sciatica/low back pain

Question 1

what structures and involved

Answer 1

• intervertebral discs
• sciatic nerve
• muscles = erector spinae, abdominals, obliques

Question 2

structures involved

reasoning for intervertebral disc

Answer 2

• aggravated by bending/lifting, causing pain and numbness
• herniation can lead to nerve impingement and functional impairment

5 in the lumbar

cushion of fibrocartilage and principle joint between 2 vertebrae in spinal column

Question 3

structres involved

reasoning for sciatic nerve

Answer 3

• potential compression/irritation contributing to numbness
• important for relieving symptoms and preventing further issues

major nerve extends from lower spinal cord down back of thigh and divides above knee

Question 4

structures involved

reasoning for muscles

Answer 4

• muscles supprting lumbar spine, likely strained or injured
• should be assessed to alleviate pain and stiffness and prevent further issues

Question 5

structures involved

what do the erector spinae muscles do

Answer 5

• allow us to stand and lift objects
• help hold up the spine

Question 6

structures involved

what do the abdominal muscles do

Answer 6

allow us to flex, bend forward, lift and arch lower back

Question 7

strcutres involved

what do the oblique muscles do

Answer 7

help rotate spine and maintain proper posture

Question 8

what are the tissue mechanics

Answer 8

• muscle strain
• intervertebral disc compression
• nerve compression

Question 9

tissue mechanics

muscle strain

Answer 9

when muscle fibers can cope with the demands placed on them by exercise overload and leads to tearing of the fibers

Question 10

tissue mechanics

intervertebral disc compression

Answer 10

• when a disc degenerates, small bony outgrowths may form at edges of affected vertebrae
• these bone spurs may compress spinal nerves, leading to weakness or numbness in arms/legs

Question 11

tissue mechanics

nerve compression

Answer 11

continuous compression can cause further damage in sciatic nerve

Question 12

what is the dominant pain mechanism

Answer 12

mechanical low back pain

Question 13

pain mechanism

what is mechanical low back pain

Answer 13

source of pain may be in spinal joints, discs, vertebrae, soft tissues

Question 14

MUST tests

Answer 14

• gait
• ROM of legs and spine
• myotomes - L4-S3
• straight leg raise

Question 15

MUST tests

gait

Answer 15

• limp?
• overcompensation on opposite side

Question 16

MUST tests

myotomes

Answer 16

L4 = ankle DF
L5 = big toe extension
S1 = ankle eversion
S2 = ankle PF

Question 17

MUST tests

legs/spine ROM

Answer 17

leg = hip flex, ext, abd, add, rotation
spine = flex, ext, side flex, rotation

Question 18

MUST tests

straight leg raise

Answer 18

• supine
• knee extension
• hip flexion

positive if pain in lower back (L4/S1)

Question 19

SHOULD tests

Answer 19

• dermatomes - L4-S2
• reflexes - L3/S1
• provocative test - SLUMP

Question 20

SHOULD tests

dermatomes

L4-S2

Answer 20

L4 = supine, knee to big toe
L5 = supine, knee to middle 3 toes
S1 = prone, middle of calf to pinky toe
S2 = prone, top of thigh to middle of calf

Question 21

SHOULD tests

reflexes

L3/S1

Answer 21

L3/4 = supine, leg over therapist thigh, slight knee flexion, bottom of patella
S1 = foot DF, achilles tendon

Question 22

SHOULD tests

SLUMP

Answer 22

• sitting
• slumped upper body
• head flexed
• straighten one leg
• positive if pain is reproduced