lumbar disorders Flashcards
(45 cards)
when is diagnostic imagining indicated for patients with low back pain?
only if they have severe progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition
serious medical conditions can present as low back pain in a very small percentage of patients, when should we be concerned lumbar pain is a possible red flag?
failure to improve with conservative care >30 days should raise suspicion
what are some medical conditions that are red flags and could present with lower back pain?
cancer, cauda equina syndrome, infection, spinal fracture, abdominal aortic aneurysm, inflammatory disorders
what are the two extreme responses to the fear of pain?
confrontation and avoidance
what is avoidance behavior perceived to be?
a maladaptive response to lower back pain and it is associated with chronic disability
what does avoidance behavior result in?
physical disuse, deconditioning, and guarded movements
what are some clinical conditions that cause low back pain?
herniated lumbar disc
radiculopathy
adherent nerve root
lumbar stenosis
spondylosis
spondylolysis
sprains and strains
facet joint arthropathy
are herniated lumbar discs on MRI easy to identify?
75% w/identifiable abnormality of the disc or spinal canal– Mild stenosis, disc degeneration, bulging and small herniations
27% w/disc protrusions
Disc extrusions, free fragments of disc (sequestrations), and major nerve compression are rare in individuals
without LBP
Findings in asymptomatic subjects do not predict the development of LBP
how do we score the oswestry?
Each topic category is followed by 6 statements describing different potential scenarios in the patient’s life relating to the topic. The patient then checks the statement which most closely resembles their situation.
Each question is scored on a scale of 0–5 with the first statement being zero and indicating the least amount of disability and the last statement is scored 5 indicating most severe disability.
The scores for all questions answered are summed, then multiplied by two to obtain the index (range 0 to 100). Zero is equated with no disability and 100 is the maximum disability possible
how do we interpret the oswestry?
0%–20%: Minimal disability
21%–40%: Moderate disability
41%–60%: Severe disability
61%–80%: Crippling back pain
81%–100%: These patients are either bed-bound or have an exaggeration of their symptoms
Success = drop by more than 50% or scores below 20%
describe herniated discs
Insidious onset or related to trauma
May start w/pain in the lumbar region and
progress to LE
Worse with flexion activities (ex. sitting)
Mornings and evenings worse
95% of herniated discs occur at the lower
lumbar spine (L4/5 and L5/S1 level)
what is the common patient population for herniated discs?
30-50 y/o most common as disc is
still hydrophilic (more men than
women)
what are herniated discs a result of?
trauma, poor posture (flexed),
rep. microtrauma
who is at risk for herniated disks?
Certain professions at risk (truck drivers, office/factory workers, etc)
smokers, sedentary lifestyle, obese
more at risk
describe lumbar radiculopathy
Initially back pain presents before leg pain
Pain/parasthesia presents suddenly “I woke up and the leg felt funny.”
what are the symptoms for lumbar radiculopathy?
Sx vary depending on activity and position but usually worse with flexion and better with standing or walking
Pt may report weakness or difficulty with gait
is a neuro exam mandatory for lumbar radiculopathy?
yes
how are herniated discs and lumbar radiculopathy diagnosed?
MRI
Electrodiagnostic testing- EMG/NCV testing
Neuro exam- DTRs, myotomes, dermatomes, SLR/slump
If progressive neurologic decline is noted (also check B/B), surgical consult is indicated, especially is related to protrusion or extrusion of
the disc
what is the treatment for herniated disc/lumbar radiculopathy?
- Education- Posture/activity modification
- Specific exercise from TBC- Likely extension
- May use targeted manual therapy -CVPs (facilitate extension)
- Ensure to eventually prescribe stabilization exercises (promoting extension)
- Neural mobility (sliders vs tensioners)
- General fitness activity
- RTW education/training
- If patients peripheralize with extension or have a positive contralateral straight leg raise, consider traction
- NSAIDs/Corticosteroids to control inflammation
what should therapists not do with patient education?
- Recommend or promote bed rest/activity avoidance
- Give detailed pathoanatomical explanations for a specific cause of LBP
what should therapists emphasize with patient education?
- Anatomical/structural strength of the spine
- Explain pain perception
- Proper posture
- Overall favorable prognosis for LBP
- Stay active approach (active pain coping strategies, early resumption of activity) –
activity modification - Improvement in activity level, not just pain
- Discuss patient goals and RTW/recreational activity
describe adherent nerve root (ANR)
Episode of back pain w/radiculopathy months ago: or h/o surgery
Leg symptoms never completely went away
Sitting not an issue and walking may be painful at first but then improves
Reports episodes of burning and aching or parasthesias
Unable to bend forward or SB away due to neural tension and sharp pain in LE- ANRs will deviate to the side of the ANR
Neuro exam mandatory
what is the treatment for chronic lumbar radiculopathy?
- Education
- Carefully address adverse neural tension
- May use targeted manual therapy to address local lumbar impairments- CVPs, UVPs, TPs w/ROM exercises
- Ensure to eventually prescribe stabilization exercises
- General fitness activity
describe lumbar stenosis (degenerative)
Complains of cramping, aching and or N/T in one or both legs cramping with walking
Worse w/ standing and walking
Intermittent sx in back “stiffness”
