Week 3 SPP Back pain

Question 1

Explain the evolutionary perspective on low back pain.

Answer 1

• mechanical back pain from wear and tear and injury of spinal joints and associated soft tissues
• pre humans: active lifestyle of hunters and gatherers
• modern: sedentary life style, excessive sitting and poor sitting posture
• Becomign bipedal: develop a S shaped curve in spine,

Question 2

What structural portion of the back is the source of most cases of back pain?

Answer 2

-back muscles

Question 3

Most patients who present to primary care physician with back pain have one of the following causes of pain:

Answer 3

1. muscle or ligamentous strain
2. disk degeneration/rupture
3. osteoarthritis
4. vertebral fracture or collapse (freq. in older ppl with osteoporosis)
5. psychosocial factors
6. spinal stenosis

Question 4

What serious underlying diseases must be ruled out in back pain?

Answer 4

1. Infection
2. Neoplasm
3. metabolic problems
4. extrinsic disease such as aortic aneurysm

Question 5

What are risk factors for low back pain?

Answer 5

1. age
2. occupation
3. multiparity
4. overweight
5. smoking slows recovery
   Risk factors for disability due to low back pain
   -poor health habits
   -job dissatisfaction
   -less appealing work environment
   -poor rating by supervisors
   -psychological disturbances
   -compensatory injuries
   -history of prior disability

Question 6

Which of the following positions is the highest L5-S1 nucleus pulpous pressure?

Answer 6

Sitting slumped

Question 7

Which part of the vertebral column chronically has the highest stress?

Answer 7

L5-S1, bears most of weight

Question 8

Describe location of the pain, numbness, motor weakness, reflex affected, and screening exam used with regards to injury to L4, L5, S1 dermatomes of lower limbs.

Answer 8

1. L4
   - pain from side of butt down front of leg
   - numbness in anterior medial part of leg around knee
   - motor weakness of extension of quads
   - screen via squat and rise
   - diminished knee jerk reflex
2. L5
   - pain from posterior, superior part of butt down lateral side of leg
   - numbness on lateral calf
   - motor weakness of dorsiflexion of great toe and foot
   - screening: heel walking
   - no reliable reflex
3. S1
   - pain: posterior butt, down posterior lateral leg
   - numbness: posterior calf
   - motor weakness: plantar flexion of great toe and foot
   - screening: walking on toes
   - reflexes: ankle jerk diminished

Question 9

Which nerve would be effected by a lateral disc protrusion between L4 and L5? What about a L5-S1 disc protrusion?

Answer 9

L4/5: Affects L5 nerve

L5/S1: affects S1

Question 10

What are some red flags for potentially serious conditions, with regards to back pain?

Answer 10

1. possible fracture
   - major or minor trauma from strenuous lifting or accident
2. Tumor or infection
   - >55 age, or <20 yrs
   - hx of cancer
   - constitutional symptoms: fever, chills, recent weight loss
   - risks: IV drug use, recent bacterial infection e.g. UTI, immune suppression
   - pain that is worse in supine, severe nighttime pain
3. Cauda equina syndrome
   - saddle anesthesia
   - recent onset bladder dysfunction, i.e. urinary retention, increased frequency or overflow
   - severe or progressive neurologic deficit
   - laxity of anal sphincter, perianal loss, motor weakness of quads, ankle plantar flexors, evertors, and dorsiflexors

Question 11

What are some psychosocial issues associated with low back pain?

Answer 11

1. Depression
2. Anxiety
3. Hypochondriasis
4. acute remunerative back pain-seeking monetary compensation