Flashcards in Back Deck (55)
how is the spine a shock absorber along with the legs?
This occurs because the spine is flexible, and is supported by strong muscles and tendons
What happens if the spine is no longer able to absorb shocks?
we lose the ability to protect ourselves from abnormal shocks and vibrations (ankylosing spondylitis)
what are the 3 main curves in the spin?
what does kyphosis mean?
excessive outward curvature
what does lordosis mean?
excessive inward curvature
what part of the spine is most flexible and why?
Cervical spine is the most mobile part of the spine, due to having relatively thick discs in comparison to the size of the adjacent vertebrae
what part of the spine is least flexible and why?
Thoracic spine is the least mobile, partly due to the ribs inhibiting movement
what part of the spine is mainly shock absorbers?
the interverebral discs
at what time of day is the discs most stiff?
They are most stiff in the morning. They are swollen with water so the annulus and intervertebral ligaments resist bending strongly and are more vulnerable to injury
How does the disc become more flexible but what potential problem can this cause?
As the day progresses, discs lose up to 20% of their water and height so the spine is more supple but low back pain can increase during the day and with standing
what happens to the spine especially the intervetebral discs with increae age?
Discs lose water and lose strength and become thinner
Vertebral endplates and underlying bone structure loses strength
Repetitive loading/trauma can result in annular tears in the discs
Dryer, weaker discs result in slacker ligaments
Spine is less stable
New bone grows (osteophytes) to try to stabilise the spine
Increased load over the facet joints
what is the problem with osteophytes?
they usually grow in areas they should not
what are osteophytes?
they are new bone for compensation to the spine. To help with the added pressure in certain parts of the vertebral column
what is clinical importane does this have on the vertebral column for elderly people?
Loss of movement
Muscle weakness and wasting
Both due to ‘fear avoidance
what should people with LBP do?
what determines back pain?
Muscle strength need them to support spine
Mechanical loading strengthens vertebral bodies and increases the water content within discs
OVERloading should be avoided
what occupation risk factors are there for lower back pain?
Heavy physical jobs
Driving to work
Previous episodes of LBP
Posture- laptops, seating, desk set-up
what are the classifications of LBP?
Nerve root involvement
Possible serious spinal pathology
describe the the first episode of Mechanical (simple) back pain?
First episode often sudden onset while lifting/twisting/turning
With mechanical back pain what occurs with reccurent episdoes?
Recurrent episodes with decreasing inter-episode frequency
Variable pain related to position/posture
how do patients elevate mechanical back pain?
Better lying flat
where else can pain radiate to with mechanical back pain and when during the day is it worse?
May radiate to buttock and leg
Often worse at the end of the day and better with lying down/resting
what is a characteristic of sciatic pain?
pain below the knees
what was the old thinking with treatment to mechanical back pain?
How to lift
Don’t return to work until 100% better
what is the current thinking with treatment to mechanical back pain?
Light duty option
Work to contact re welfare
with LBP how long should you rest for?
no longer than 1-3 days
when do you refer a patient with LBP to secondary care?
after 6 weeks of pain
what is LBP early management guidlelines?
Physiotherapy if symptoms > few days
Rest for no longer than 1-3 days
Practice psychosocial management
Work absence only if unavoidable
Early return to work, possibly graded
Consider secondary care referral if on going at 6 weeks
what is the drug treatment for LBP?
Tricyclic anti-depressants (amitriptyline)