Quiz 2: Neck and Lower Back Flashcards
Neck pain is the ___th leading cause of disability in the U.S.
4th
Up to ___% of people will be affected by neck pain at some point in their lifetime.
66%
True or False:
Neck pain can be episodic and recurrent.
True
In a percentage, how many people experience at least 1 episode within 1 year of the initial onset?
60%
How many bones are in the spine total? How many of that number are:
- cervical
- thoracic
- lumbar
25 total
C: 7
T: 12
L: 5
(sacrum)
In the cervical spine, how many vertebra are there are how many nerves?
7 vertebra
8 nerves
What are the functions of the cervical spine?
- support weigh to head
- allow for motion of the head
- protect critical neural and vascular structures
What are the 4 motions of the head?
- flexion
- extension
- lateral flexion
- rotation
What are the 10 risk factors for neck pain?
- females > males
- middle age
- genetics
- biopsychosocial factors
- occupation (office / manual)
- sleep issues
- smokers
- sedentary
- obesity
- trauma history
As far of duration of neck pain, what are the indications for:
- acute
- subacute
- chronic
acute: < 6 weeks
subacute: < 3 months
chronic: > 3 months
What are the 4 mechanisms of neck pain?
- mechanical
- neuropathic
- mixed
- secondary to another cause
What is mechanical neck pain?
pain originating in the spine or supporting structure
What is neuropathic neck pain?
pain resulting from injury or disease (involves peripheral nervous system)
What is mixed neck pain a combination on?
mechanical and neuropathic
True or False:
Specific tissues that cause the pain is often unknown.
True
When the pathophysiology is relative unknown or unclear, what is the neck pain classified as?
nonspecific
True or False:
There are numerous anatomical structure in the cervical spin which could cause pain
True
What are some causes of neck pain? (6)
- physical factors of the person (strength, PA, posture)
- workplace psychosocial factors (high job strain/high demand and low support)
- low levels of satisfaction or comfort
- sustained sitting
- ergonomics (setting)
- low task variation
What are the 4 categories that neck disorders commonly fall under?
- degeneration
- trauma
- deformity
- tumor and infection
What are the characteristics of the degeneration neck disorder?
- herniated nucleus pulposus (HNP)
- cervical stenosis (narrowing of canal)
- cervical spondylosis (DDD, facet arthritis, discogenic pain)
What are the characteristics of a bulging disc?
- common
- not all bulging discs are created equal
- abnormal if nerve roots or spinal cord get compressed
- compression and swelling of spinal cord
__________ __________ (arthritis) causes changes in the disc, spinal canal, and vertebra.
cervical spondylosis
True or False:
As we age, chemical components of disc change, resulting in a loss of water-holding capacity, and a progressive loss of elasticity and compressive strength of the disc.
True
What happens as the disc degenerates?
- end plates become overloaded
- segmental motion increases and becomes irregular
- ligaments become strained > inflamed > pain
- disc height is lost, spurs form, alignment shifts
What are presenting symptoms?
- axial neck pain (stiffness, pain, headaches)
- referred pain (symptoms over traps, rhomboids, scapulae)
- radicular pain (pain in spinal nerve distribution)
- myelopathy (poor motor control, weakness, spasticity)
What are common neck pain symptoms?
- mild in nature
- dull, achy, sharp
- starts gradually
- waxes and wanes
- worsens w/ stress or activity
- improve with OTC meds
What are more serious neck pain symptoms?
- severe
- fever, chills, unexplained weight loss
- associated w/ injury
- sudden onset of pain
- night pain
- progressively worsens
- pain, numb, weak in arms or legs
What are characteristics of cervical radiculopathy?
- pain down the arm
- burning
- numbness
- tingling
- weakness
- worsen with neck movement
What are characteristics of cervical myelopathy?
- compressed spinal cord
- more serious than compressed nerve
- risk of permanent damage
- numbness/tingling
- weakness
- loss of dexterity
- troubling walking
- incontinence
What is text neck?
- overuse syndrome
- results from excessive strain on neck from looking down
- can lead to headaches, neck pain, shoulder/arm pain, breathing compromise
True or False:
Most acute cases of neck pain will resolve in 2 months, but approximately 50% will continue to have some pain or frequent recurrence up to 1 year after
True
Recovery typically occurs most rapidly within __ to __ weeks post-injury
6 to 12
For benefits of exercise, what are the strongest evidences for conservative treatment?
- active or passive physical exercise
- stretching
- strengthening
- endurance
True or False:
Weaker evidence for massage, acupuncture, manipulations
True
What is the chin tuck?
- good for posture and activating deeper stabilizers
- pull chin straight back
- “double chin”
What is the upper trap stretch?
- gently tilt head to side with one hand
- should feel a gentle, comfortable stretch
What is the shoulder shrug?
- move shoulders straight up towards the ears
- then pull shoulder blades down and back
What is scapular retraction?
- squeeze shoulder blades down and back
- good for those who sit for long periods of time
- activates muscles that are often not worked enough when we sit with forward posture
- progress to TB rows
What is a pec stretch?
- stand in doorway, raise arms up with elbows bent, place palms on doorframe
- step forward with one foot or lean forward until you feel a gentle stretch in front of chest and shoulders
What are banded horizontal abductors?
- with arms straight out in front, keep elbows straight and pull band apart
- standing or supine
What are banded pulldowns?
- keep elbows straight and pull band down towards hips
- keep top of shoulders relaxed
What is low back?
the lumbar and sacral vertebrae that structurally support the trunk and head
What are intervertebral discs?
maintain the spaces between each vertebrae, and provide shock absorption throughout the spinal column
What is low back pain?
acute or chronic discomfort in the lumbar and sacral regions of the spine
What is acute low back pain?
a disruption of the intervertebral discs and nerve innervations of muscles that control and stabilize the spine
True or False:
Most low back pain tends to be acute.
True
What is chronic low back pain?
pain that persists for 12 weeks or longer (20% of the acute become chronic)
What is chronic low back pain associated with?
depression, anxiety, and insomnia
What is the most effective treatment for low back pain?
exercise
What are 4 low back pain causes?
- sprains
- strains
- intervertebral disc degeneration
- herniated or ruptured discs
What is radiculopathy?
compression, inflammation, and/or injury to a spinal nerve root (pressure on nerve root may result in pain/numb/tingle)
What is sciatica?
a form of radiculopathy caused by compression of the sciatic nerve
What is spinal stenosis?
narrowing of the spaces between the spine thus compressing the nerves and resulting over time to motor and sensory loss
What is lumbar canal stenosis?
narrowing of the spinal canal, compressing the nerves passing through the low back into the lower extremities
What are symptoms of lumbar canal stenosis?
pain, numbness, or weakness in the hips/legs/back
In lumbar canal stenosis, symptoms worsen with_______________
Symptoms ease with ______________
worsen: walking or standing
ease: lying down, sitting, leaning slightly forward
What is spondylolisthesis?
forward displacement of one vertebra on another, potentially compressing nerve roots, and resulting in pain
What movement can cause further displacement of spondylolsthesis?
hyperextension
What activities are linked to spondylolsthesis?
- heavy overhead pressing
- gymnastic maneuvers
- line blocking in football
(weak core muscles are also a contributing factor)
What is spondylosis?
degeneration of deficient development of the pars interarticularis of a vertrbra
Who does spondylosis most often occur in and how?
young athletes
- involving hyperextension
True or False:
The pars is the weakest part of the vertebra
True
What is ankylosing spondylosis?
“bamboo spine”
- a rare form of arthritis causing inflammation of the lumbosacral area that can cause vertebrae to fuse resulting in chronic pain and impaired mobility
What is cauda equina syndrome?
(happens below S1)
- a rare complication of a ruptured disc, which results from disc material being pushed into the spinal canal compressing the cauda equina (lumbar and sacral nerve roots), resulting in loss of bladder and bowel control
What is spina bifida?
a congenital disorder involving one or more vertebrae failing to fuse on the posterior column during fetal development
What are the classifications of spina bifida?
- Myelomeningocele: most serious and most common form, results from neurological damage
- Meningocele: less serious form that rarely causes neurological damage
- Oculta: mildest and least serious
Intervertebral discs are the largest ________ structures in the body, and are comprised of annulus fibrosus and nucleus pulposus
avascular
What is annulus fibrosus?
a ring of fibrous tissue that comprises the exterior of the intervertebral disc that surrounds the nucleus pulposus
What is nucleus pulposus?
an elastic pulpy mass lying in the center of each intervertebral fibrocartilage (the jelly)
True or False:
Nucleus pulposus dehydrates with age
True
_________ _________ tears can cause disc herniation
annulus fibrosus
What is a disc herniation?
a tear in the annulus allowing extrusion of the nucleus pulposus through this annular defect
True or False:
spinal nerves extend from the posterior side of each disc out to organs and extremities
True
True or False:
Radicular symptoms can centralize or peripheralize
True
____________ refers to symptoms of pain/numbness/tingling traveling away from origin
Peripheralization
____________ refers to symptoms returning toward the origin of pain or resolving completely (this is the goal of treatment)
Centralization
What is the sciatic nerve?
the largest nerve in the body, arising from the sacral plexus on each side, descending through the greater sciatic foramen, and down the posterior thigh, dividing into the tibial and common peroneal nerves
True or False:
Sciatic pain is a type of radiculopathy
true
What is a compression fracture?
a vertebral segment that has decreased 15-20% in height due to fracture
Where do compression fractures most often occur?
thoracic spine
For LBP, what exercise approach should you take?
with severe pain, begin with basic pelvic tilt exercises
What are flexion exercises for LBP?
strengthen the abdominal muscles and stretch the back extensors to open the intervertebral foramina and facet joints
What are extension exercises for LBP?
focus on strengthening the back extensors and improving mobility
What are the 5 core muscles?
- rectus abdominis
- internal and external obliques
- transverse abdominis
- latissimus dorsi, teres major
- iliopsoas
Lumbar stabilization exercises strengthen and support that stabilize the lumbar spine:
- transverse abdom
- rectus abdom
- int/ext obliques
- erector spinae
- multifidus (small muscles parallel to spinal column)
- quadratus lumborum
When are low back exercises most effective?
when performed daily
