?
- Pain in buttock that shoots/burns or aches down the back of the leg.
- Worse in the morning, inactivity worsens.
What are the risk factors for piriformis syndrome?
- Trauma to the buttock
- Prolonged sitting
- Hypertrophy of hip ER
- Anatomical variations where the sciatic nerve passes through the muscle belly of piriformis.
What are common examination findings for piriformis syndrome?
- (+) Positive pain with resisted ER or passive IR (FAIR position)
- (+) Positive SLR
- Negative hip testing other than hip derotation test and FAIR
- (+) Positive palpation of the piriformis
What manual therapy techniques are used for piriformis syndrome?
- Mobilizations/manipulations to the lumbar spine, pelvis, and hip joint
- STM/MFR of piriformis and glutes
- Dry needling to piriformis
What therapeutic exercises are recommended for piriformis syndrome?
- Stretching/inhibiting the piriformis muscle
- Nerve glides to sciatic
- Hip strengthening to glut med and max
- Lumbar stabilization/motor control exercises
What is the classification of lumbar spondylosis/facet syndrome?
- Lumbar spondylosis
- Facet syndrome
- Local lumbar syndrome
- Lumbago
- Spinal arthritis
- Degenerative joint
What is the typical pain pattern for lumbar spondylosis/facet syndrome?
- Facet pain referral pattern
- Well-localized LBP with any LE pain located above the knee
- Absence of neuro deficits/nerve tension
- Lateral pain non-midline
What are the risk factors for lumbar spondylosis/facet syndrome?
- Age > 50 years
- History of DDD
What are common examination findings for lumbar spondylosis/facet syndrome?
- Possible hyperlordosis
- Hypomobility in spring test
- Pain late & 3D ROM, ext+rot (ipsi) +SB (ipsi)
- (+) Positive hypomobility and spring test
What manual therapy techniques are used for lumbar spondylosis/facet syndrome?
- Joint-specific traction
- joint mobilization (lumbar, pelvis, and thoracic)
- STM/MFR of paraspinals, glutes, piriformis
What therapeutic exercises are recommended for lumbar spondylosis/facet syndrome?
- postural retraining
- mobility focus
- facet distraction in flexion or rotation
- thoracic postural muscles
- directional preference for flexion
What is the classification of spondylolisthesis?
- Lumbago
- Spondylosis
- Anterolisthesis
- Flexion preference
What is the typical pain pattern for spondylolisthesis?
- history of trauma
- repeated unprovoked episodes of low back feeling unstable
- aberrant motions
- Gowers sign
What are the risk factors for spondylolisthesis?
- Age < 20 years
- males > females
- hyperextension activities
- impact-related activities
- repetitive posturing
What are common examination findings for spondylolisthesis?
- excessive lumbar lordosis
- restricted ROM
- (+) positive PIT test
- (+) positive stork test
What manual therapy techniques are used for spondylolisthesis?
- Sacral counternutation
- STM/MFR of paraspinals, glutes, QL
What therapeutic exercises are recommended for spondylolisthesis?
- flexion-based exercises, reduce hyperlordosis
- squat retraining
- deep core stabilization, activation & endurance
- thoracic postural muscles
- sensory awareness of positioning
What is the classification of lumbar spine instability?
- Lumbar laminectomy
- lumbar hypermobility syndromes
- anteriolisthesis
- spondylolisthesis
What is the typical pain pattern for lumbar spine instability?
- Varies, with subjective complaints of popping and clunking, end ranges of motion cause pain.
What are the risk factors for lumbar spine instability?
- trauma
- ligamentous laxity
What are common examination findings for lumbar spine instability?
- Gowers sign
- choppy movements
- guarded movements
- high levels of muscle guarding
- (+) positive PIT
- (+) positive hip abduction test
- (+) positive bilateral leg lowering test
What therapeutic exercises are recommended for lumbar spine instability?
- progressive loading
- stabilization exercises
- address fear avoidance behaviors
- utilize directional preferences
- address impairments
- sensory angle reproduction
- laser neutral/tracing
- add secondary task
- add reflex reactivation
What is the classification of lumbar sprain/strain?
- Sprain strain
- SI joint dysfunction
- myositis
What is the typical pain pattern for lumbar sprain/strain?
- localized low back pain with no leg pain
- guarding and pain posturing
What are the risk factors for lumbar sprain/strain?
- lifting
- trauma (MVA)
- women > men
- anxiety or depression
- older age
What is the typical pain pattern for lumbar Sacroiliac Joint Dysfunction (SIJD)?
- Worse when standing from seated position
- End range pain
- Running worse than walking
- Buttock pain
- Tender to Palpation
What is the typical manual therapy for lumbar Sacroiliac Joint Dysfunction (SIJD)?
Joint Mobilization:
- SI joint manipulation
- SI joint Muscle Energy
SIJD vs Lumbar
What is the typical pain pattern for Pelvic Floor Dysfunction?
- Pelvic/abdominal/hip Myofascial pain
- Dyspareunia: pain with intercourse
- Vaginismus = spasms
- Vulvodynia: Chronic vulva pain
