Lx

Question 1

lbp sources

Answer 1

List of suspects

• Disc • Z Joints • SI Joints • Ligaments • Muscles

Question 2

trauma

Answer 2

• Fractures of the lumbar spine occur when forces of compression, distraction, and rotation exceed the strength of the spinal column.
• Common injuries resulting in fractures of the lumbar spine include fall from a height; motor vehicle and pedestrian accidents; high velocity sports.

Question 3

microtrauma

Answer 3

Microtrauma can cause a low level inflammation that cannot be seen or felt.
Arise in muscle, ligament, vertebrae, and discs, either singly or in combination.
Repetitive microtrauma not allowed time to heal can result in more serious conditions

Question 4

risk factors

Answer 4

§ Being middle-aged (risk drops after age 65). § Being male.
§ Having a family history of back pain. § Heavy manual occupation.
§ Having had a previous back injury. § Psychosocial factors, anxiety, depression. § Being overweight, smoking, unfit , poor posture § Having had trauma to the spine.
§ Having had previous back surgery.
§ Having spine problems since birth (congenital). § Being pregnant.

Question 5

proposed causes of back pain

Answer 5

§ The HISTORY and PHYSICAL EXAMINATION provide the important information
§ Such factors as age of patient, current history and behaviour of symptoms coupled with examination findings and response to treatment are most commonly used to provide a possible DIAGNOSIS

Question 6

the aging spine

Answer 6

§ The disc dehydrates and undergoes fibroses
§ Alters spinal loads in the body
§ Facet joints undergoes OA changes
§ Ligaments/capsules and muscles also age

Question 7

structure of the intervertebral disc

Answer 7

§ The two basic components of the disc are the annulus fibrosis (outer part ) and the nucleus pulposus ( the inner part).

Question 8

Spinal stenosis

Answer 8

• Structural changes narrowed spinal canal
• congenital or developmental bony anomaly in elderly
populations > 60 • degenerative changes
Z joint and disc bulges
flexion posture, avoids extension

Question 9

IV disc prolapse

Answer 9

Bulge - herniation - prolapse
peak age = 20 - 45yrs More common in males
3:2 Herniation of nucleus
through the annulus, most commonly posterolateral

Question 10

Common signs with disc prolapse

Answer 10

1. LBP + Sciatica
2. Quality of pain = severe, sharp and aggravated with flexion activities
3. Possibly neurological signs
4. Often a shift or deviation of the spine

Question 11

yellow flags

Answer 11

§ Psychosocial factors that increase the risk of developing or perpetuating long term disability
§ Fear avoidance
§ Low mood and social withdrawal
§ Belief that back pain is harmful/disabling

Question 12

red flags

Answer 12

§ Cauda equina compression
§ Persistent or progressive neurological deficit § Intractable pain
§ Serious spinal pathology
§ Tumour/cancer
§ Inflammatory disorders (Ankylosing Spondylitis & related disorders)

Question 13

proposed risks for LBP

Answer 13

• Manual handling
• Lifting
• Pushing/pulling
• Extreme postures (forward flexion)
• Cyclic loading (whole body vibration)
• Sitting postures (in occ areas with no lifting or manual handling)
• Work related psychological stress
• Lifestyle factors

Question 14

Functional interactions of the spine

Answer 14

• All trunk muscles together provide muscular stability to trunk
– Subconsciously – relaAve to environment
– Against external forces
– Establish a base for limb
movement
• Spinal stability – combinaAon of intrinsic and extrinsic stabilisers
– Large overlap between intrinsic and extrinsic in contribuAng to both staAc and dynamic stabilisaAon

Question 15

Spinal stability - intrinsics

Answer 15

• Intrinsic stabilisers
– Transversospinal group - mulAfidis – Short segmental group
– Deep abdominal muscles – TrA
– Diaphragm…
• Segmental stability – control precise alignment and sAffness of one or few intervertebral juncAons at Ame
• Provide fine control of vertebral column to avoid – Excessive spinal curvature
– Excessive interspinal movement
– And/or painful instability

Question 16

Extrinsic stabilisers

Answer 16

• Provide gross movement, high torque generators for trunk and hip movement with coarse stability
• Important in stabilising, parAcularly at the lower trunk, against external forces
• Forces that impact on the trunk are effecAvely transferred across SIJ, through hips and through lower extremiAes
• Clinically → strengthening exercises for stability in LBP paAents should challenge both trunk and hip muscles in all 3 planes of moAon

Question 17

Ways to reduce force while lifting

Answer 17

• To reduce force required of extensor muscles
– êthe magnitude of the external load
• Obviously…… but o9en not possible
– êthe speed of li9ing
• Slow and smooth to maximise motor unit recruitment
– êthe length of the external moment arm
• Keep object close to the spine
• To reduce force required of extensor muscles cont’d
– éthe length of the internal moment arm
• Stabilise your spine and core to maintaining neutral curves (esp Lx lordosis) while recruiting the prime mover muscles.
• CapiAlise on your joint leverage in general
• *not always possible to achieve ALL these points
• Also
– Make full use of hip and knee extensors – squat li9
– Minimise verAcal and horizontal distance load must be li9ed
– Choose frontal plane movements
– Push or pull in the same plane,direction and height. • Avoid twisAng
– Increase base of support – e.g. wider stance – Ensure good ground contact and foot support – Use double handed techniques
– Have no physical objects to free-movement – Use mechanical device or get assistance