Lower Back Pain 2

Question 1

What nerves contribute to iliopsoas strength?

Answer 1

L1 to L3

Question 2

What nerves contribute to quadriceps strength?

Answer 2

L2 to L4

Question 3

What nerves contribute to the hip adductor muscle strength?

Answer 3

L2 to L4

Question 4

What nerve contributes to tibialis anterior strength?

Answer 4

L4

Question 5

What nerve contributes to extensor hallucis longus strength?

Answer 5

L5

Question 6

What never contributes to extensor digitorum longus and brevis strength?

Answer 6

L5

Question 7

What nerve contributes to gluteus medius strength?

Answer 7

L5

Question 8

What nerve contributes to fibularis longis and brevis strength?

Answer 8

S1

Question 9

What nerve contributes to gluteus maximus strength?

Answer 9

S1

Question 10

What nerves contribute to gastrocnemius and soleus strength?

Answer 10

S1 and S2

Question 11

During the iliopsoas testing, if there is low back pain excerbaton what could that indicate?

Answer 11

Discogenic pain

Question 12

What is psoas syndrome and what are some etiologies?

Answer 12

Flexion-contracture of the iliopsoas due to prolonged positioned with a shortened psoas

Question 13

What is the quality of iliopsoas pain and where is it located?

Answer 13

Achy muscle spasm

In the lower back, radiating to the groin

Question 14

What are the signs and symptoms of ilipsoas syndrome?

Answer 14

Increase pain standing or walking
Positive thomas test
Positive tp medical to ASIS
Positive pelvic shift test
Nerve weakness in L1 and L2
Contralateral periformis spasm

Question 15

How would you treat ilipsoas syndrome?

Answer 15

Acute - ice and no use of heat initially
Indirect followed by direct OMM
Chronic - stretch

Question 16

What is tested for L1, L2 and L3 for sensation?

Answer 16

Anterior thigh

Question 17

What is tested for L4 for sensation?

Answer 17

Medial side of the foot

Question 18

What is tested for L5 for sensation?

Answer 18

Web space between great toe and second toe

Question 19

What is tested for S1 for sensation?

Answer 19

Lateral side of the foot

Question 20

What is tested for S2, S3, S4 and S5 for sensation?

Answer 20

Perianal skin

Question 21

What kind of tests can you do for sensation

Answer 21

Pin prick for pain
Light touch with a wisp
Vibration with a tuning fork

Question 22

If there is an abdominal source of lower back pain where is a likely location?

Answer 22

Retroperitoneal viscera

Question 23

When palpating the abdomen what should you been palpating and testing?

Answer 23

Palpate for guarding response, masses and presence of abdominal aneurysm

Question 24

What does the Valsalva exam test for?

Answer 24

It will exacerbate the symptoms of any space occupying lesion in the spinal canal
Positive test for pain reproduction

Question 25

How is the Valsalva test performed?

Answer 25

Patient is supine Place hand or fist on mid-abdominal area Gently inc pressure and have patient press back with abdominal wall

Question 26

How would the Soto Hall test be performed?

Answer 26

Patient is supine Restrain the sternum Passively flex the neck

Question 27

What does it mean when pain is elicited in the Soto Hall test?

Answer 27

Spinal disorder

Question 28

What tests can be done for scaroiliac joint pain?

Answer 28

``` Pelvic Rock test (grabs AIIS and wiggle) Gaenslen test (grab one knee, drop the other) Patrick test (scottish dancing) ```

Question 29

What does the Patrick test look for?

Answer 29

Tests for sacroiliitis | Also tests for joint disease

Question 30

What type of test is a Patrick test and what are the motions?

Answer 30

Pain reproduction test FABERE Flexion, Abduction, External Rotation and Extension

Question 31

What will a positive Nachalas test produce?

Answer 31

Pain radiation down the anterior though which implies femoral nerve entrapment/disease

Question 32

How is the Nachalas test performed?

Answer 32

Patient is prone | Leg flexed at the knee

Question 33

What are the two ways to test trunk strength?

Answer 33

Raise shoulders prone and hold 10 seconds | Raise legs prone and hold 10 seconds

Question 34

What is the pathogenesis for spinal stenosis?

Answer 34

Degenerative changes in the L-spine: Hypertrophy of facet joints Ca++ deposits in lig lavum/post long lig Loss of intervertebral disc height

Question 35

What is the quality and location of pain in spinal stenosis?

Answer 35

Lower back to lower legs | Achy, shooting pain with paresthesias

Question 36

What are the signs and symptoms of spinal stenosis?

Answer 36

Worsened by extension (standing, walking, lying supine) | Osteophytes and decreased intervertebral space on imaging

Question 37

What is the treatment for spinal stenosis?

Answer 37

OMT : decrease restriction, inc ROM PT, NSAIDs, low dose steroids Epidural steroid injection Surgical laminectomy with decompression

Question 38

What is the pathogensis of a herniated nucleus propulsus

Answer 38

Narrowing of posterior long lig 95% at L4-L5 or L5-S1 Exterts pressure on nerve root of vertebra below

Question 39

Where is the location and quality of pain in a herniated nucleus propulsus?

Answer 39

Low back and lower leg | Numbness, tingling, sharp burning, shooting pain worsens with flexion

Question 40

What are the signs and symptoms of a herniated nucleus propulsus?

Answer 40

Weakness and decreased reflexes Sensory deficit in corresponding dermatome Positive straight leg test

Question 41

What test is a the gold standard for herniated nucleus propulsus?

Answer 41

MRI

Question 42

What is the treatment for a herniated nucleus propulsus?

Answer 42

Less than 5% are surgical candidates Bed rest for max 2 days Indirect OMM follow by gentle direct