Pain Generators Of Lumbar Spine (2)

Question 1

What is the cause of most LBP?

Answer 1

Unknown in >85%

Question 2

What percentage of patients can the pain generator be isolated?

Answer 2

15%

Question 3

What are potential pain generators in the lumbar spine?

Answer 3

Muscles

Ligaments

Dura mater

Nerve roots

Zygapophyseal joints

Sacroiliac joint

Annulus fibrosis

Thoracolumbar fascia

Vertebrae

Question 4

Radiculitis

Answer 4

Sharp, shooting superficial or deep pain into extremity (no neural deficits)

Question 5

Radiculopathy

Answer 5

Radiating paresthesia

Numbness in Dermatome

Weakness in Myotome

Hyporeflexia (causes neural
Deficits)

Question 6

Somatic pain

Answer 6

Poorly localized, aching pain

Question 7

What does inflammation of the nerve root equal?

Answer 7

Leg pain

Question 8

Where is sciatica leg pain?

Answer 8

Posterior leg

Question 9

What produces sciatica 99% of the time?

Answer 9

Actively irritated spinal nerve root

Question 10

What causes only LBP and not sciatica?

Answer 10

Stimulation of the annulus of the disc

Question 11

What does exposure to nuclear material of a disc cause?

Answer 11

Inflammatory response

Question 12

Where do lumbar roots emerge?

Answer 12

Below their vertebrae (L4/L5 disc emerges at L5)

Question 13

What is the most common source of compressive Radiculopathy?

Answer 13

Intervertebral disc herniation

Question 14

Where is compressive radiculopathy most vulnerable?

Answer 14

Just above exit of foramen

Question 15

Where is the most common nerve root compressions?

Answer 15

L4/5 (50%)

L5/S1 (46.3%)

Question 16

What spinal levels are always referred to as lumbar spine pain?

Answer 16

L1-2

L2-3

L4-5

Question 17

What spinal levels are gluteal region associated with?

Answer 17

L5-S1

Question 18

What type of pain is facet pain?

Answer 18

Deep and achy

Question 19

What are common areas for facet pain?

Answer 19

Flank pain

Buttock pain

Pain overlying the iliac crest

Pain radiating into groin

Question 20

When is pain worst with facet pain?

Answer 20

In the morning

Question 21

What makes pain worse with facet pain?

Answer 21

Extension, twisting, stretching, lateral bending

Question 22

What is the prevalence range of SIJ pain?

Answer 22

2-30%

Question 23

Where can bone pain arise from?

Answer 23

Paget’s disease

Tumors

Fractures

Question 24

Spondylosis

Answer 24

Degenerative changes in the spine

Question 25

Spondylolysis

Answer 25

Bone degradation around the para interarticularis

Question 26

Spondylolisthesis

Answer 26

Slippage where one vertebrae moves forward on the other (mostly asymptomatic and does not progress much)

Question 27

What are common contracting impairments in patients with LBP?

Answer 27

Atrophy Reduced activity with movements Decreased muscle strength Increased fatigue Change in % of fiber types

Question 28

What muscle disorders are associated with pain generators?

Answer 28

Muscle strain Spasms or guarding Myofascial complaints (trigger points)

Question 29

What do muscle disorders lead to?

Answer 29

Altered activity in painful muscles Lower blood flow to muscles

Question 30

When does Myofascial pain syndrome occur?

Answer 30

When muscles are short/contracted with increased tone, stiffness, and trigger points

Question 31

What are trigger points?

Answer 31

Tender 3-6 mm nodules that provoke radiating pain into localized areas

Question 32

What can Myofascial pain and trigger points occur due to?

Answer 32

Trauma Exposure to repetitive strain Postural dysfunction Nerve root dysfunction