Sacral, Lumbar and Thoracic joint Pathology Flashcards
The majority of low back pain is due to…
Soft tissue issues.
Types of soft tissue issues which can cause lower back pain
Muscle strains, ligament sprains, postural abnormalities, poor muslce tone, neuromuscular disease.
The second leading cause of low back pain
Disc disease.
Idopathic back pain.
Also called mechanical back pain. Pain of musculoskeletal origin.
Most common joints involved in low back pain
Facet and sacroiliac
Priciples for managing low back pain
Screen for more sinister diseases, reassure and manage symptoms, address underlying issude and return to function ASAP.
Risk factors for LBP
Repeated lifting, bad posture, weak core muscles, adaptive shortening, coughing, disc degeneration, osteoporosis, spondylolisthesis and underdating excessive work.
Pain
An unpleasant sensory and emotional experience associated with real or potential tissue damage.
Delayed return to work can be influenced by
The belief that the pain is work related, psychological or psychosocial issues, compensation and time off.
First phase of healing
Inflammatory/acute phase
Inflammatory/acute phase of healing
Lasts 48-72 hours. Includes vascular and immune response. Includes pain, loss of ROM, heat, swelling and reciprocal weakness.
Second phase of healing
Fibroplastic or subacute phase.
Third phase of healing
Remodeling or chronic phase.
Fibroplastic or subacute phase of healing
Days 3-21. Scar tissue is laid down. ROM is increased and pain and swelling are decreased.
Remodelling or chronic phase of healing
Day 21 to 6 to 12 months. Vascularity is lost and scar tissue is strengthened and aligned.
Spinal stenosis
Abnormal narrowing of the spinal canal, either central or lateral intervertebral foramen.
Causes of central spinal stenosis
Osteophyte enlargement of the inferior articular bodies, congenitally decreased diameter, hypertrophy of ligamentum flava, spondylolisthesis or neoplasm.
Causes ot lateral spinal stenosis
Subluxation of facets as a result of disc narrowing. Symptoms are usually segmental.
Signs and symptoms of spinal stenosis
Pain, motor deficits, tingling, numbness. Worsened by standing, walking, coughing and sneezing. Relieved by sitting and flexion.
Pain of osteoporosis
Is due to collapsing vertebrae compressing nerves, not the actual bone collapses themselves.
LBP due to ligaments
Felt primarily over the affected ligament, but may spread to a leg. Strethcing the ligament causes sharp, localized pain.
LBP due to muslce sprains
Cause stiffness, weakness and postural changes. Will heal spontaneously as long as activity is maintained.
LBP due to myofascial restrictions
Lead to postural limitations and can result in changes to other structures.
First step in detemrining low back pain
Client interview
Components of a client interview for LBP
Quality and quantity of pain, patient history, recent injuries and daily activities.
Second step in determining low back pain
General assessments
General assessments for LBP
Posture, gait, flexion (standing and seated), active ROM.
Possible findings in a posture assessment in a patient with LBP
Sway back, lordosis, kyphosis, side bending, iliac crest discrepencies.
Possible findings in a gait analysis in a patient with LBP
SHort stride, heavy heel strike, umbilicus tracking
Third step in determining LBP
Specific assessments
Specific assessments relevant to LBP
Coxa, sacrum, pelvis and lumbar
Myotome
All muscles innervated by a single spinal nerve
How to test a myotome
Hold a contraction for 6 seconds, then compare bilaterally
L1/L2 myotome
Hip flexion; psoas, iliacus, sartorius, gracilis, pectineus, adductor longus and brevis
L3 myotome
Knee extension; quadriceps, adductor magnus, longus and brevis
L4 myotome
Tibialis anterior and posterior, quadriceps, TFL, adductor magnus, obturator externus
L5 myotome
EHL, EDL, gluteus medius and minimus, obturator internus, semis, peroneus tertius and popliteus
S1 myotome
Gastrocnemius, soleus, glute max, obturator internus, piriformis, biceps femoris, semitendinosus, popliteus, peroneus longus and brevis, extensor digitorum brevis
S2 myotome
Biceps femoris, piriformis, soleus, gatroc, FDL, EHL and intrinsic foot muslces.
S3 myotome
Intrinsic foot muscles, FHB, FDB, EDB
