Low Back Exam

Question 1

What are the goals of a PE?

Answer 1

1. Determine the symptoms do not represent life or function threatening
2. Where pain is coming from

Question 2

What are the four causes of LBP?

Answer 2

1. Referred pain
2. Activity related pain
3. Non-activity related
4. Psych

Question 3

What is lumbago?

Answer 3

LBP

Question 4

What is sciatica?

Answer 4

Pain in the lower back and hip, radiating down the thigh and into the leg. Is a descriptive term for a distribution of pain, not a diagnosis.

Question 5

What is the cause of sciatic nerve neuropathy?

Answer 5

Piriformis tightness

Question 6

Foot and ankle paresthesias = ?

Answer 6

Peroneal neuropathy

Question 7

What causes a leg radiculopathy?

Answer 7

L5/S1 nerve compression by herniated disc

Question 8

SI joint ligament pattern can cause what?

Answer 8

Sciatica

Question 9

Steadily increasing back pain, especially in the elderly, could suggest what?

Answer 9

Malignancy

Question 10

Continuous pain, not altered by posture or movement is suspicious for what?

Answer 10

Renal stones

Psychogenic causes

Question 11

True or false: isolated pain in the upper lumbar region is generally not concerning

Answer 11

false–could be AAA

Question 12

What is spondylolysis?

Answer 12

Breakage of a vertebral segment

scottie dog

Question 13

Scottie dog appearance on x-ray = ?

Answer 13

spondylolysis

Question 14

Why is coughing or sneezing that worsens back pain concerning?

Answer 14

Increased abdominal pressure leads to pressure on the spine

Question 15

Back pain with lying down or wakes up at night (not relieved by turning over) is concerning for what?

Answer 15

Bone CA

Question 16

Why is asking about function important with LBP?

Answer 16

See how bad it really is

Assess what needs to be done

Question 17

Pt failing to improve is suspicious for what?

Answer 17

Psychosocial issues

Question 18

Heel and toe walking assess what?

Answer 18

L5/S1 nerves

Question 19

What does the Adam’s forward bending test check for?

Answer 19

Scoliosis

Question 20

Flexion of the spine loads the anterior or posterior parts of the spine?

Answer 20

Anterior

Question 21

Extension of the spine loads the anterior or posterior parts of the spine?

Answer 21

Posterior

Question 22

Flexion of the spine stretches the anterior or posterior parts of the spine?

Answer 22

Posterior

Question 23

Extension of the spine stretches the anterior or posterior parts of the spine?

Answer 23

Anterior

Question 24

What does side-bending spine load?

Answer 24

The facets of either sides, closing the neural foramen

Question 25

What does ROM of the spine check for?

Answer 25

Non specific muscles

Question 26

What is the capsular pattern for the lumbar spine?

Answer 26

limited ROM in all directions

Question 27

What does capsular pain indicate?

Answer 27

Capsule inflammation/irritation

Question 28

Toe walking = which nerve root?

Answer 28

S1, S2

Question 29

Heel walking = which nerve root?

Answer 29

L4, L5

Question 30

Single leg calf raises checks for what nerve levels?

Answer 30

S1, S2

Question 31

Weakness or inability to perform heel/toe walking without an explanable condition =?

Answer 31

Acute plantar fasciitis

Question 32

Why is fixation of the back in lordosis with flexion of the lumbar spine concerning?

Answer 32

may indicate fusion of the spine, like ankylosing spondylitis

Question 33

What does the slump test check for?

Answer 33

Dural tension for the sciatic nerve root

Question 34

True or false: when looking at reflexes we need to look for only the maximal response

Answer 34

False--one that is most reproducible (and maximal)

Question 35

What if LE MSR are brisk?

Answer 35

Look at UE reflexes to localize the issue

Question 36

True or false: symmetric absence of Achilles is increasingly common with age

Answer 36

True

Question 37

When are reflexes/sensory signs particularly concerning?

Answer 37

Asymmetry

Question 38

What does the FABER test check for?

Answer 38

SI joint pain

Question 39

What are the positive signs for the FABER test?

Answer 39

Anterolateral hip region (hip path) | Posterior (sacroiliac) pain

Question 40

SLR tests for what?

Answer 40

L4, L5, or S1 nerve root irritation vs hamstring pain

Question 41

Positive SLR is what?

Answer 41

Pain that goes down the back of the leg and into the foot/ankle

Question 42

What is Bragard's test?

Answer 42

Dorsiflex the foot in SLR. Confirms positive or ambiguous SLR

Question 43

SLR is a sign of what?

Answer 43

Dural tension/pulling on sciatic nerve roots

Question 44

How can you quickly assess for claudication?

Answer 44

check peripheral pulses

Question 45

What is the buttock sign?

Answer 45

hip flexion more painful than SLR

Question 46

Femoral nerve stress test is what? Positive is what?

Answer 46

Checks for femoral nerve irritation (L2, L3, or L4) Positive = pain or paresthesias along anterior/medial leg

Question 47

False positives with femoral nerve stress test is what?

Answer 47

Axial spine pain d/t facet joints OA of the hip

Question 48

Step-off signs along the spine indicates what?

Answer 48

Spondylolisthesis

Question 49

What are the 4 causes of activity related pain?

Answer 49

- Discogenic pain - Facet joint pain - Stenotic pain - Arthritic pain