Week 2: Thu 1.21.16 Lumbar Subjective Flashcards
In what age groups is LBP most likely to occur?
20-50
What are the most consistently reported occupational factors associated with the development of LBP? (4)
- heavy and frequent lifting
- high exposure to whole body vibrations such as driving
- prolonged or frequent bending or twisting
- postural stresses (ie. high load, awkward postures)
What is the U-shaped curve between physical (and probably occupational) activity and LBP?
- U-shaped curve- too little or too much activity equally increases risk of LBP.
- Physical activity not associated w/ CLBP by type, intensity, duration. But extremes of total activity pattern are associated w/ CLBP.
- Example: One extreme being a very sedentary lifestyle versus the opposite, a physically strenuous lifestyle.
LBP: which body areas and common symptoms should be cleared during the subjective exam? (3)
- Lower thoracic spine and lumbosacral spine (unilaterally and centrally)
- Bilateral buttocks and both lower extremities (circumferentially)
- Abdominal and groin (anteriorly)”
Accepted MCID for the NPRS
2 points
How should the PT proceed with the subjective exam if the patient reports a gradual or insidious onset of pain?
If onset is gradual or insidious, clinician must ask about predisposing factors: unusual activity, repetitive activities, changes in work, training, recent illness, or stress.
What can gradual onset of pain mean?
“Gradual” may mean over one day or over weeks or months. Spinal loads with cumulative or repetitive stress and biomechanical creep leading may subject some tissues to fatigue damage.
Why is insideous onset a concern?
A truly insidious onset merits concern about the underlying cause of the condition and raises the suspicion of a non musculoskeletal problem.
What pattern of progression, stability or response to previous treatment suggests a red flag?
Symptoms unchanged, worsened, or improved then get worse again despite appropriate PT interventions are considered a red flag
What is the analytic value of agg and ease of standing/walking? (3, sorta 5)
- lumbar extension
- lower extremity loading and balance
- hip stability and mobility
What is the analytic value of agg and ease of relaxed sitting? (2)
- mostly lumbar flexion
- adequate hip mobility
What is the analytic value of agg and ease of bending? (1)
produces more flexion of the lumbar spine than squatting
What is the analytic value of agg and ease of lying?
depends on many factors, but also upon position- supine, prone, or side lying
4 positions/movements that may have analytic value when reviewing agg/ease factors for LBP
- standing/walking
- relaxed sitting
- bending
- lying supine/prone/sidelying
Two important reasons for inquiring about sleep?
- Night pain can a red flag
- If pain is most intense at night and the patient is unsure of what wakes him or her, gets up and walk around, and has difficulty returning to sleep, consider possibility of an active inflammatory component or more serious pathology
- Pain at night is typical of mechanical problem- pt. reports inability to lie on the involved side or waking w/ symptoms that are simply relieved by a change of position and return to sleep.
- determine the frequency, provocative position, and symptoms produced.
