Sacral, Lumbar and Thoracic joint Pathology

Question 1

The majority of low back pain is due to…

Answer 1

Soft tissue issues.

Question 2

Types of soft tissue issues which can cause lower back pain

Answer 2

Muscle strains, ligament sprains, postural abnormalities, poor muslce tone, neuromuscular disease.

Question 3

The second leading cause of low back pain

Answer 3

Disc disease.

Question 4

Idopathic back pain.

Answer 4

Also called mechanical back pain. Pain of musculoskeletal origin.

Question 5

Most common joints involved in low back pain

Answer 5

Facet and sacroiliac

Question 6

Priciples for managing low back pain

Answer 6

Screen for more sinister diseases, reassure and manage symptoms, address underlying issude and return to function ASAP.

Question 7

Risk factors for LBP

Answer 7

Repeated lifting, bad posture, weak core muscles, adaptive shortening, coughing, disc degeneration, osteoporosis, spondylolisthesis and underdating excessive work.

Question 8

Pain

Answer 8

An unpleasant sensory and emotional experience associated with real or potential tissue damage.

Question 9

Delayed return to work can be influenced by

Answer 9

The belief that the pain is work related, psychological or psychosocial issues, compensation and time off.

Question 10

First phase of healing

Answer 10

Inflammatory/acute phase

Question 11

Inflammatory/acute phase of healing

Answer 11

Lasts 48-72 hours. Includes vascular and immune response. Includes pain, loss of ROM, heat, swelling and reciprocal weakness.

Question 12

Second phase of healing

Answer 12

Fibroplastic or subacute phase.

Question 13

Third phase of healing

Answer 13

Remodeling or chronic phase.

Question 14

Fibroplastic or subacute phase of healing

Answer 14

Days 3-21. Scar tissue is laid down. ROM is increased and pain and swelling are decreased.

Question 15

Remodelling or chronic phase of healing

Answer 15

Day 21 to 6 to 12 months. Vascularity is lost and scar tissue is strengthened and aligned.

Question 16

Spinal stenosis

Answer 16

Abnormal narrowing of the spinal canal, either central or lateral intervertebral foramen.

Question 17

Causes of central spinal stenosis

Answer 17

Osteophyte enlargement of the inferior articular bodies, congenitally decreased diameter, hypertrophy of ligamentum flava, spondylolisthesis or neoplasm.

Question 18

Causes ot lateral spinal stenosis

Answer 18

Subluxation of facets as a result of disc narrowing. Symptoms are usually segmental.

Question 19

Signs and symptoms of spinal stenosis

Answer 19

Pain, motor deficits, tingling, numbness. Worsened by standing, walking, coughing and sneezing. Relieved by sitting and flexion.

Question 20

Pain of osteoporosis

Answer 20

Is due to collapsing vertebrae compressing nerves, not the actual bone collapses themselves.

Question 21

LBP due to ligaments

Answer 21

Felt primarily over the affected ligament, but may spread to a leg. Strethcing the ligament causes sharp, localized pain.

Question 22

LBP due to muslce sprains

Answer 22

Cause stiffness, weakness and postural changes. Will heal spontaneously as long as activity is maintained.

Question 23

LBP due to myofascial restrictions

Answer 23

Lead to postural limitations and can result in changes to other structures.

Question 24

First step in detemrining low back pain

Answer 24

Client interview

Question 25

Components of a client interview for LBP

Answer 25

Quality and quantity of pain, patient history, recent injuries and daily activities.

Question 26

Second step in determining low back pain

Answer 26

General assessments

Question 27

General assessments for LBP

Answer 27

Posture, gait, flexion (standing and seated), active ROM.

Question 28

Possible findings in a posture assessment in a patient with LBP

Answer 28

Sway back, lordosis, kyphosis, side bending, iliac crest discrepencies.

Question 29

Possible findings in a gait analysis in a patient with LBP

Answer 29

SHort stride, heavy heel strike, umbilicus tracking

Question 30

Third step in determining LBP

Answer 30

Specific assessments

Question 31

Specific assessments relevant to LBP

Answer 31

Coxa, sacrum, pelvis and lumbar

Question 32

Myotome

Answer 32

All muscles innervated by a single spinal nerve

Question 33

How to test a myotome

Answer 33

Hold a contraction for 6 seconds, then compare bilaterally

Question 34

L1/L2 myotome

Answer 34

Hip flexion; psoas, iliacus, sartorius, gracilis, pectineus, adductor longus and brevis

Question 35

L3 myotome

Answer 35

Knee extension; quadriceps, adductor magnus, longus and brevis

Question 36

L4 myotome

Answer 36

Tibialis anterior and posterior, quadriceps, TFL, adductor magnus, obturator externus

Question 37

L5 myotome

Answer 37

EHL, EDL, gluteus medius and minimus, obturator internus, semis, peroneus tertius and popliteus

Question 38

S1 myotome

Answer 38

Gastrocnemius, soleus, glute max, obturator internus, piriformis, biceps femoris, semitendinosus, popliteus, peroneus longus and brevis, extensor digitorum brevis

Question 39

S2 myotome

Answer 39

Biceps femoris, piriformis, soleus, gatroc, FDL, EHL and intrinsic foot muslces.

Question 40

S3 myotome

Answer 40

Intrinsic foot muscles, FHB, FDB, EDB