Readings - LBP Flashcards
List clinical indicators to central sensitisation in LBP
- Widespread tissue sensitivity to palpation
- Widespread tissue sensitivity to cold
- Widespread tissue sensitivity to movement
- Localising pain to spinal levels is difficult
- Pain provoked with minimal biomechanical stress
- Minor mechanical pain provocation in multiple directions
- Multiple trigger points in surrounding muscles
What pain pattern is associated with an individual that actively holds their Lsp in hyperlordosis and their spine in lordosis
Active extension pattern
What active pain pattern is associated with an inability to relax the back muscles during forward bending
Active extension pain pattern
An anterior pelvic tilt may be present in what type of pain pattern
Active extension pain pattern
How may muscles present in an active extension pain pattern ?
Deconditioned - gluteus and H/S
Tight - hip flexors
Relief in lumbar flexion may be seen in what pain pattern ?
Active extension pain pattern
What pain pattern is associated with a sway posture whilst holding thoracic flexion
Passive extension pain pattern
During palpation - increased muscle tension of the upper abdominal wall may indicate what pain pattern
Passive extension pain pattern
What movements may give relief to someone with a passive extension pain pattern
Lumbar flexion
Thoracic extension
During lifting and bending, a fixed pelvis in posterior rotation may indicate what pain pattern
Flexion pain pattern
What postures may be seen with a flexion pain pattern
Thoracolumbar flexion
Or
Lower lumbar flexion + thoracolumbar extension
Muscle deficits in the hip flexors may be associated with what pain pattern
Flexion pain pattern
Muscle deficits in thee lumbar extensors may be associated with what pain pattern
Flexion pain pattern
Loss of H/S flexibility may be associated with what pain pattern
Flexion pain pattern
3 exercise treatment principles given to a pt with an active extension pain pattern ?
Give four positional progressions for the first
- posterior pelvic rotation exercises
- Stretch hip flexors
- Reconditioning of H/S and glutes
Crook lying to Sitting To Sit to stand To Squatting
What pain pattern may need anterior pelvic rotation exercises
Flexion pain pattern
Pain that is worse at rest but may be eased with movement - what profile complexity is this ?
High
In basic terms, what is radicular pain?
Pain associated with nerve root compression or irritation
In somatic referred pain, where can the ‘disrupted transmission’ occur ?
(3)
- Dorsal horn of spinal cord
- Thalamus
- Within the brain itself
Basic conceptualisation of somatic referred pain
- the brain attempting to localise the pain in response to ambiguous input
Define neuropathic pain
Pain arising as a direct consequence of a lesion or disease affecting the somatosensory system
Is basic terms, how does central sensitisation occur ?
As pain persists, the CNS switches to a state of spinal hypersensitivity, generating Allodynia
What happens to the descending control pathways in central sensitisation
They switch from inhibition to excitation
List Three objective test findings that may indicate central sensitisation
- Loss of two point discrimination
- Cold sensitivity
- Tenderness to palpation away from injury site
Pain that does not fit a dermatomal or myotomal distribution pattern could be indicative of what ?
Centrally dominated pain or neuropathic pain
Define Allodynia
Stimuli that do not normally evoke pain but are now capable of evoking pain
Define hyperalgesia
Stimuli that are normally painful now evoke more pain
Clinical presentation of a reduced thermal heat pain threshold may indicate what two underlying causes
- Peripheral sensitisation
2. Cortical modulation
