Lumbar spine pathologies

Question 1

What is non-specific lower back pain?

Answer 1

Mechanical syndrome for non-specific back pain without nerve root involvement
It is mechanical pain of musculoskeletal origin in which symptoms vary with physical activity
age 20-55 years

Question 2

What is the body chart/symptoms of non-specific lower back pain?

Answer 2

pain/muscle tension localised below costal margins and above inferior gluteal folds
morning stiffness common

no neural symptoms

Question 3

Aggravating and easing factors of non-specific lower back pain?

Answer 3

pain worsens over the course of the day
Pain is mechanical in nature; varies with physical activity and time- often a chronic problem in which periods of little pain/disability are interrupted by acute episodes of severe pain

patient feels ‘well’

Question 4

What is Spondylosis?

Answer 4

Degeneration of the intervertebral disc (with osteophytic formation)
Unilateral/bilateral defect in the region of the pars interarticularis
Most common due to repetitive trauma (activities involving lumbar hyperextension with rotation e.g. gymnastics, rugby and wrestling) to the growing immature skeletal
More common in males, mean age of diagnosis is 15 years

Question 5

What is the body chart/symptoms of Spondylosis

Answer 5

dull, aching pain in the lower back, buttocks and posterior thigh

Question 6

Aggravating and easing factors of Spondylosis?

Answer 6

recurrent axial low back pain increases with activity

exacerbated by lumbar hyperextension

Question 7

management ideas of non-specific lower back pain?

Answer 7

self-management- education and encouragement to continue with activities
reassure high probability in improvement of symptoms
accessory movements

Question 8

What is acute spinal nerve compression?

Answer 8

30-50 years

Nerve root compression may be caused by; herniated intervertebral disc, spondylolisthesis, spinal stenosis

Question 9

What is the body chart/symptoms?

Answer 9

unilateral leg pain worse than low back pain
pain radiated to foot/toes
dermatomal paraesthesia

Question 10

Aggravating and easing factors of acute spinal nerve compression?

Answer 10

often worse when sitting, bending, lifting, coughing and sneezing
eases when standing

Question 11

Management ideas for acute spinal nerve compression ?

Answer 11

self-management advice- education of nature of lower back pain and encouragement to continue activities
accessory movements

Question 12

What is spinal stenosis?

Answer 12

degenerative > 60 years
either congenital narrowing of spinal canal or degeneration
Reduced a/p dimension of spinal canal/ narrowing of spinal canal and/ or neural foramina
Causing compression of nerve roots

Question 13

What is the body chart/symptoms of spinal stenosis?

Answer 13

Bilateral leg pain

numbness in leg/buttock, change in sensation

Question 14

Aggravating and easing factors for spinal stenosis?

Answer 14

pain in extension due to narrowing of neural canal but eased in flexion
often relieved in sitting, exacerbated in periods of standing/walking

Question 15

Management ideas for spinal stenosis?

Answer 15

trunk flexion exercises
trunk dynamic stabilisation exercises
neurodynamic mobilisations

Question 16

What is Spondylolisthesis?

Answer 16

s the forward slip (olisthesis) of one vertebral body
The vertebra with the pars defect slipping forwards on the vertebra below
>20 years
activities involving lumbar hyperextension

Question 17

What is the body chart/symptoms of Spondylolisthesis?

Answer 17

often bilateral
constant nagging backache, radiating into buttock, thigh and sometimes down leg
A ‘step’ can sometimes be felt below where olisthesis has occurred
Neurological signs may be present in severe cases with decreased reflexes, muscle weakness and paraesthesia in the foot

Question 18

Aggravating and easing factors of Spondylolisthesis?

Answer 18

pain in extension, eased in flexion

uncomfortable standing, prefers sitting, constant need to change position

Question 19

Management of Spondylolisthesis?

Answer 19

trunk flexion exercises
trunk dynamic stabilisation exercises
neurodynamic mobilisations