Week 10 Task Sheet - Chronic LBP

Question 1

What is creep phenomenon?

Answer 1

When sitting, the IVD is compressed anteriorly - contents of IV disc moves posteriorly, stretching the PLL

Question 2

Why does creep phonomenon cause pain?

Answer 2

When disc is building posteriorly and a pt moves into extension (e.g. standing) there is pinching of the innervated outer disc causing pain = reduces as standing as disc creeps back centrally

Question 3

What positions are painful for patients with facet joint arthosis and why?

Answer 3

Extension (e.g. standing) as increases the pressure on the facet joints

Question 4

Why do patients with facet joint athrosis have ‘giving way’?

Answer 4

Weakness of the surrounding musculature due to pain avoidance postures = muscle atrophy and so the spine feels less stable

May also be due to Pain Inhibition (Hilton’s Law) where irritation of structures in the spine are referred to local muscles and causes inhibition

Question 5

What causes decreased lumbar lordosis?

Answer 5

Posterior pelvic tilt due to:

• Tight erector spinae
• Weak gluteus maximus
• Weak abdominals
• Tight illeospoas

Question 6

What is the effect of decreased lumbar lordosis?

Answer 6

Increased pressure on anterior lumbar disc

Question 7

What is spondylolythesis?

Answer 7

translation of one vertebral body on another in the sagittal pain (slipping of the vertebral body) – most commonly anterior translation

Question 8

How is spondylolythesis graded?

Answer 8

Percentage of upper disc slip on lower disc:
Grade 1 = 0-25%
Grade 2 = 26-50%
Grade 3 = 51-75%
Grade 4 = 75-100%

Question 9

What are the symptoms of spondylolythesis? (7)

Answer 9

• Diffuse Low-back pain
• Pain radiating down the leg
• Neurological symptoms (possible evolution towards cauda equine syndrome)
• Atrophy of the muscles, muscle weakness
• Tense hamstrings, hamstrings spasms
• Diminished ROM (spine)
• Disturbances in coordination and balance

Question 10

What is lumbar spinal stenosis?

Answer 10

narrowing of the Lx spinal canal and IV foramen resulting in compression of neural and vascular structures of the canal

Question 11

What is the pathophysiology of spinal stenosis?

Answer 11

Loss of structural integrity of the discs –> increased stress on facet joints and ligaments –> osteophyte formation on facet joints and vertebral endplates –> thickening of ligamentum flavum –> narrowing of the spinal canal –> compression of spinal cord or nerve roots & blood vessels –> ischemia

Question 12

What are the symptoms of spinal stenosis?

Answer 12

• insidious onset aching pain increasing with Lx extension
• eases with Lx flexion
• pain bilaterally in leg and lower back
• pain worse when standing/walking
• heavy/deep/aching pain

Question 13

What is spondylolysis?

Answer 13

separation of the neural arch – due to a defect in pars interarticularis (part of the vertebrae between the inferior and superior articular process of the facet joint) - usually due to stress fracture = usually results in spondylolisthesis