Back Pain

Question 1

Why is back pain important?

Answer 1

3 overall cause of disability

2nd only to common cold as cause for primary care visit (cypress)

Question 2

What are the top three most costly procedures in the US health care system?

Answer 2

narcotics

in-patient admissions

magnetic resonance imaging

Question 3

What are the common causes of pain in the back?

Answer 3

disc

facet joint

sacroiliac joint

ligaments - PLL, ALL

nerves

muscle

vertebral body

Question 4

Where does the back have the greatest motion?

Answer 4

L 4-5 and L5-S1

most common areas of pain

Question 5

What happens to the canal size with extension and flexion?

Answer 5

canal size decreases with extension and increases with flexion

Question 6

What happens to intradiscal pressure with posture?

Answer 6

intradiscal pressure increases with forward bend or seated with arms unsupported

Question 7

What happens to facet load with extension and flexion?

Answer 7

increases with extension and decreases with flexion

Question 8

What is cauda equina syndrome?

Answer 8

a serious neurologic condition in which damage to the cauda equinacauses acute loss of function of thelumbar plexus, (nerve roots) of the spinal canal below the termination (conus medullaris) of the spinal cord

requires surgery!

Question 9

What are the neurodynamic tests for back pain?

Answer 9

straight leg raise

slump test

femoral stretch

Question 10

How is acute LBP treated?

Answer 10

decrease pain/inflammation (modalities, medications)

early mobilization - the more movement, the more strength

directional movement pattern to centralize pain

Question 11

How is subacute LBP treated?

Answer 11

flexibility, stabilization, proprioception, sport specific training, multiple planes

Question 12

What is the role of passive treatments for LBP?

Answer 12

limited role

best utilized during acute phase for periods of time

may be useful to facilitate a more active functional rehabilitation program

Question 13

What are the outcomes of matched vs. opposite care?

Answer 13

matched care is much better than opposite care in terms of disease and pain outcome

Question 14

Whats the relationship between strength and LBP?

Answer 14

not found to a predictor of firs ttime injury

little relationship with low back health

however, important for athletic performance objectives

Question 15

What is the relationship between aerobic fitness and back pain?

Answer 15

walking decreases spinal loading

fast walking with arms swinging results in lower oscillating spine loads

Question 16

What is the role of spinal injections in LBP?

Answer 16

symptoms refractory to intial conservative interventions

useful diagnostically to confirm a pain generator

ESI efficiency proven in radicular pain

fluoro guidance to ensure proper administration of meds and minimize complications

failed NSAIDs, oral corticosteroids, therapeutic exercises

identify the pain generator

Question 17

What is the preferred route for epidural injections?

Answer 17

transforaminal is preferred for selective nerve root block

most useful role of spinal injections seem to be in combination with othe rtreatments usch as hysical therapy and medications