Week 2: LBP and Lumbar Flashcards
What happens to the IV disc during flexion
Discs move posteriorly
What happens to the IV disc during extension
Discs move anteriorly
What happens to the IV disc during rotation
discs mash
Is back pain a symptom or a condition
Symptom
The source of low back pain is unknown for what percent of cases?
90% of low back cases have unknown pathophysiology
For acute low back pain, in 6 weeks what percent of patients had recovered?
60% –> improves by itself, good natural history
Risk factors for non-specific low back pain
Heavy and frequent lifting (>25kg)
Obesity, smoking, depressive symptoms
TUNAFISH Red Flags Analogy
Trauma
Unexplained weight loss
Neurologic symptoms
Age >50
Fever
Intravenous drug use
Steroid use
History of cancer
Lumbar Stenosis signs and symptoms
Bilateral buttock pain, thigh or leg pain, older age
Aggravated by longer walking and released by sitting or flexing
Cook clinical decision rule for lumbar stenosis
age >48 years
Bilateral symptoms
Leg pain more than back pain
Pain during walking/standing
Pain relief upon sitting
At least 3/5 positive
Revel’s criteria for low back pain caused by Facet joint
Age >65
Forward flexion
extension
Pain well relieved by recumbency
no exacerbation of pain with coughing and sneezing
rising from flexion
extension rotation test
Main components of non-specific LBP management
education and reassurance
analgesics
non-pharmacological therapies (exercise, manual therapy, massage, acupuncture)
Main groups in LBP
Non-specific pathology (90-95%)
Serious pathology (<1%)
Specific pathology (5-10%)
Serious pathology conditions
Malignancies
Systemic inflammatory disorders
Infections
Cauda equina syndrome
Based on clinical examination, medical investigation
Leads to medical management
Specific pathology conditions
Fracture (traumatic/stress)
Disc prolapse with radicular pain
Type 1 Modic changes
Sponylolisthesis
Radicular pain
Spinal stenosis
Radiological imaging
Leads to medical management
What is spinal stenosis and how do you diagnose it?
Spinal stenosis is the narrowing of the spinal canal leading to nerve compression
Diagnosed based on symptoms like bilateral leg pain, pain relief when bending forward, and confirmed by imaging showing narrowing of the spinal canal
Main prognostic factors of LBP
higher disability
presence of sciatica
older age
poor general health
increased psychological or psychosocial distress
negative cognitive characteristics
poor relationships with colleagues
heavy physical work demands
Typical words used in patient interview and observation suggestive of non-specific LBP
Stiffness
Pain comes and goes
worse/better with certain movements
flare ups
no specific trauma, activity or mechanism
postural related (lots of sitting/standing)
Reasons for PAIVMs
Improved ROM
Decrease in pain/stiffness
improved QoL
Patient preference
