Is there difference in the incidence of back pain between sedentary workers and physical laborers?
No - almost everyone will experience back pain at some point in their lives
Does most back pain need treatment?
No - vast majority will resolve without intervention within 6 weeks
WHat are 7 questions you should ask a patient with back pain?
Character and location of pain
Relationship to work or activity
Exacerbating or relieving factors
What is the most common cause of back pain in adults?
mechanical low back pain caused by muscle spasms
can also be facet joint inflammation or SI joint dysfunction
Why is it sometimes hard to figure out how the back pain started?
Often the pain won't develop until days after the inciting incident, so people don't put 2 and 2 togehter
WHat are some psycho-social modulators of low back pain?
Stress (home or work)
Other Secondary Gain
What is the technical term for a "step off"? WHat is it?
it's when one of the discs slides off over the top of the disc below it.
What is the most important step in treatment for mechanical low back pain (and any back pain really)?
get them up and moving! the sooner they get back to their normal activities, the sooner their pain will improve
In what population is prednisone more successful in?
older patients who have had back pain for at least 10 days.
True or false: recurrence rate for mechanical LBP is low.
62% will recur in 1 year and 80% will recur in 2 years
What are the 3 potential causes of spinal stenosis?
Under what category do they all fall?
They are all degenerative disease....
What is stpinal stenosis in general?
It's gradual narrowing of the spinal canal and/or neural foramina
You can get it from osteophyte formation, facet hypertrophy, bulging disks, and hypertrophy of the ligamentum flavum
In spinal stenosis, the back pain will radiate where?
down the back of the leg to the ankles or feet
In what position will the symptoms of spinal stenosis be worse?
erect posture (neurogenic claudication)
What are some associated neurological symptoms that may present with spinal stenosis?
paresthesas and foot drop
What is spondylolithesis usually cause by?
bilateral pars defects (stress fracture) which can be developmental, traumatic, degenerative or pathologic
WHat are some physical exam findings you'd get with an acute disc herniation?
1. splinting - walking favoring to one side
2. with or without tenderness to palpation
3. positive straight leg raise (with contralateral leg too)
4. Motor/sensory function impairment
What are two surgeries they can do for a herniated disc?
microdiscectomy where they go in an basically suck out the nucleus pulposus
fusion where they take the disc out and stick bone between the vertebral bodies and screw them together
True or false:
those who have surgery for disc herniation do much better than those who don't.
True and false in a way...
those hwo have surgery heal faster, but after 10 years there is virtually no difference between the two groups
What are some causes of sciatica?
What signs are used to tell if someone's faking back pain?
What is the most common cause of back pain in children?
it's almost never mechanical...
psychosomatic (especially if parent with back pain)
What group of kids is especially prone to sponylolysis/spondylolisthesis?
How does a three phase bone scan work?
you inject them with a radioactive marker that will get incorporated into bone - a very sensitive way to look for stress fractures