Physiatric Approach to Low Back Pain

Question 1

Complications of prolotherapy and PRP include:

Answer 1

Vascular or neurologic injection

Pneumothorax

Infection

Persisting symptoms

Question 2

Prolotherapy ideally induces a proliferative response at the ________.

Answer 2

Enthesis

Question 3

Differential diagnosis for shooting pain or weakness in the low back should include ________ and ________ nervous systems.

Answer 3

Central, peripheral

Question 4

The final complication of the degenerative cascade is one level stenosis which may progress to multilevel. This can occur if the facet joints undergo ________ or if the intervertebral disc develop ________.

Answer 4

Enlargement of the articular processes, osteophytes

Question 5

PRP aids in healing by releasing ________ of which the two main ones are ________ and ________.

Answer 5

Growth factor, PDGF, TGF-β

Question 6

Continuing degeneration of facet joints or radial tears can cause ________.

Answer 6

Herniation

Question 7

What are some of the red flags when taking a functional history?

Answer 7

Gait ataxia, upper motor neuron signs, night pain/weight loss, cooler lower limbs/feet

Question 8

For chronic low back pain, the most important muscles to strengthen are the ________ muscles.

Answer 8

Core

Question 9

The degenerative cascade includes the following: dysfunction leading to ________, which then causes instability leading to ________, which can lead to one level stenosis, which may progress to ________.

Answer 9

Herniation, lateral nerve entrapment, multilevel spondylosis and stenosis

Question 10

Pain that is described as shooting, burning, or pins and needles is usually descriptive of a ________ problem.

Answer 10

Neurologic

Question 11

Contraindications for prolotherapy and PRP include:

Answer 11

Metastatic cancer

Non-musculoskeletal pain

Spinal anatomical defects

Systemic inflammation

Morbid obesity

Bleeding disorders

Low pain threshold

Whole body pain

Hepatic disorders

Question 12

If a patient asks what exercises will help them with their pain and function, you would tell them that ________ and ________ are best.

Answer 12

Stretching, strengthening

Question 13

When exercising, strengthening, and stretching muscles, they must be worked in ________ planes.

Answer 13

All three

Question 14

Intradiscal pressure is highest in what position?

Answer 14

Seated, bending forward, lifting weight

Question 15

Referred pain from ________ is one of the most common things that presents with low back pain.

Answer 15

Hip osteoarthritis

Question 16

The ________, ________, and ________ are key muscles to stretch.

Answer 16

Pectoralis, hamstrings, iliopsoas

Question 17

With shooting pain or weakness in the low back, differential diagnoses fort the central nervous system should include ________ for the brain and ________ for the spinal cord.

Answer 17

MS, myelopathy

Question 18

________ is used to treat relaxed or incompetent connective tissue (ligaments, veins, etc.) by inducing the formation of new fibro-elastic connective tissue.

Answer 18

Prolotherapy

Question 19

One of the earliest responses to musculoskeletal pain is change in ________.

Answer 19

Muscle tone (use it or lose it)

Question 20

After prolotherapy or PRP, a patient cannot take ________ to help with the pain.

Answer 20

NSAIDs

Question 21

Good exercises for core strengthening include ________, ________, ________ and ________.

Answer 21

Planks, quadruped, bridges, clamshells

Question 22

Prolotherapy injections are typically composed of ________ and ________.

Answer 22

Lidocaine, 50% dextrose

Question 23

When prescribing exercise, the patient should work out ________ days a week and for at least ________ mins.

Answer 23

5, 30-60

Question 24

Dysfunction (in the degenerative cascade) can either be caused by ________ of the facet joints or ________ of the intervertebral disc.

Answer 24

Synovitis hypomobility, circumferential tears

Question 25

One fo the most common injection sites of prolotherapy is at the ________ ligament and ligaments of the ________ and ________.

Answer 25

Iliolumbar, shoulder, ankle

Question 26

The ________ is the most important core muscle to strengthen.

Answer 26

Transversus abdominus

Question 27

A good way to measure patient improvement is to see if they have cut down on their use of ________.

Answer 27

Pain medications

Question 28

With shooting pain or weakness in the low back, differential diagnoses fort the peripheral nervous system should include:

Anterior horn cell - \_\_\_\_\_\_\_\_
Axon/myelin - \_\_\_\_\_\_\_\_
Root - \_\_\_\_\_\_\_\_
Plexus - \_\_\_\_\_\_\_\_
NMJ - \_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_

Answer 28

ALS (presents in vesiculations on the tongue in a 25 y/o)

Guillane Barre

Radiculopathy

Traumatic plexopathy

Myasthenia gravis, Lambert Eaton syndrome

Peripheral nerve

Muscle, bone, tendon, ligament

Question 29

Instability can result from ________ of the facet joints or ________ of the intervertebral disc.

Answer 29

Capsular laxity, internal disruption

Question 30

If the facet joints have become so lax that they subluxate, ________ may occur. Likewise, this may occur if the intervertebral disc undergoes ________.

Answer 30

Lateral nerve entrapment, disc resorption

Question 31

When instructing a patient to do exercises for musculoskeletal pain, what aspect is critical on your part?

Answer 31

Supervision