Physiatric Approach to Low Back Pain

Question 1

Intradiscal pressure is highest in what position?

Answer 1

Seated, bending forward, lifting weight

Question 2

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 2

Herniation, lateral nerve entrapment, multilevel spondylosis and stenosis

Question 3

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

Answer 3

Synovitis hypomobility, circumferential tears

Question 4

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

Answer 4

Herniation

Question 5

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

Answer 5

Capsular laxity, internal disruption

Question 6

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

Answer 6

Lateral nerve entrapment, disc resorption

Question 7

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 7

Enlargement of the articular processes, osteophytes

Question 8

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

Answer 8

Neurologic

Question 9

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

Answer 9

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

Question 10

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

Answer 10

Hip osteoarthritis

Question 11

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

Answer 11

Muscle tone (use it or lose it)

Question 12

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

Answer 12

Supervision

Question 13

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

Answer 13

All three

Question 14

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

Answer 14

5, 30-60

Question 15

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

Answer 15

Stretching, strengthening

Question 16

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

Answer 16

Pectoralis, hamstrings, iliopsoas

Question 17

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

Answer 17

Core

Question 18

The ________ is the most important core muscle to strengthen.

Answer 18

Transversus abdominus

Question 19

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

Answer 19

Planks, quadruped, bridges, clamshells

Question 20

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

Answer 20

Pain medications

Question 21

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

Answer 21

Prolotherapy

Question 22

Prolotherapy ideally induces a proliferative response at the ________.

Answer 22

Enthesis

Question 23

Prolotherapy injections are typically composed of ________ and ________.

Answer 23

Lidocaine, 50% dextrose

Question 24

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

Answer 24

Iliolumbar, shoulder, ankle

Question 25

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

Answer 25

Growth factor, PDGF, TGF-β

Question 26

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

Answer 26

NSAIDs

Question 27

Contraindications for prolotherapy and PRP include:

Answer 27

Metastatic cancer

Non-musculoskeletal pain

Spinal anatomical defects

Systemic inflammation

Morbid obesity

Bleeding disorders

Low pain threshold

Whole body pain

Hepatic disorders

Question 28

Complications of prolotherapy and PRP include:

Answer 28

Vascular or neurologic injection

Pneumothorax

Infection

Persisting symptoms

Question 29

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

Answer 29

Central, peripheral

Question 30

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 30

MS, myelopathy

Question 31

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 31

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