SM 237a - Back Pain Flashcards
What will often make discogenic low back pain worse?
Flexion
Valsalva maneuver
What is the role of core stabilization in the treatment of low back pain?
Emphasis on spine-neutral ab exercises
More effective than general exercise for decreasing pain, improving function in the short term
What are the indications for surgical referral in a patient with lower back pain?
- Cauda equina symptoms
- Bilateral leg weakness/numbness
- Saddle anesthesia
- Progressive neurologic deficit
- Numbness/weakness in a muscle associated with a nerve
- Ex: Foot drop
- Numbness/weakness in a muscle associated with a nerve
- Suspected spinal cord compression
- Clearly failed a comprehensive trial of non-surgical treatment
What is the #1 cause of disability under age 45?
Lower back pain
How does canal size change with extension and flexion of the back?
How does facet load change with extension and flexion of the back?
- Canal size
- Decreases with extension
- Increases with flexion
- Facet load
- Increases with extension
- Decreases with flexion
Describe the subacute management of lower back pain
Work on:
- Flexibility
- StabilizationProprioception
- Sport specific training
- Multiple planes
Bedrest does not help!
What is spinal stenosis?
Describe its presentation
Narrowing of the spinal canal
- Pain is caused by neurogenic claudication
- Leg pain is worse with walking, prolonged standing, downhill walking
- Leg pain is releived by sitting, bening forward, walking uphill
- “Shopping cart sign”
What is the role of spinal injection in the treatment of lower back pain?
What would you inject?
Usually adjunctive, if first-line therapy does not help
- Epidural steroid injection
- Surgery-sparing intervention
- Facet injection
- Medial branch blocks/ablation
Describe the presentation of zygapophysial vs. discogenic low back pain
- Zygapophysial
- Worse with extension, rotational movements
- Discogenic
- Worse with flextion, valsalva maneuver
What is lumbar radiculopathy?
Describe the presentation
- Nerve root compression or inflammation
- Usually radiates to leg in a dermatomal distribution
- May have deficits in sensation and/or muscle weakness; reflexes are often abnormal
Describe the acute management of acute lower back pain
- Decrease pain/inflammation
- Eary mobilization
- Directional movement pattern to centralize pain
Bedrest does not help!
What positions would typically provoke symptoms in a patient with lumbar stenosis?
Things that increase extension
- Prolonged walking, standing
- Extension decreases the size of the spinal canal
What is the difference between radiculopathy and radicular pain?
- Radiculopathy
- Associated with an objective finding (muscle weakness, foot drop, etc)
- Radicular pain/radiculitis
- Pain, but no objective finding
Which Position Would Typically Provoke Symptoms In A Patient With Lumbar Stenosis?
A. Prolonged Sitting
B. Walking Uphill
C. Bending Forward
D. Prolonged Walking
D. Prolonged Walking
- Extension (ex: standing, walking) decreases the size of the vertebral canal. This exacerbates stenosis
_____ of people with chronic back pain have depression
30-50% of people with chronic back pain have depression
What are the indications for epidural steroid injection?
Radicular pain due to suspected nerve-root irritation
Pain that is refractory to initial therapy
Which of the following positions puts the most amount of pressure on the disc?
A. Sitting in Poor Posture
B. Laying on the Side
C. Bending Forward
D. Standing
E. Bending Backwards
A. Sitting in Poor Posture
What are the indications for imaging in lower back pain?
- Pain does not respond to treatment
- Suspected fracture
- Neurologic deficits
- Suspected vertebral infection
- Suspected cancer
- Evaluation for spine injection or surgery
Note: imaging is not indicated in the first 4-6 weeks of lower back pain
Where in the lower back does the greatest motion occur?
Lower lumbar
L4-L5 and L5-S1
What is the role of imaging in the evaluation of low back pain?
- Imaging is generally not necessary in the first 4-6 weeks
- Radiographic findings do not always correlate with clinical severity or outcome
- Findings in asymptomatic patients -> unnecessary testing
