Lumbar Spine and SI Joint

Question 1

Lumbar Disc Pathology

Answer 1

-Degenerative processes to disc (L4/5 and L5/S1)

S/S: dull pain over lumbar spine, nerve pain, guarding

Cause: bending forward, falling, coughing, bearing down, repetitive mmts, poor posture (tight hip flxors and hamstrings)

Better: Laying down with knees and hips flexed, walking, extension

Worse: Sitting, bending forward, lifting

Treatment:
-PT: decrease symptoms, inflammation
-extensor based exercises

Question 2

Lumbar Degenerative Joint Disease

Answer 2

-Degenerative processes to facet surfaces with loss of cartilage

S/S: unilateral pain, stiffness, cracking, loss of lumbar lordosis

Cause: progressive degeneration, repetitive mmts, breakdown of hyaline cartilage

Better: sitting, flexion based, restt

Worse: inactivity, activities, close down facet joints, more wear and tear

PT: thoracic extension, conditioning, education

Question 3

Interforaminal Stenosis

Answer 3

-loss of interforaminal space and disc height

S/S: shooting pain over lumbar spine, nerve pain, weakness

Cause: bone spurs, wear and tear, inflammation, progressive

Better: openinng space, beinding forward, decompression

Worse: closing mmts, walking, compression

Treatment:
-PT: improve joint and muscle mobility,
-flexion based exercises, education

Question 4

Lumbar Radiculopathy

Answer 4

-spinal root dysfunction

S/S: shooting pain and numbness and tingling, weakness of musculature, leg pain

Cause: progressive degeneration that cause impingement, herniation,a cute injurry, DDD, DJD, Spondylolisthesis, leg lengths

Worse: coughing, sitting

PT:
-surgery
-releiving symptoms
-exercise
-education

Question 5

Lumbar Ligament Strain

Answer 5

-tearing of fibers of lumbar ligaments (80% of lumbar cases)

S/S: localized LBP without referral

Cause: forces exceed tissue capacity, fails at weakest point, overuse, hyper ROM,

Better: rest, neutral postures

Worse: stretching of ligs, end range positions

PT: pain free motion, strength, stabilization of trunk

Question 6

Lumbar Muscle Strain

Answer 6

-soft tissue injury, most common LB injury (errector spinae)

S/S: pain over low back, pain with resisted extension, does not radiate to leg,

Cause: trauma, repetitive mmts, stretch or compression, body mechanics

Better: neutrtal posture, rest

Worse: Sitting, twisting, lifting, flexionn

Treatment:
-PT: rest, modalities, mobility, strenghening

Question 7

Lumbar Spondylolysis/Spondylolisthesis

Answer 7

Spondylolysis: fracture at pars interarticularis (MC: L5)
Spondylolisthesis: superior verttebra slips forward (MC: L4/S1)

-Dysplastic: congenital
-Isthmic: stress fracture, hyperextension
-Degenerative: slippage due to facets
-Traumatic: acute fx
-Pathological: damage due to tumor

S/S: back and/or leg pain with extension, asymptomatic

Cause: forced extension of some kind; degeneration

Better: flexion, rest

Worse: extension

Treatment:
-PT: flexion exercises, bracing
-surgery

Question 8

SI Joint Pathology

Answer 8

-pain in the region

S/S: pain in low back to butt to thigh (not lumbar)

Cause: pregnancy, arthropathy, falling

Better: hooklying

Worse: Sitting, walking, cycling

Treatment:
-PT: manipulation, hip ROM, strengthening core