Mechanical/Non-Specific Back Pain

Question 1

Define chronic back pain.

Answer 1

Back pain which lasts longer than 3 months

Question 2

List 5 different anatomical origins of back pain.

Answer 2

Ligaments
Facet joints
Paravertebral muscles/fascia
Intervertebral discs
Spinal nerve roots

Question 3

What are the 3 main types of back pain?

Answer 3

Mechanical/non-specific back pain
Systemic processes
Referred pain

Question 4

Describe the clinical features of mechanical/non-specific back pain. (2)

Answer 4

Early morning stiffness (<30 minutes)
Pain, which:
-Improves with rest
-Worsens on movement/prolonged standing

Question 5

List 8 causes of mechanical/non-specific back pain.

Answer 5

Lumbar strain/sprain
Degenerative discs (spondylosis)
Degenerative facet joints
Disc prolapse (herniated nucleus pulposus)
Spondylolisthesis
Spinal stenosis
Compression fractures
Cauda equina syndrome

Question 6

Describe the pathophysiology of lumbar sprain/strain. (1)

Answer 6

1. Trauma causes muscle spasms in the back

a. These settle within 24-48 hours

Question 7

Define spondylosis.

Answer 7

Degenerative discs

A spinal condition resulting from degeneration and flattening of the intervertebral discs in the cervical, thoracic or lumbar regions

Question 8

Describe the clinical features of spondylosis. (3)

Answer 8

Pain, which increases with:

• Flexion
• Sitting
• Sneezing

Question 9

Describe the clinical features of degenerative facet joints. (1)

Answer 9

Pain, which increases with:

-Extension

Question 10

Describe the clinical features of disk prolapse (herniated nucleus pulposus). (4)

Answer 10

Sudden onset (e.g. sneezing)
Positive straight leg raising test (i.e. sciatic pain when straight leg is raised)
Reduced reflexes
Leg pain, which is:
-Like sciatica
-Dermatomal distribution

Question 11

Define spondylolisthesis.

Answer 11

A condition in which a vertebral body slips out of position, either forwards or backwards

Question 12

Describe the clinical features of spondylolisthesis. (3)

Answer 12

Asymptomatic

Pain, which:

• Radiates to posterior thigh
• Increases with extension

Question 13

What condition is spondylolisthesis associated with?

Answer 13

Pars interarticularis defect (fracture in vertebral arch)

Question 14

Define spinal stenosis.

Answer 14

Anatomical narrowing of the spinal canal, which may be congenital or degenerative

Question 15

Describe the clinical features of spinal stenosis. (2)

Answer 15

Claudication
Variable improvement (rule of 1/3s)

Question 16

Describe the clinical features of vertebral compression fractures. (3)

Answer 16

Sudden onset
Kyphosis
Severe pain, which:
-Radiates in a belt around chest/abdomen

Question 17

What condition are vertebral compression fractures most commonly associated with?

Answer 17

Osteoporosis

Question 18

Describe the clinical features of cauda equina syndrome.

Answer 18

Neuropathic symptoms, e.g.

• Bilateral sciatica
• Saddle anaesthesia

Bladder/bowel dysfunction, e.g.
-Reduced anal tone

Question 19

How would you manage mechanical/non-specific back pain? (8)

Answer 19

Patient education, e.g.

• Self-management
• Stay active
• Exercise programmes
• Physiotherapy

Analgesia, e.g.

• Paracetamol
• NSAIDs
• Codeine

Acupuncture

Question 20

For which types of mechanical back pain would you recommend surgery? (5)

Answer 20

Cauda equina syndrome
Vertebral compression fracture
Spondylolisthesis
Disk prolapse (if not resolved within 12 weeks)
Spinal stenosis

Question 21

List 6 red flags indicating cauda equina syndrome.

Answer 21

Urinary retention
Saddle anaesthesia
Reduced anal tone
Hip/knee weakness
General neuro deficit
Progressive spinal deformity