Midterm: Low Back Pain Flashcards by Mitch Nichols

How long does back pain have to happen before it becomes chronic?

12 weeks.

-anything greater is chronic

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Does acute back pain need treatment, most of the time?

No, 80% of the time it will resolve

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What are some risk factors for back pain?

Lifting at work
Smoking (nicotine makes everything feel worse)
Depression
Obesity
Inactivity

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What are some protective factors from back pain?

Regular exercise with good form

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Top four causes of back pain?

MSK (70%)
Degenerative Disc (10%)
Radicular (7%)
Compression fracture (4%)

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In ____ etiologies of back pain, there will be no change in pain due to position

Visceral

-only 2% of the cause of back pain

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A ____is an injury to muscle. Which muscles are involved in MSK back pain?

Strain

Paraspinalis
Erector spinae
Q. lumborum

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A _____ is an injury to ligaments. Which ligaments are involved in MSK back pain?

Sprain

-Iliolumbar and sacroiliac

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What is the pain pattern for a sprain?

aching pain right over the structure

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What causes piriformis syndrome?

Hypertonicity of the piriformis muscle and entrapment of the sciatic nerve

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Symptoms of Piriformis syndrome?

Aching/burning in gluteal region, parasthesia down the posterior leg

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How do you diagnose piriformis syndrome?

FAIR test

-It can also be worse when sitting, so can rule out as a diagnosis of exclusion

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Is piriformis syndrome worse when sitting or standing?

sitting!

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Origin and Insertion of Piriformis?

Anterior sacrum–>greater trochanter

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Etiology of Psoas Syndrome?

Chronic hypertonicity of psoas muscle

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Origin and Insertion of Psoas?

T12-L4–>Greater Trochanter

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A patient that haunches and flexes lumbar spin, with pain originating at thoracolumbar junction or hip pain can be a sign of?

Psoas syndrome

When is Psoas syndrome worse?

When extended/Standing straight

How do you diagnose Psoas syndrome?

Thomas test, pelvic side shift, palpation of psoas

Which way does the pelvis shift in pelvic side shift test?

Will translate away from the affected side

Which way will the pelvis shift for a left psoas syndrome?

to the right!

This syndrome is due to overuse. Pain will be over the lower back and is worse when walking. Created by a sacral unleveling leading to stress imbalance in muscles.

Short Leg Syndrome

Which way will the pelvis shift in a right short leg?

To the left!

-PELVIS SHIFT WILL NOT CHANGE WITH MANIPULATION

How do you treat short leg syndrome?

Heel lift therapy

-1/8 or 1/16 of inch until fully replaced

What would cause an acute short leg syndrome?

Hip surgery! | -so just immediately replace the full heel length

This condition is a nonspecific pain that is due to age. It is worse when bending forward or sneezing, and is diagnosed via radiograph.

Degenerative disc disease | -up to 80% of older adults have this

This condition is common in young athletes due to repetitive stress creating a stress fracture. It is worse in hyperextension. X-ray confirms with scotty dog sign.

Spondylolysis | -most commonly L5

Step off injury first created by spondylolysis. Pain is non-specific and worsens with activity.

Spondylolisthesis | -aging is a risk factor

This condition is usually due to old age, menopause, and malignancy. Can happen if an older lady sneezes too hard. It is worse when sitting, in extension, and with movement. You can diagnose via x-ray

Compression fracture

What are the three causes of radicular pain?

Spinal stenosis (most common) Spinal Disc herniation Cauda equina syndrome

This condition is due to narrowing of neural foramen. Presents with a unilateral numbness and tingling over L4-S1 nerve roots. it is worse when standing or walking, best at rest. You can diagnose with MRI.

Spinal Stenosis

What is the shopping cart sign a (+) sign of?

Spinal stenosis | -better when leaning over in flexion

Pain between L4-S1 due to a compression of the nerve root from herniation.

Herniated disc

What position makes a herniated disc worse? How do you diagnose?

Worse in flexion | Diagnose with MRI

Presents with numbness and tingling in perineum, fecal/urinary incontinence, numbness and weakness of legs. What should you do?

Emergency surgery consult for Cauda Equina

How do you diagnose cauda equina?

MRI

What are some red flags for back pain?

Progress LE weakness Saddle Anasthesia Deep bone pain/unexplained weight loss Fever/Chills

Should you do any imaging before 12 weeks for back pain?

Start with conservative treatment, unless red flags, as back pain often resolves within 12 weeks

Should you order imaging within the first 6 weeks?

NO!

What is Greenman's Dirty Half Dozen?

1. Muscle Imbalance 2. Lumbar Spine Type 2 DsyFxn 3. Pubic Symphysis dysfxn 4. Short leg 5. Sacral extension dysfxn 6. Innominate shear

What are some invasive ways to treat low back pain if all else fails?

Epidural injection Facet injection Radiofrequency ablation Spinal surgery