W/W - Lower Back Pain

Question 1

low back pain that arises from the spine, intervertebral discs, or surrounding soft tissues

Answer 1

mechanical lbp

Question 2

causes of mlbp

Answer 2

acute traumatic event

cumulative trauma

Question 3

3 common lbp complaints that W/W stressed

Answer 3

pain associated w.:

SIJ region

lumbar facet

discogenic

Question 4

2 special tests for mlbp

Answer 4

SLR

Fabers

Question 5

umbrella term for different forms of age-related degeneration of the spine

Answer 5

spondylosis

Question 6

narrowing of the spaces in the spine → compresses spinal cord and nerve roots exiting each vertebrae

Answer 6

spinal stenosis

Question 7

stress fx thru the pars interarticularis of the lumbar vertebrae

Answer 7

spondylolysis

Question 8

vertebrae in the spine moves forward out of the proper position onto the bone blow it

Answer 8

spondylolisthesis

Question 9

what structures does mclbp arise from (5)

Answer 9

bone

ligaments

discs

joints

nerves

Question 10

t/f: mlbp typically has progressive neuro defect

Answer 10

F!

Question 11

chronic lmbp lasts >

Answer 11

3 months

Question 12

rf associated w. progression of acute to chronic lbp

Answer 12

genetics

female

sedentary/obesity/smoking

poor social support/anxiety/dpn/poor coping skills

trauma

occupational

greater dz burden

Question 13

what movement to avoid due to risk of acute lbp

Answer 13

BLT → bend, lift, twist

Question 14

what movement to avoid due to risk of acute lbp

Answer 14

BLT → bend, lift, twist

Question 15

sx of spinal abscess (a do not miss on differential for lbp)

Answer 15

fever + back pain

Question 16

SIJ pain can mimic

Answer 16

sciatic pain

Question 17

piriformis syndrome is associated w. inflammation of the __ n

Answer 17

sciatic

Question 18

SIJ dysfunction involves __ of the joint

Answer 18

hypomobility

Question 19

3 PE tests for SIJ dysfxn

Answer 19

patricks/fabers

leg length measurement

forward bend and march

Question 20

leg length measurement and forward bend/march tests look for

Answer 20

hypomobility of SIJ

Question 21

patricks/fabers are intended to __ the SIJ

Answer 21

stress

Question 22

what do you think when you see a pt leaning to one side while sitting w. limited ROM in L/S and normal neuro exam

Answer 22

SIJ dysfxn

Question 23

what test is this

Answer 23

patricks/fabers

Question 24

what test is this

Answer 24

SI distraction

Question 25

what test is this

Answer 25

leg length discrepancy

Question 26

gs for measuring true leg length discrepancy

Answer 26

x-ray PLUS measure

Question 27

what does this make you think

Answer 27

SIJ dysfxn

Question 28

what is a (+) finding on a forward bend test

Answer 28

affected SIJ rises

Question 29

what is a (+) finding on a march test

Answer 29

affected SIJ drops w. ipsilateral hip flexion *weak data supporting this test*

Question 30

small, stabilizing joint that prevents the spine from translating anteriorly

Answer 30

facet joint

Question 31

what do you think when you see a pt w. vague/dull lbp, rubbing back w. both hands

Answer 31

facet syndrome

Question 32

facet syndrome is associated w.

Answer 32

muscular spasm

Question 33

facet syndrome pain is worse w. \_\_ and improved w. \_\_

Answer 33

L/S extension forward flexion

Question 34

what condition contributes to facet pain

Answer 34

arthritis

Question 35

facet syndrome rarely involves \_\_, but can mimic

Answer 35

spinal nerves sciatica

Question 36

what do you think when you see, tenderness over facet joints, pain w. extension and rotation, and tight hamstrings

Answer 36

lumbar facet pain

Question 37

lumbar facet pain

Question 38

lumbar facet pain is associated w. (4)

Answer 38

tight hamstrings lordotic curve truncal obesity lordosis of pregnancy

Question 39

what test is used to test for facet syndrome/peripheral spinal stenosis

Answer 39

quadrant kemps test

Question 40

who is at risk for discogenic pain

Answer 40

physically demanding jobs **repetitive lifting/pulling/pushing** **bending sideways and twisting** exposure to vibration static posture weak core prolonged sitting

Question 41

2 critical aspects of assessing discogenic pain

Answer 41

comprehensive H/P ## Footnote **N/V exam**

Question 42

common complaints w. discogenic pain

Answer 42

hurts w. sneeze/cough/bear down/laugh pain w. L/S flexion relief w. laying down radicular pain/paresthesias muscle spasm affect on ADLs

Question 43

do not miss red flags in lbp

Answer 43

AAA pregnancy ectopic pregnancy CA pyelo PID nephrolithiasis prostatitis PMS endometriosis spinal cord abscess AI

Question 44

early management of lbp (first visit)

Answer 44

avoid imaging x 6 weeks rule out red flags pt ed → stay active, return to ADLs asap avoid opioids **early PT**

Question 45

later management of lbp (2nd visit)

Answer 45

assess adherence to recs consider NSAIDs continued PT encourage activity re-evaluate for other dx

Question 46

what do you think when you see: progressive motor or sensory loss, new urinary retention or incontinence, fecal incontinence, saddle anesthesia

Answer 46

cauda equina

Question 47

what do you think when you see: recent spinal procedure, IVDU, immunosuppression, fever

Answer 47

spinal infxn

Question 48

case 1: 64 yo f, right sided lbp, achy burning, radiates to right posterior leg/knee/calf, numbness in 4th/5th toes standing/sitting/bending worsens pain began 6-8 weeks ago, fell skiing, change in gait after caring for mom

Answer 48

**discogenic** radiates → nerves involved

Question 49

case 2: 60 yo m, 2-3 years of achy/stabbing lbp, worsens intermittently after activity, worse in AM can not straighten spine - “something stuck in back” worse w. bending/twisting/walking, better w. sitting

Answer 49

**facet →** can't straighten, can't bend/twist

Question 50

case 3: 81 yo m, severe tight lbp, radiates to posterior legs/ankles w. standing/walking relieved w. sitting, began gradually 2 years ago, now consistent, interfere w. ADL

Answer 50

**discogenic** radiates → nerve involvement

Question 51

case 4: 69 yo m, left sided lbp, “hot needle in back," does not radiate, constant worst in AM when getting out of bed, better w. lying down, affects ADLs began 2 months ago after trip w. walking/fishing/lifting/dragging suitcase

Answer 51

**facet →** does not radiate, better w. laying down, affects ADLs