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Low back pain Flashcards

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1
Q

Prevalence of low back pain world wide

A

18.3%

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2
Q

Criteria of acute low back pain

A

<12 weeks, high likelihood to resolve, little to no management required

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3
Q

Criteria of chronic low back pain

A

> 12 weeks, high risk for loss of function, treatment resistant

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4
Q

Risk factors for low back pain

A

lifting weight at work, smoking, depression, obesity, inactivity

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5
Q

Protective/preventive factors

A

regular exercise alone, education with exercise

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6
Q

Primary causes of low back pain

A

mechanical, visceral, nonmechanical

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7
Q

Etiologies of visceral low back pain

A

GI organs, abdominal aorta, renal, GU organs, endometriosis

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8
Q

Etiologies of nonmechanically induced low back pain

A

neoplasm, infection, inflammatory

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9
Q

Most common mechanical etiologies of low back pain

A

sprain/strain/overuse, piriformis syndrome, psoas syndrome, short leg syndrome

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10
Q

strain

A

injury to muscle

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11
Q

sprain

A

injury to ligament

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12
Q

pain pattern of sprain/strain

A

aching pain over injured structure

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13
Q

Etiology of piriformis syndrome

A

hypertonic piriformis muscle, nerve entrapment of sciatic n.

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14
Q

Origin piriformis

A

anterior sacrum

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15
Q

Insertion piriformis

A

greater trochanter

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16
Q

What muscles does the sciatic n. pass between?

A

superior gemellus and piriformis

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17
Q

pain pattern piriformis syndrome

A

aching/burning pain in gluteal region, paresthesia down posterior thigh

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18
Q

Etiology psoas syndrome

A

chronic hypertonicity of psoas muscle

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19
Q

origin psoas

A

T12-L4

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20
Q

Insertion psoas

A

greater trochanter

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21
Q

pain pattern psoas syndrome

A

patients will flex lumbar spine, pain originates at thoracolumbar region, worsens with extension

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22
Q

diagnosis of psoas syndrome

A

palpation of muscle, Thomas test, pelvic side shift resolves with manipulation

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23
Q

pelvic side shift

A

laterally translate innominate to test for preference

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24
Q

etiology of short leg syndrome

A

anatomic leg length discrepancy creates sacral base unleveling

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25
pain pattern short leg syndrome
similar to overuse syndrome, pain in affected structures above low back
26
pelvic side shift for short leg syndrome
lateral translation of pelvis away from short leg
27
Treatment for short leg syndrome
heel lift therapy if discrepancy is >5mm or >1/5 inch
28
Heel lift therapy process
add 1/8 or 1/16 inch every 2 weeks
29
Prevalence of degenerative disc disease on radiographic finding
60-80% of adults > 49 yo
30
Etiology of degenerative disc disease
degeneration causes stress and inflammation of nociceptors
31
pain pattern of degenerative disc disease
nonspecific location
32
Degenerative disc disease pain worsens with...
bending forward, sneezing, coughing
33
Etiology spondylolysis
defect/stress factor of pars interarticularis
34
Pain pattern spondylolysis
asymptomatic, pain is common at L5 vertebrae
35
Spondylolysis pain worsens with...
hyperextension
36
Diagnostic Xray image of spondylolysis
Scotty dog
37
Etiology spondylolisthesis
anterior displacement of vertebrae secondary to bilateral pars defects
38
pain pattern spondylolisthesis
nonspecific
39
Risks of spondylolisthesis
age, bilateral spondylolysis
40
Spondylolisthesis pain worsens with...
extension and activity
41
Etiology of compression fracture
acute atraumatic fracture or chronic loss
42
pain pattern of compression fracture
asymptomatic or acute lower mid thoracic/thoracolumbar junction pain
43
Risks of compression fracture
age, osteoporosis, menopause, malignancy
44
Compression fracture worsens with...
sitting, spine extension, valsalva maneuver, movement
45
sciatica
symptom of numbness tingling pain in sciatic nerve distribution
46
Etiology spinal stenosis
narrowing of neural foramen or central canal
47
Pain pattern spinal stenosis
unilateral numbness and tingling, L4/L5/S1 nerve roots
48
Spinal stenosis pain worsens with...
standing and walking
49
Spinal stenosis pain improves with...
flexion, leaning forward, and sitting
50
pain pattern herniated disc
typically between L4-L5 (L5 nerve root) and L5-S1 (S1 nerve root)
51
pain pattern cauda equina syndrome
numbness and tingling in perineum, fecal/urinary incontinence, radicular numbness tingling or weakness
52
Delayed treatment of cauda equina will lead to
permanent incontinence and disability
53
Red flag symptoms of low back pain
progressive lower extremity weakness, saddle anesthesia/loss of bladder and bowel control, deep bone pain or unexplained weight loss, and fever/chills
54
When should imaging not be ordered?
low back pain within first 6 weeks unless there is progressive neuro deficit
55
Conservative methods of back pain management
reassurance, continue activity, avoid bed rest, muscle relaxers, antidepressants, physical therapy, OMM
56
Greenman's dirty half dozen
muscle imbalance, lumbar spine type 2 dysfx, short leg, sacral extension dysfx, innominate shear
57
Invasive treatments for back pain
epidural injection, facet injection, radiofrequency ablation, decompression or fusion surgery
58
Lumbar prone direct long lever--Rotation
stand opposite of PTP, grasp ipsilateral pelvis around ASIS; rotate lumbars sequentially up slightly superior to SD, hypothenar or pisiform on PTP and thrust after exhalation
59
Lumbar longer lever--Rotation
stand opposite PTP, grasp ipsi leg above knee, rotate lumbars superior to SD, hand on named vertebra or one below SD
60
Lumbar direct rotational-sidebending
localize sidebending by pulling on leg--posterior and lateral for type I and towards floor for type 2
61
Prolotherapy
chemical or mechanical irritant to induce growth and formation of new fibro-elastic connective tissue
62
Clinical suggestions of sacral base unleveling
uneven medial malleoli, knee height inequity
63
Expected compensations in short leg syndrome
Lumbar spine bent away from short side, innominate rotated anterior on side of dysfx, superior pelvic sheer or posterior rotation of long leg, foot on long leg pronated with internal rotation
64
X-ray measurement on postural scan for short leg syndrome
sacral declination--line of eburnation

OSIII (11 decks)

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