2. Low Back Nerological Assessment

Question 1

What are examples of somatic tissues that can cause deep scleratogenous referred pain?

Answer 1

Disc
Cartilage
Ligament
Joint capsule
Bone

Question 2

Describe a scleratogenous refereed pain field

Answer 2

• spreads out over time (radiates)
• referral territory grows
• may not be contiguous and may skip to more distal region

Question 3

What is the most common type of spine related extremity pain seen in practice?

Answer 3

Scleratogenous referred pain

Question 4

What is the convergence-projection phenomenon?

Answer 4

Neurological pathways from two different areas converge in the spinal cord and conduct to the brain. Pain can then be perceived in both areas even though only one may be experiencing noxious stimuli

Question 5

What is central sensitization?

Answer 5

Pain signals from an injured tissue can activate spinal WDRs making them hyperactive. This can result in spontaneous pain and hyperalgesia to any stimulation

Question 6

What are the 5 clues from the H&P that help distinguish between the the 5 different causes of back and leg pain?

Answer 6

• leg pain (territory/location, quality, severity, affect of spine position)
• leg paresthesia (territory/location)
• lumbar tension tests
• Neuro deficits/abnormalities on SMR testing
• lumbar joint loading procedures

Question 7

What are the 5 possible causes of simultaneous back and leg pain?

Answer 7

• cord lesion (myelopathy)
• nerve root lesion (radiculopathy)
• peripheral nerve lesion (neuropathy)
• deep referred pain
• separate lesions

Question 8

Describe the leg pain associated with radiculopathy.

Answer 8

• may go past knee
• may follow a dermatomal pattern
• more superficial
• often sharp, stabbing, electrical, sharp, painful cold, lancinating
• leg pain often worse than back pain
• sometimes affected by spine position