WEEK 7 Joint Disorders, Lumbar Spine & SI Joint Flashcards
In the lumbar region, what spinal levels do disc herniations occur 90% of the time?
L4/5 and L5/S1
Next most common disc to be injured is L3/4.
What type of pain is experienced in back with disc bulge?
Dull, deep, poorly localized pain.
What type of pain happens if disc bulges posterolaterally against nerve root?
Sharp nerve root pain.
What pathology do the following mechanisms of injuries belong to: bending forward w/ or w/o rotation, falling onto buttock w/ spine flexed, coughing & sneezing, bearing down for bowel?
Lumbar disc pathology.
When injured, the body will protect the lumbar region by contracting large global muscles in response to what?
Inflammation.
What are some of the local lumbar muscle groups?
- Multifidus
- Transverse abdominus
Which tight muscle groups affect the lumbar region?
- Hip flexors
- Hamstrings
Disc will commonly refer pain locally into low back and extend down posteriorly to which region?
Gluteal region.
What type of exercises should be done to minimize stress to the disc?
- Lying in hooklying
- Pain-free ROM
- Extension-based
What is the term for when repetitive extension reduces leg paresthesias by anterior migration of nucleus?
Centralization.
Lumbar DJD occurs in concert with DDD, leading to loss of disc what?
Height.
Symptomatic lumbar DJD is rarely found in people under what age?
40 years old.
True or False: Walking relieves lumbar disc pathology but aggravates DJD & interforaminal stenosis.
True.
How should knees and hips be positioned to relieve lumbar disc pathology & DJD?
Flexed.
To improve posture for DJD, there should be progressive thoracic what and shoulder extension/retraction?
Extension.
What are some stretches used for lumbar DJD?
- Double knee to chest
- Single knee to chest
- Hamstring
- Piriformis
Soft tissue mobilization is done to decrease pain by relaxing muscular tension & increasing what release?
Endorphin.
What is the normal response of the body when the space that nerve occupies shrinks, leading to impingement & damage?
Inflammation.
In interforaminal stenosis, postural deformities that (open/close) up foramen are seen in highly irritable patients.
Open.
True or False: Sitting & bending forward aggravates interforaminal stenosis.
False.
True or False: Extension-based exercises are encouraged for interforaminal stenosis since flexion aggravates symptoms but can be used in adjacent regions to decrease stress.
False.
What fraction of people with back pain have radiculopathy?
3 out of 10.
In how many months do most cases of lumbar radiculopathy resolve?
1-2 months.
What is the type of lumbar radiculopathy with inflammation of the sciatic nerve?
Sciatica.
Leg length discrepancy contributes to radiculopathy since the (shorter/longer) leg side may have relative ipsi concavity in lumbar spine, decreasing size of foramen.
Longer.
True or False: Leg pain is often worse than back pain with radiculopathy.
True.
Most radiculopathies involve lower lumbar nerve roots (which levels) leading to symptoms below the knee?
L4-S1.
Upper lumbar radiculopathies are not as common but cause pain in which part of the thigh?
Anterior thigh.
If herniated disc is the cause for radiculopathy, symptoms will worsen with lifting, bending, lumbar what, and sitting?
Flexion.
If stenosis, DDD, or DJD is the cause for radiculopathy, symptoms will worsen with standing, backward bending, & trunk what?
Extension.
What is the indicator of decreased pressure on the nerve root?
Symptom centralization.
What are some indicators for surgery for patients with lumbar radiculopathy?
- Progressive neurological deficit
- Cauda equina syndrome
- Bowel/bladder dysfunction
- Severe unrelenting pain
What type of lumbar ligament tear leads to lumbar segmental instability?
Complete.
Approximately what percentage of people with lumbar ligament tear will experience LBP?
80%.
What percentage of all back pain cases are attributed to soft tissue injuries, grouped together as sprain/strain?
80%.
What is the prognosis for lumbar ligament tears?
Excellent, with over 90% of patients recovering within 1-2 months.
In the elderly & the young, where is the weakest point of the ligament?
Ligament-to-bone intersection.
In most adults, where is the weakest point of the ligament?
Midsubstance.
True or False: Ligament sprain is usually caused by trauma and not overuse.
True.
True or False: Pain from ligament sprains tend to have referral into lower extremities.
False.
What type of postures will fatigue or overstress a ligament?
Sustained or end-range.
Which muscle groups should be worked on in strengthening exercises with ligament sprains?
- Abs
- Hip extensors
- Hip abductors
- Spinal extensors
What is the most common injury to the low back?
Lumbar strain.
What is the most common lumbar muscle strained?
Erector spinae.
A microtear of lumbar muscle or tendon most commonly occurs at which two spots?
- Z-line
- Musculotendinous junction
A lumbar strain may take how many weeks to heal?
4-12 weeks.
Symptoms of a mild lumbar strain usually resolve within how many weeks?
2-3 weeks.
In the elderly & young, where is the weakest point of the muscle-tendon-bone complex?
Tendon-to-bone intersection.
In most adults, where is the weakest point of the muscle-tendon-bone complex?
Myotendinous junction.
True or False: Postural deformities increase the risk of lumbar muscle strain.
False.
What is the mechanism for a traumatic strain?
Forced extension usually from a position of trunk flexion or eccentric contractions of lumbar extensors as they resist trunk flexion.
Where does pain from lumbar muscle strain radiate to?
Butt.
True or False: Passive trunk extension with lumbar muscle strain typically has pain.
False.
For lumbar muscle strain, which regions besides spinal/trunk should be included in mobility exercises?
- Hips
- Thoracic spine
Which lumbar vertebrae is spondylolysis most common?
5th.
Which lumbar vertebrae is the second most common for spondylolysis?
4th.
What are the three most common spondylolisthetic levels (in order)?
- L5/S1
- L4/L5
- L3/L4
Describe the four grades of spondylolisthesis.
- Grade 1: 0-25% slippage
- Grade 2: 25-50%
- Grade 3: 50-75%
- Grade 4: over 75%
Which type of spondylolisthesis is true congenital (rare) and has rapidly progressing neuro deficits?
Dysplastic.
Which type of spondylolisthesis is from stress fracture with hyperextension and is most common at L5/S1?
Isthmic.
Which type of spondylolisthesis is slippage of the superior vertebral segment because of facet arthritis where facets have more sagittal plane orientation?
Degenerative.
Which type of spondylolisthesis is caused by acute fracture of facet or pars interarticulatis?
Traumatic.
Which type of spondylolisthesis is caused by damage to posterior elements from tumor, metastases, or metabolic bone disease?
Pathological.
Which two types of spondylolisthesis are most common?
- Isthmic
- Degenerative
Which spondylolisthesis has more of a stenotic history (pain with extension, symptoms of radiculopathy or neurogenic claudication)?
Degenerative.
A posterior to anterior what force and compression through shoulders in standing can aggravate spondylolisthesis?
Shear.
How is radicular pain treated in spondylolisthesis?
Epidural steroids.
What are the indicators of surgery with spondylolisthesis?
- > 50% slippage
- Progressive neuro deficits
- Severe restriction of activity
- Pain that is not responding to conservative care (after 6 weeks)
What is the term for dysfunction of innominate articulations that exclusively create pelvic pain verified by intraarticular anesthetic injections?
SI joint pathology.
Which gender is more at risk for SI joint pathology?
Women.
What is the most common correlation with the development of pelvic pain?
Pregnancy.
True or False: SI joint pain can be related to activities that require opposing innominate motion (ex: posterior vs anterior rotation).
True.
SI joint pain is in the what sulcus, medial to posterior superior iliac spine, extending to the buttock & posterior thigh?
Sacral.
Which laying positions help relieve SI joint pain?
Crooklying & hooklying.
Which muscles are focused on in SI joint pathology rehab?
- Transverse abdominus
- Internal oblique
- Pelvic floor muscles
