OPP Lect 29 LBP II
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| Lumbar Strain | Back strain, non-radiateing lbp secondary to mechanical stress on lumbar spine.
**Usually secondary to overuse or injury/deformity of anatomical structures
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| ***Know L4,L5,S1 dermatome, motor, and DTR for test*** |
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| 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.
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| 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.
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| 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
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| 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
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| 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.
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| List the 4 main RED FLAGS of lbp | 1.Neurological deficiets.
2.Incontinence.
3.Doesn't get better with rest (Fracture).
4.Fever/infection.
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| 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.
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| 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)
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| What is the action of the piriformis | External rotation and ABduction of the hip.
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| 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.
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| 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.
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| Does pain increase with valsalva squeeze in a patient with Piriformis syndrome | NO
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| A patient with Piriformis syndrome will be restricted in what ROM? | Internal Rotation at the hip.
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| Treatment for Piriformis Syndrome | 1.OMT: counterstrain, myofascial release (indirect is better), ME, Sacroiliac articulatory.
2.NSAIDS & muscle relaxanats (at night).
3.Home exercises.
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| A patient with Iliopsoas syndrome will usually be doing what motion at the time of injury? | Flexion.
**They will have trouble Standing straight up.
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| 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.
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| Treatment for Iliopsoas Syndrome | 1.OMT: counterstrain & ME (towards the injured iliopsoas).
2.NSAIDS & muscle relaxants.
3.Home exercise.
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