Physiatric Approach to Low Back Pain Flashcards
Intradiscal pressure is highest in what position?
Seated, bending forward, lifting weight
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 ________.
Herniation, lateral nerve entrapment, multilevel spondylosis and stenosis
Dysfunction (in the degenerative cascade) can either be caused by ________ of the facet joints or ________ of the intervertebral disc.
Synovitis hypomobility, circumferential tears
Continuing degeneration of facet joints or radial tears can cause ________.
Herniation
Instability can result from ________ of the facet joints or ________ of the intervertebral disc.
Capsular laxity, internal disruption
If the facet joints have become so lax that they subluxate, ________ may occur. Likewise, this may occur if the intervertebral disc undergoes ________.
Lateral nerve entrapment, disc resorption
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 ________.
Enlargement of the articular processes, osteophytes
Pain that is described as shooting, burning, or pins and needles is usually descriptive of a ________ problem.
Neurologic
What are some of the red flags when taking a functional history?
Gait ataxia, upper motor neuron signs, night pain/weight loss, cooler lower limbs/feet
Referred pain from ________ is one of the most common things that presents with low back pain.
Hip osteoarthritis
One of the earliest responses to musculoskeletal pain is change in ________.
Muscle tone (use it or lose it)
When instructing a patient to do exercises for musculoskeletal pain, what aspect is critical on your part?
Supervision
When exercising, strengthening, and stretching muscles, they must be worked in ________ planes.
All three
When prescribing exercise, the patient should work out ________ days a week and for at least ________ mins.
5, 30-60
If a patient asks what exercises will help them with their pain and function, you would tell them that ________ and ________ are best.
Stretching, strengthening
The ________, ________, and ________ are key muscles to stretch.
Pectoralis, hamstrings, iliopsoas
For chronic low back pain, the most important muscles to strengthen are the ________ muscles.
Core
The ________ is the most important core muscle to strengthen.
Transversus abdominus
Good exercises for core strengthening include ________, ________, ________ and ________.
Planks, quadruped, bridges, clamshells
A good way to measure patient improvement is to see if they have cut down on their use of ________.
Pain medications
________ is used to treat relaxed or incompetent connective tissue (ligaments, veins, etc.) by inducing the formation of new fibro-elastic connective tissue.
Prolotherapy
Prolotherapy ideally induces a proliferative response at the ________.
Enthesis
Prolotherapy injections are typically composed of ________ and ________.
Lidocaine, 50% dextrose
One fo the most common injection sites of prolotherapy is at the ________ ligament and ligaments of the ________ and ________.
Iliolumbar, shoulder, ankle
PRP aids in healing by releasing ________ of which the two main ones are ________ and ________.
Growth factor, PDGF, TGF-β
After prolotherapy or PRP, a patient cannot take ________ to help with the pain.
NSAIDs
Contraindications for prolotherapy and PRP include:
Metastatic cancer
Non-musculoskeletal pain
Spinal anatomical defects
Systemic inflammation
Morbid obesity
Bleeding disorders
Low pain threshold
Whole body pain
Hepatic disorders
Complications of prolotherapy and PRP include:
Vascular or neurologic injection
Pneumothorax
Infection
Persisting symptoms
Differential diagnosis for shooting pain or weakness in the low back should include ________ and ________ nervous systems.
Central, peripheral
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.
MS, myelopathy
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 - \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_
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
