The Lumbar Spine Flashcards
Up to ___% of all people experience LBP at some point in their lifetime.
80%
List 7 questions to ask a patient experiencing LBP.
- Has the patient experienced low back pain in the past? If so, was it the same type of LBP that the patient is currently experiencing?
- What was the result of intervention for any previous incidences of back pain?
- How did the injury occur? Lifting? Insidious onset?
- What is the patient’s occupation? Is the patient currently working?
- Where is the pain located?
- Is the pain constant or intermittent?
- Is the patient experiencing sxs of numbness/tingling or problems with bowel/ bladder?
Pain radiating below the ____ is an indication that there could be a disc injury
KNEE
Radiating pain that is greater in the buttock and/or leg than in the low back is also an indication of a _____.
Disc herniation
List 5 common medical diagnoses that can cause LPB (red flags).
- Spinal fractures
- Spinal infection
- Neoplasm
- Cauda Equina Syndrome
- Ankylosing Spondylitis
List 2 indications that may suggest the presence of a fracture.
- History of trauma
2. Point tenderness over the area of the fracture
Compression fractures are common in patients with _____ and with a history of ______.
Osteoporosis (age >50, Asian/Caucasian, female)
History of steroid use
List 3 risk factors for neoplasms.
- Hx of cancer
- Cancers that metastasize to the spine (breast, lung, prostate)
- Age > 50 years
List 5 signs and symptoms of neoplasm.
- Unexplained weight loss
- Constant pain
- No relief with bed rest
- Night pain
- Symptoms do not improve with PT
List 4 characteristics of cauda equina syndrome.
- MEDICAL EMERGENCY
- Saddle anesthesia
- Recent onset of bladder dysfunction
- Progressive lower extremity symptoms
List 5 characteristics of ankylosing spondylitis.
- Male gender
- Age < 35 years
- Night pain
- Morning stiffness
- Reduction in symptoms with exercise and activity
List 4 risk factors for spinal infection.
History of
- Recent bacterial infection
- Recent spinal surgery
- IV drug abuse
- Immunosuppression
List 3 characteristics of a spinal infection.
- Fever
- Deep constant pain
- Spinal rigidity
List 4 things to observe, in addition to the usual items, in patients with back pain.
- Posture
- Gait
- Willingness to move (transfer out of chair)
- Inconsistent movement patterns
List 3 things to palpate when examining patients with low back pain.
- Soft tissue integrity
- Bony landmarks in lumbar spine and SI joint
- Bony landmarks in the pelvis and LE for leg length discrepancy
Tightness in what 7 muscle groups can contribute to back problems?
- Gastrocsoleus
- Quadriceps
- Hamstrings
- Hip flexors
- Glut maximus
- Hip adductors
- Hip rotators
Most of the motion in the lumbar spine in to forward bending occurs at ____ and _____, and only a small amount of ____ occurs in the lumbar spine.
L4-L5 and L5-S1
Small amount of ROTATION at the lumbar spine
How is range of motion into forward bending measured at the lumbar spine? Normal values?
- With the patient in a neutral position, put one end of the tape measure on T12, and stretch the tape measure down the lumbar spine to S1.
- Instruct the patient to bend forward as far as possible before pain.
- Normal: 5cm difference
- Abnormal: Less than 3cm
Strength of the ____, ____ and _____ should be assessed in patients with back pain.
Abdominals
Back extensors
LE muscles
______ testing is not performed in the lumbar spine because it is difficult to eliminate motion in joints.
Resistive Isometric Testing
L5 nerve root is usually affected by the ____, and the S1 nerve root is usually affected by the ____ disc.
L5 nerve root = L4/5 disc
S1 nerve root = L5/S1 disc
Spondylosis is _____ at the lumbar spine, and it includes _____ disease and _____.
Osteoarthritis
Degenerative disc disease
Stenosis
What is the prevalence, etiology, and prognosis of lumbar radiculopathy? What segments are more most commonly effected?
- Prevalence: ~5% of all patients with low back pain
- Etiology: more common among patients aged < 55
- Prognosis favorable, recovery could take longer than simple nonspecific LBP
- Most common at L4/L5 and L5/S1
List 5 signs and symptoms of lumbar radiculopathy.
- Pain radiating below the knee
- Pain that is worse in the buttocks and/or leg than in the low back
- Pain that is worse with sitting than most other positions (causes posterior migration of disk)
- Nerve root signs (sensory deficits, motor deficits, deep tendon reflex changes) that are consistent with one nerve root level
- Positive SLR, with pain limiting range to no more than approximately 40 degrees of hip flexion
List 3 interventions used to treat lumbar radiculopathy.
- Extension exercises
- Activity regulation
- Maintaining a lordosis with ADLs
What is the difference between spondylosis and spondylolisthesis?
- Spondylosis: presence of a fracture in the pars intraarticularis.
- Spondylolisthesis: presence of a vertebra that has slipped forward due to the presence of bilateral fractures in the pars intraarticularis.
List 2 possible causes of spondylosis and spondylolisthesis.
- Failure of the neural arch (surrounding the spinal cord) at the pars intraarticularis to unite during growth (more common)
- Fracture of the pars intraarticularis.
What are 2 onsets of pain for spondylosis and spondylolisthesis?
- Sudden quick movement into extension
2. Repetitive movements into extension
What kinds of pain should be monitored for in patients with spondylosis and spondylolisthesis? (2)
- Pain with positions/ activities that entail extension (increases tendency for vertebra to slip anteriorly)
- Pain is better with positions that entail flexion
The presence of a _____ on X-ray is a sign of the presence of a fracture
‘Scotty dog collar’
List the 4 grades of slippage as determined by an xray for spondylosis and spondylolisthesis.
- Grade I if up to 1/4 of the vertebral body has slipped forward in relation to the vertebral body below
- Grade II if up to 1/2 of the vertebral body has slipped forward in relation to the vertebral body below
- Grade III if up to 3/4 of the vertebral body has slipped forward in relation to the vertebral body below
- Grade IV if more than 3/4 of the vertebral body has slipped forward in relation to the vertebral body below
How is spondylosis/OA of the spine diagnosed?
via X-ray and MRI
___ exercises and ___ mobilization have been shown to reduce symptoms in patients with spondylosis/OA.
Stabilization exercises
Hip Mobilizations
What is the cause of spinal stenosis?
Bony encroachment into the spinal canal (central stenosis) and/or intervertebral foramen (lateral stenosis) secondary to degenerative changes
Stenosis is characterized by a pain pattern in which symptoms increase with ___ and decrease with ____.
Increases with extension
Decreases with flexion
List 2 symptoms that stenosis can cause.
- Sxs attributable to a nerve root compression
2. Neurogenic claudication sxs (nerve root ischemia causing poorly localized leg pain, parasthesia and cramping)
Stenosis pain can be described as resembling ____ pain, and often increases with ____.
Ischemic pain
Walking
How can one distinguish between spinal stenosis and LE claudication? (3)
- Place patient on stationary bike
- If sxs increase with biking- intermittenet claudication
- If sxs remain the same = stenosis
What are 5 diagnosis criteria for spinal stenosis?
4/5 must be positive:
- Bilateral symptoms
- Leg pain greater than back pain
- Pain during walking/standing
- Pain relief when sitting
- Age > 48 years
What is ankylosing spondylitis? (3)
- Rheumatic, sero-negative condition
- Characterized by ossification of spinal ligaments and joint capsules
- Spinal mobility gradually decreases over time
Patients with signs of _____ and _____ or a positive _____are likely to benefit from lumbar traction.
- Nerve root compression
- Peripheralization of sxs
- Positive crossed leg raise test
List 4 advantages of using lumbar bracing.
- Controls lordotic positioning
- Reminds patient to maintain lordosis
- Reduces stress on spine by increase intra-abdominal pressure
- Reduces stress on the spine by decreasing lever arm created by abdomen to bring abdominal contents towards the spine
List 3 disadvantages of using lumbar bracing.
- Atrophy of trunk muscles
- Skin breakdown
- Cosmetic issues
