Mechanical Spinal Pain Syndromes Flashcards
What is the main complaint of spinal muscle strain?
Back/neck pain
Does not radiate to extremities
What are mechanical spinal pain syndromes?
Local disorders of the spine and are purely musculoskeletal diseases
Pain secondary to overuse, injury or deformity or normal anatomical structure
Characteristically exacerbated by certain activities and relieved by others.
What can cause spinal muscle strain?
Mechanical stress (overuse/over stretching) Prolonged abnormal posture
May be associated with structural leg length discrepancies >5mm
What are the clinical presentations/physical examination findings of spinal muscle strain?
Pain with resisted isometric contraction or passive stretching Tender on palpation Localised pain Hypertonic (muscle spasm) Normal neurological examination
What are the presentation of a ligamentous (supraspinous) sprain?
Pain with passive stretching (flexion)
What is the main complaint of lumbar spine strain?
Lower back pain
What are underlying causes of lumbar spine strain?
Trauma Repetitive mechanical stress Abnormal anatomy (scoliosis) Hyperlordosis
What causes the onset of pain in lumbar spine strain?
Flexion/extension
Contraction of injured muscles
Activity related
In what motions does pain occur in lumbar spine strain?
Stress > supporting structure’s ability to sustain
F(load) > ability of muscle to resist - transfer of force to ligaments
F(generated) > load (excessive movement exceeding limits)
What is the correlation between lumbar spine strain and hyperlordosis?
Increased angle of L5/S1 segment increases shear forces on disc
Approximation of articular surfaces, modifies function to weight bearing
Increased stress on supporting ligaments
What are the clinical presentations of lumbar spine strain?
Local or diffuse low back pain
May refer to buttock and posterior thigh
Non-dermatomal
What are the physical examination findings of lumbar spine strain?
Pain on resisted isometric contraction and passive stretching
Tenderness on palpation
Hypertonic
Describe the 3 categories of lumbar spine strain.
Mild:
Subjective pain with no objective findings
Recovery <3 weeks
What can cause cervical spine strain?
Trauma -> over stretching -> Protective spasm of surrounding muscles
Abnormal head posture
What is the result of the protective reflex recruitment of surrounding muscle?
Autonomic reflex
Decreased blood flow
Produces anaerobic conditions in injured muscle
What can cause muscle hypertonicity?
Trauma
Postural strain
Increased muscle tension
What are the extraneous factors affecting muscle tension?
Fatigue
Emotional stress (anger, anxiety, depression)
Pain
What is the main complaint of cervical spine strain?
Pain and associated headaches
What are the clinical presentations of a patient with cervical spine strain?
Pain in middle/lower part of posterior aspect of neck
May radiate to shoulders (scapular area), occipital area, chest wall
Rare Hx of injury
Dull aching pain
Exacerbated by neck motion, relieved by rest
Onset: awkward nights sleep, rapid head movement, coughing, sneezing
What are the physical examination findings of cervical spine strain?
Locally tender areas lateral to spine Loss of cervical motion Pain on resisted isometric contraction Passive ROM > active ROM Normal neurological examination
List management of back and neck strain.
Manual therapy Controlled physical activity Non-steroidal anti-inflammatory drugs Muscle relaxants Ice/heat (patients specific) Dry needling Rehabilitative exercises
What is posterior facet syndrome?
Pain originating from any structure integral to both function and configuration of facet joints
What are aetiologies of posterior facet syndrome?
Trauma
Degeneration
Faulty posture (hyperextension)
What are the clinical history findings of posterior facet syndrome?
Back pain radiating to groin, hip, buttock, leg (above knee)
Increased pain when sleeping on abdomen, sitting in upright position, lifting hands/arms above head, sneezing, coughing
Minor sensory changes (not true loss)
Subjective muscle weakness due to pain
Low back stiffness (AM/inactivity)
How would you provide treatment/management for posterior facet syndrome?
Manipulation Corrective exercise Postural Correction -pelvic tilt Strengthen abdominal wall Injection of anesthetic solution
What are the clinical features of cervical posterior facet syndrome?
Radiation to sub occipital region, shoulders and mid back (non-dermatomal)
Previous Hx of hyper extension injury or other trauma
What is the purpose of plain film x-rays on the c-spine?
Detect: Instability Gross fracture Abnormal lesions Osteoarthritis