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OPP Lect 29

OPP Lect 29 LBP II

Lumbar Strain Back strain, non-radiateing lbp secondary to mechanical stress on lumbar spine. **Usually secondary to overuse or injury/deformity of anatomical structures
***Know L4,L5,S1 dermatome, motor, and DTR for test***
Differentiate b/w 1st, 2nd, 3rd degree strains 1st: Microscopic muscle fiber tears. 2nd: Macroscopic muscle fiber tears. 3rd: Complete disruption with joint stability. **Due to excessive stress or tension.
Commonly seen causes of Lumbar strain 1.Direct or Indirect trauma. 2.Muscle spasms associated w/ prolonged contraction (flexion). 3.Paraspinals become deconditioned after injury.
Describe how somatic dysfunction can lead to a lumbar strain 1.Starts out as a reflex w/ intent of protecting the lumbar spine from furher injury. 2.Sustained contraction becomes site of nocioception. 3.sustained contraction leads to muscle fatigue. 4.will eventually involve muscles, joints, fascia, and ligament
What is pain that is localized to the lumbar/lumbosacral area that does NOT radiate to the extremities (maybe the buttocks) indicative of? Lumbar Strain
How can you differentiate b/w lumbar strain and iliolumbar ligament syndrome? iliolumbar ligament syndrome will cause pain to radiate down into the inner thigh as well as the iliosacral region (mimics an inguinal hernia). **there will be no radiation down the extremities with lumbar strain.
List the 4 main RED FLAGS of lbp 1.Neurological deficiets. 2.Incontinence. 3.Doesn't get better with rest (Fracture). 4.Fever/infection.
What muscles in the lower extremity could cause lumbar strain if they lock the pelvis, putting the burden of constant flexion on the lumbar spine? Hamstrings. **tight hamstrings will also slow recovery time.
treatment for Lumbar strain 1.OMT (HVLA may not be tolerated for Acute strains). 2.NSAIDS, ice, muscle relaxants. 3.Control physical activity for TWO days. **Active exercise programs should start EARLY in treatment (stretching then strengthening)
What is the action of the piriformis External rotation and ABduction of the hip.
What is usually the cause of Piriformis Syndrome? Sciatic Nerve compression/entrapment by the overlying piriformis. **Epineural irritation leads to inflammation which would add to the pain sensation. There will be tenderness above muscle belly.
Are there any neurological deficits with piriformis syndrome? NO: No numbness, DTR changes, or muscle weakness, Neg straight leg raise test. **Only pain that does NOT go past the knee.
Does pain increase with valsalva squeeze in a patient with Piriformis syndrome NO
A patient with Piriformis syndrome will be restricted in what ROM? Internal Rotation at the hip.
Treatment for Piriformis Syndrome 1.OMT: counterstrain, myofascial release (indirect is better), ME, Sacroiliac articulatory. 2.NSAIDS & muscle relaxanats (at night). 3.Home exercises.
A patient with Iliopsoas syndrome will usually be doing what motion at the time of injury? Flexion. **They will have trouble Standing straight up.
What symptoms/findings would you expect with a patient who has Iliopsoas syndrome? 1.Sciatic pain usually not past the knee due to piriformis spasm (on opposite side). 2.L1-L2 FRxSx. 3.Pelvis shifts towards the opposite side of the injured iliopsoas.
Treatment for Iliopsoas Syndrome 1.OMT: counterstrain & ME (towards the injured iliopsoas). 2.NSAIDS & muscle relaxants. 3.Home exercise.
Created by: WeeG