Readings - LBP

Question 1

List clinical indicators to central sensitisation in LBP

Answer 1

1. Widespread tissue sensitivity to palpation
2. Widespread tissue sensitivity to cold
3. Widespread tissue sensitivity to movement
4. Localising pain to spinal levels is difficult
5. Pain provoked with minimal biomechanical stress
6. Minor mechanical pain provocation in multiple directions
7. Multiple trigger points in surrounding muscles

Question 2

What pain pattern is associated with an individual that actively holds their Lsp in hyperlordosis and their spine in lordosis

Answer 2

Active extension pattern

Question 3

What active pain pattern is associated with an inability to relax the back muscles during forward bending

Answer 3

Active extension pain pattern

Question 4

An anterior pelvic tilt may be present in what type of pain pattern

Answer 4

Active extension pain pattern

Question 5

How may muscles present in an active extension pain pattern ?

Answer 5

Deconditioned - gluteus and H/S

Tight - hip flexors

Question 6

Relief in lumbar flexion may be seen in what pain pattern ?

Answer 6

Active extension pain pattern

Question 7

What pain pattern is associated with a sway posture whilst holding thoracic flexion

Answer 7

Passive extension pain pattern

Question 8

During palpation - increased muscle tension of the upper abdominal wall may indicate what pain pattern

Answer 8

Passive extension pain pattern

Question 9

What movements may give relief to someone with a passive extension pain pattern

Answer 9

Lumbar flexion

Thoracic extension

Question 10

During lifting and bending, a fixed pelvis in posterior rotation may indicate what pain pattern

Answer 10

Flexion pain pattern

Question 11

What postures may be seen with a flexion pain pattern

Answer 11

Thoracolumbar flexion

Or

Lower lumbar flexion + thoracolumbar extension

Question 12

Muscle deficits in the hip flexors may be associated with what pain pattern

Answer 12

Flexion pain pattern

Question 13

Muscle deficits in thee lumbar extensors may be associated with what pain pattern

Answer 13

Flexion pain pattern

Question 14

Loss of H/S flexibility may be associated with what pain pattern

Answer 14

Flexion pain pattern

Question 15

3 exercise treatment principles given to a pt with an active extension pain pattern ?

Give four positional progressions for the first

Answer 15

1. posterior pelvic rotation exercises
2. Stretch hip flexors
3. Reconditioning of H/S and glutes

Crook lying to Sitting To Sit to stand To Squatting

Question 16

What pain pattern may need anterior pelvic rotation exercises

Answer 16

Flexion pain pattern

Question 17

Pain that is worse at rest but may be eased with movement - what profile complexity is this ?

Answer 17

High

Question 18

In basic terms, what is radicular pain?

Answer 18

Pain associated with nerve root compression or irritation

Question 19

In somatic referred pain, where can the ‘disrupted transmission’ occur ?

(3)

Answer 19

1. Dorsal horn of spinal cord
2. Thalamus
3. Within the brain itself

Question 20

Basic conceptualisation of somatic referred pain

Answer 20

• the brain attempting to localise the pain in response to ambiguous input

Question 21

Define neuropathic pain

Answer 21

Pain arising as a direct consequence of a lesion or disease affecting the somatosensory system

Question 22

Is basic terms, how does central sensitisation occur ?

Answer 22

As pain persists, the CNS switches to a state of spinal hypersensitivity, generating Allodynia

Question 23

What happens to the descending control pathways in central sensitisation

Answer 23

They switch from inhibition to excitation

Question 24

List Three objective test findings that may indicate central sensitisation

Answer 24

1. Loss of two point discrimination
2. Cold sensitivity
3. Tenderness to palpation away from injury site

Question 25

Pain that does not fit a dermatomal or myotomal distribution pattern could be indicative of what ?

Answer 25

Centrally dominated pain or neuropathic pain

Question 26

Define Allodynia

Answer 26

Stimuli that do not normally evoke pain but are now capable of evoking pain

Question 27

Define hyperalgesia

Answer 27

Stimuli that are normally painful now evoke more pain

Question 28

Clinical presentation of a reduced thermal heat pain threshold may indicate what two underlying causes

Answer 28

1. Peripheral sensitisation

2. Cortical modulation