W/W - Lower Back Pain Flashcards
low back pain that arises from the spine, intervertebral discs, or surrounding soft tissues
mechanical lbp
causes of mlbp
acute traumatic event
cumulative trauma
3 common lbp complaints that W/W stressed
pain associated w.:
SIJ region
lumbar facet
discogenic
2 special tests for mlbp
SLR
Fabers
umbrella term for different forms of age-related degeneration of the spine
spondylosis
narrowing of the spaces in the spine → compresses spinal cord and nerve roots exiting each vertebrae
spinal stenosis
stress fx thru the pars interarticularis of the lumbar vertebrae
spondylolysis
vertebrae in the spine moves forward out of the proper position onto the bone blow it
spondylolisthesis
what structures does mclbp arise from (5)
bone
ligaments
discs
joints
nerves
t/f: mlbp typically has progressive neuro defect
F!
chronic lmbp lasts >
3 months
rf associated w. progression of acute to chronic lbp
genetics
female
sedentary/obesity/smoking
poor social support/anxiety/dpn/poor coping skills
trauma
occupational
greater dz burden
what movement to avoid due to risk of acute lbp
BLT → bend, lift, twist
what movement to avoid due to risk of acute lbp
BLT → bend, lift, twist
sx of spinal abscess (a do not miss on differential for lbp)
fever + back pain
SIJ pain can mimic
sciatic pain
piriformis syndrome is associated w. inflammation of the __ n
sciatic
SIJ dysfunction involves __ of the joint
hypomobility
3 PE tests for SIJ dysfxn
patricks/fabers
leg length measurement
forward bend and march
leg length measurement and forward bend/march tests look for
hypomobility of SIJ
patricks/fabers are intended to __ the SIJ
stress
what do you think when you see a pt leaning to one side while sitting w. limited ROM in L/S and normal neuro exam
SIJ dysfxn
what test is this
patricks/fabers
what test is this
SI distraction
what test is this
leg length discrepancy
gs for measuring true leg length discrepancy
x-ray
PLUS
measure
what does this make you think
SIJ dysfxn
what is a (+) finding on a forward bend test
affected SIJ rises
what is a (+) finding on a march test
affected SIJ drops w. ipsilateral hip flexion
weak data supporting this test
small, stabilizing joint that prevents the spine from translating anteriorly
facet joint
what do you think when you see a pt w. vague/dull lbp, rubbing back w. both hands
facet syndrome
facet syndrome is associated w.
muscular spasm
facet syndrome pain is worse w. __
and improved w. __
L/S extension
forward flexion
what condition contributes to facet pain
arthritis
facet syndrome rarely involves __,
but can mimic
spinal nerves
sciatica
what do you think when you see, tenderness over facet joints, pain w. extension and rotation, and tight hamstrings
lumbar facet pain
lumbar facet pain
lumbar facet pain is associated w. (4)
tight hamstrings
lordotic curve
truncal obesity
lordosis of pregnancy
what test is used to test for facet syndrome/peripheral spinal stenosis
quadrant kemps test
who is at risk for discogenic pain
physically demanding jobs
repetitive lifting/pulling/pushing
bending sideways and twisting
exposure to vibration
static posture
weak core
prolonged sitting
2 critical aspects of assessing discogenic pain
comprehensive H/P
N/V exam
common complaints w. discogenic pain
hurts w. sneeze/cough/bear down/laugh
pain w. L/S flexion
relief w. laying down
radicular pain/paresthesias
muscle spasm
affect on ADLs
do not miss red flags in lbp
AAA
pregnancy
ectopic pregnancy
CA
pyelo
PID
nephrolithiasis
prostatitis
PMS
endometriosis
spinal cord abscess
AI
early management of lbp (first visit)
avoid imaging x 6 weeks
rule out red flags
pt ed → stay active, return to ADLs asap
avoid opioids
early PT
later management of lbp (2nd visit)
assess adherence to recs
consider NSAIDs
continued PT
encourage activity
re-evaluate for other dx
what do you think when you see: progressive motor or sensory loss, new urinary retention or incontinence, fecal incontinence, saddle anesthesia
cauda equina
what do you think when you see: recent spinal procedure, IVDU, immunosuppression, fever
spinal infxn
case 1: 64 yo f, right sided lbp, achy burning, radiates to right posterior leg/knee/calf, numbness in 4th/5th toes
standing/sitting/bending worsens pain
began 6-8 weeks ago, fell skiing, change in gait after caring for mom
discogenic
radiates → nerves involved
case 2: 60 yo m, 2-3 years of achy/stabbing lbp, worsens intermittently after activity, worse in AM
can not straighten spine - “something stuck in back”
worse w. bending/twisting/walking, better w. sitting
facet →
can’t straighten, can’t bend/twist
case 3: 81 yo m, severe tight lbp, radiates to posterior legs/ankles w. standing/walking
relieved w. sitting, began gradually 2 years ago, now consistent, interfere w. ADL
discogenic
radiates → nerve involvement
case 4: 69 yo m, left sided lbp, “hot needle in back,” does not radiate, constant
worst in AM when getting out of bed, better w. lying down, affects ADLs
began 2 months ago after trip w. walking/fishing/lifting/dragging suitcase
facet →
does not radiate, better w. laying down, affects ADLs
