Chapter 22 Lumbar Spinal Conditions Flashcards
(16 cards)
What are lumbar contusions, strains and sprains?
Reduced spinal flexibility, repeated stress and activities that require maximal extension of the lumbar spine – chronic LBP
Muscle strains – sudden extension action with trunk rotation on an overtaxed, unprepared or underdeveloped spine, chronic strains – improper posture, excessive lumbar lordosis, flat back or scoliosis
What is low back pain in runners?
Muscle tightness in hip flexors and hamstrings
Tight hip flexors – produce a forward body lean anterior pelvic tilt and hyper lordosis of l/s
Reducing low back pain in runners
Wear properly fitted shoes that control heel motion and provide max shock absorption
Increase flexibility at hip, knee, ankle PF and trunk extensors
What is myofascial pain?
Referred pain that emanates from a myofascial trigger point – hypersensitive localized nodule within a taut band of muscle tissue and its surrounding fascia
Piriformis and quadratus lumborum common trigger point sites
What is facet joint pathology?
Facet joint syndrome – pain, soreness, stiffness that increase with active extension and in periods of prolonged sitting
S/S – nonspecific low back, hip and buttock pain with a deep/achy quality, pain worse in the morning, aggravated by rest and hyperextension relieved by repeated motion, flattening of lumbar lordosis, pain exacerbated by rotation and extension, lateral side bending
What is lumbar spinal stenosis?
Involved narrowing of the spinal canal with cord or nerve impingement resulting in symptoms of radiculopathy or pseudoclaudication
Narrowing vertebral canal, lateral recess or neuroforamina
Central or lateral stenosis that can occur focally or diffusely throughout several spinal levels
Degenerative (most common), spondylolisthetic, iatrogenic (postsurgical), posttraumatic and metabolic (Paget disease)
What is sciatica?
Inflammatory condition of the sciatic nerve
MOI – herniated disk, annular tear, myogenic or muscle-related disease, spinal stenosis, facet joint arthropathy, compression of the nerve between the piriformis muscle
Sciatica only – no sensory or muscle weakness
Sciatica with soft signs – some sensory changes, mild or no reflex change, normal muscle strength, normal bowel and bladder function
Sciatic with hard signs – sensory and reflex changes, muscle weakness caused by repeated, chronic or acute condition, normal bladder function
Sciatica with severe signs – sensory and reflex changes, muscle weakness and altered bladder function, surgical decompression
What is a bulging or protruded disk?
some eccentric accumulation of the nucleus with slight deformity of the annulus
What is a prolapsed disk?
eccentric nucleus produces a definite deformity as it works its way through the fibers of the annulus
What is an extruded disk?
material moves into the spinal canal where it runs the risk of impinging on adjacent nerve roots
What is a sequestrated disk?
nuclear material has separated from the disk itself and can migrate into the canal to impinge adjacent spinal nerves
What are the most common regions of lumbar disk issues?
Most common L4-L5 and L5-S1
What is a Pars interarticularis fractures?
Weakest bony portion of the vertebral neural arch
Defects may be congenital, or caused by mechanical stress from axial loading of the lumbar spine during repeated weight loading in flexion, hyperextension and rotation
Spondylolysis – stress fracture of the pars interarticularis
Spondylolisthesis – bilateral separation of pars interarticularis and results in anterior displacement of a vertebra with respect to the vertebra below it
Most common lumbosacral joint (L5-S1)
What is a spondylolysis?
stress fracture of the pars interarticularis
What is a spondylolisthesis?
bilateral separation of pars interarticularis and results in anterior displacement of a vertebra with respect to the vertebra below it
What is a sacroiliac joint sprain?
MOI – single traumatic episode involving bending, twisting, repetitive stress from lifting, a fall on the buttocks, running on uneven terrain
Irritate or stretch the sacrotuberous or sacrospinous ligament
S/S – unilateral dull pain in the sacral area extending into posterior thigh and buttocks
What is a coccygeal conditions?
Direct blow to the region can produce contusions and fractures of the coccyx
Pain from a fracture – may last several months
Irritation of coccygeal nerve plexus – coccygodynia
