Lumbrosacral Strain and Sprain II

Question 1

What is the correct way to execute “bed rest” for low back pain?

Answer 1

Flat on back with legs elevated, no more than 2 to 4 days

Question 2

How could you avoid more back irritation?

Answer 2

Avoid certain activities and positions, sitting (for disc injury) and bending forward or in the cantilevered position

Question 3

What can you do to to improve lower back pain and make it easier to stand?

Answer 3

Change position often, use a pillow for support while sitting (maintain lordotic curve), sit in chair w/ arms rests

Question 4

How many times while awake should a person be in a position of maximal comfort?

Answer 4

At least 10-15 minutes for each waking hour

Question 5

What are some aerobic activities that can be done while recovering from lower back pain?

Answer 5

Pool Walking
Swimming
Walking (on soft surface – no treadmill)
Elliptical Trainer
Stationary Bicycle (No Recumbent Bicycle)

Question 6

How much increase in exercise should be done in the first 2 weeks?

Answer 6

20 to 30 minutes per day

Question 7

What is the evidence that stretching exercises are effective for acute low back pain?

Answer 7

None

Question 8

What is the maximum time span for activity restriction?

Answer 8

Three months

Question 9

How long should you sit and stay seated based on your pain?

Answer 9

No Pain: 50 minutes
Mild Pain: 40 minutes
Moderate: 30 minutes
Severe: 20 minutes

Question 10

How much should a woman weight lift based on pain?

Answer 10

No Pain: 40 pounds
Mild Pain: 35 pounds
Moderate: 20 pounds
Severe: 20 pounds

Question 11

It is not recommended to do routine testing in the first month of lower back pain unless:

Answer 11

A red flag shows up in a physical exam

Question 12

Why wait four weeks?

Answer 12

80% of people recover and it reduces the potential of labeling asymptomatic age related (over 30) changes in the low back as being responsible for the symptoms

Question 13

What does a radionuclide bone scan do?

Answer 13

Will “light up” areas of high bone turnover

Will also respond to severe inflammation such as very bad arthritic changes

Question 14

What testing should be done in conjunction with a radionuclide bone scan?

Answer 14

Must be interpreted in conjunction with x-ray, CT or MRI

Question 15

What is the first imaging modality of choice for back pain? Second choice?

Answer 15

1. X-ray

2. MRI

Question 16

What should be done if there is unresolved radicular pain or muscle weakness?

Answer 16

Electromyography / Nerve Conduction Velocity (EMG/NCV)

Question 17

What does the EMG/NCV do?

Answer 17

Will differentiate between nerve root damage vs a peripheral nerve lesion

Question 18

What do Somatosensory Evoked Potentials (SSEP) and Dermatomal Evoked Potentials (DEP) do?

Answer 18

Evaluate sensory system (combined with NCV)

Question 19

What are MRIs good at visualizing?

Answer 19

Demonstrating soft tissue pathology such as the herniated disc, spinal tumors, abscesses, etc

Question 20

What is computerized tomography good at visualizing?

Answer 20

Best at delineating bone pathology such as small fracture fragment

Question 21

What is the goal standard of imaging intraspinal pathology?

Answer 21

Ct and myelogram

Question 22

Which procedure has the highest risk of complications?

Answer 22

CT/myelogram combo

Question 23

Describe an open MRI;

Answer 23

0.2 to 0.3 Tesla
Better for peripheral joints which can be positioned in the magneto-center of the imaging device
Peripheral Joints may be placed in any position desired

Question 24

Describe a closed MRI;

Answer 24

1.5 to 3.0 Tesla
Probably better for spinal imaging
Clearer image due to high field magnet strength

Question 25

Why would a vertical MRI be used?

Answer 25

For patients who have negative standard MRI, but who have persistent radicular symptoms worse in the seated or erect posture

Question 26

What are some lab studies done for lower back pain?

Answer 26

Complete blood count
Sed rate
Urinalysis

Question 27

What kind of things can a complete blood count find?

Answer 27

Infection

Leukemia

Question 28

What could a red blood cell count?

Answer 28

Anemia due to marrow replacement by tumor

Question 29

What can Urinalysis find?

Answer 29

Red Blood Cells -Evidence of kidney stones, May indicate bladder or renal cancer
White Blood Cells - Urinary tract infection
Nitrates - Urinary tract infection
Crystals - May indicate propensity for stone formation

Question 30

What is normal for a erythrocyte sedimentation rate (ESR)?

Answer 30

Men: Age divided by two
Women: Age plus 10 divided by two

Question 31

What could an abnormal erythrocyte sedimentation rate (ESR) indicate?

Answer 31

The presence and intensity of an inflammatory process

Question 32

What can ESR be used for?

Answer 32

May assist in a differential diagnosis but cannot diagnose on its own

Question 33

What can cause extreme elevated levels of ESR?

Answer 33

Malignancy
Hematologic disease 
Collagen diseases 
Renal diseases
Serious systemic infections

Question 34

What could and ESR over 100 mm/hr mean?

Answer 34

Often indicates presence of metastatic cancer
Osteomyelitis
Subacute Bacterial Endocarditis
Giant Cell Arteritis
Polymyalgia Rheumatica

Question 35

What is supportive care for low back pain?

Answer 35

Medical Management of Pain Control
Therapeutic Exercise
OMT

Question 36

What are the indications for OMT in lower back pain?

Answer 36

Pain, somatic dysfunctions 2 degree symptoms
Prevent/treat complications d/t immobility
Increase range of motion

Question 37

What are the contraindications of OMT for lower back pain?

Answer 37

HVLA in cases of Spondylolisthesis and Herniated Nucleus Pulposus (HNP)
Relative contraindication