Mechanical LBP diagnosis

Question 1

History for Lumbar Internal Disc Derangement (pain, sitting, standing)

Answer 1

Back pain that is deep achy, poorly localized midline/bilateral. W/w/o referred pain to butt or extremity
Sitting intolerance
Standing relieves

Question 2

Physical exam findings for Lumbar Internal Disc Derangement

Answer 2

Flexion antalgia/lateral pelvic shift
Painful and reduced AROM with centralization (posterior w/ extension, anterior w/ flexion)
Midline + paraspinal tenderness
Valsalva/spinal compression is positive

Question 3

Ancillary studies for Lumbar Internal Disc Derangement

Answer 3

MRI and x-ray
x-ray is likely normal
a negative MRI will rule out this condition

Question 4

Treatment for Lumbar Internal Disc Derangement

Answer 4

Manual: Spinal manip., flexion/distraction
Exercise: Directional preference, lumbar stabilization exercises
Activity modification: Flexion load sparing, limit sitting
Other: epidural injections, fusion surgery, IDET and PIRFT

Question 5

History for lumbar extensor strain

Answer 5

Dull, achy pain. Bilateral non-localized

Initiated by trauma

Question 6

PE for lumbar extensor strain

Answer 6

Guarded posture and possible superficial bruising
Painful, restricted AROM. pain with passive stretch at end range.
No pain/minimal with joint palpation