| Question | Answer |
| Where is low back pain located? | As pain b/w the costal angles and the gluteal folds |
| Characterize back pain in terms of length of persistence of symptoms
**Know for test** | 1.Acute: Less than 6 weeks.
2.Subacute: 6-12 weeks.
3.Chronic: More than 12 weeks (3 months). |
| Key Low back pain prognosis based on persistence of symptoms | 1. At least 60% w/ acute LBP return to work w/in 1 month.
2. 90% return w/in 3 months regardless of the treatment.
3. 25-60% of patients will have reoccuring symptoms w/in 1-2yrs.
3. |
| What is 97% of LBP classified as? | MECHANICAL:
1.Strain/sprain (70%).
2.Degenerative Disc (10%).
3.Disc herniation.
4.Spinal Stenosis.
5.compression fracture.
6.Spondylolisthesis (1 vertebrae slips anterior to another).
**Non-mechanical: cancer, infection, inflamm arthritis, Visce |
| Red Flags during an initial assessment of a patient with LBP | 1.Cancer.
2.Infection.
3.Fractures. |
| LBP Red Flags: Suspect Fractures with | 1.Major Trauma.
2.Pain is immediate, axial, non-radiating, severe & disabling.
3.Palpation is EXTREMELY important to make sure the labs correlate with the history. |
| LBP Red Flags: Suspect Tumor with | 1.Age less that 20 or older than 50.
2.History of cancer.
3.Unexplained wgt loss.
4.Failure to improve after 4-6 weeks.
**Get and Xray. |
| LBP Red Flags: Suspect spinal Infection with | 1.IV drug users.
2.Immunosuppression.
3.Fever and/or chills.
4.Pain worsens w/ supine, night time. |
| LBP Red Flags: Cauda equina syndrome | Lesion compressing the cauda equina nerve roots.
**LBP + Saddle sensory anesthesia (is it numb when you whipe your own ass?) or Bladder & Bowel dysfunction. |
| Difference b/w Radiculopathy Vs Cauda Equina Syndrome | Radiculopathy: 1 nerve root. Cauda Equina Syndrome: Multiple nerve roots |
| Why is cauda equina syndrome a surgical emergency? | Damage can be Irreversible.
**Bowel & Bladder & ED take the longest time to recover. |
| Are imaging studies useful without any RED FLAGS w/in the first 4 weeks of LBP? | NO.
**Unless they are have progressively worse neurological deficits. |
| If you suspect neuropathy, what all should be included in your neurological exam? | 1.DTRs.
2.Motor strength testing (by nerve root).
3.Sensation testing (by dermatome).
4.Straight leg raising. |
| Neurologic Level: L4 | 1.Motor strength: Inversion.
2.DTR: Patellar.
3.Sensation: Inside of foot & lower Leg |
| Neurologic Level: L5 | 1.Motor strength: Dorsiflexion.
2.DTR: none.
3.Sensation: top of foot. |
| Neurologic Level: S1 | 1.Motor Strength: Eversion.
2.DTR: Achilles tendon.
3.Sensation: lateral aspect of foot. |
| Differentiate b/w Spondylosis, Spondylolysis, Spondylolisthesis | 1.Spondylosis: Ankylosis (stiffness) of vertebrae.
2.Spondylolysis: Degenerative OA of facets.
3.Spondylolisthesis: Ant movement of a vertebrae over the one below it.
**All cause Degeneration. |
| Lumbosacral radiculopathy results from what? | Nerve ROOT impingement/ and or inflammation. Will have pain, tingling along dermatome & muscle weakness. Think herniated DISC
**associated with acute and chronic causes of LBP. |
| What can exacerbate the pain from lumbosacral radiculopathy? | 1.Sitting.
2.Coughing.
3.Sneezing.
**Will travel from the buttock down the posterior aspect of the leg. |
| Radiculopathy in what Lumbosacral nerve roots will refer pain down the ANTERIOR thigh? Does it radiate below the knee? | L1-L3. NO. |
| What are the most common locations for Disc Herniations? | L4, L5, and S1. |
| What is a KEY INDICATOR of Lumbar Spinal Stenosis? | NEUROGENIC CLAUDICATION.
**Leg symptoms will worsen when walking, but eased with sitting, or lying down. Compensate by flexing forward (shopping cart sign). |
| Does degenerative disc pain radiate? | NO.
**Discogenic pain w/out nerve root impingement typically is diffuse, vague, and axial. |
| Is it common to see a disc bulge on an MRI if there is NO back pain? | YES, 52% at atleast one level. Therefore the lab tests must match the symptoms/history (if they have a L4 bulge with radiculopathy, then it fits). |
| Is bedrest bad for the back? | YES, want them up and moving as soon as possible |
| Does OMT Change the final outcome of reducing/ healing LBP when compared to standard medical therapies? | NO, however it did allow the same outcome to be reached with less medicine and less PT (COSTS LESS) |
| Patients with mechanical low back pain often benefit from what? | CONSERVATIVE treatment:
1.OMT.
2.PT.
3.Ice & heat.
4.Medications (NSAIDS first, muscle relaxors, OPIOIDS). |
