Terms in this set (75)
What is the incidence of back pain?
-85 % of the general population
will have low back pain
-2-5 % of the general
population yearly reports low
-Back pain occurs in 35% of
-Overuse back injuries are
prone to recurrence
-26% males/33% females
-27 % of back pain in adults is
due to musculoskeletal strains
What is the number 2 reason patients see a physician?
back pain->majority don't require surgical intervention
What is the annual lost productivity in back pain?
Annual value of lost productivity in 2010 dollars ranged
between $297.4 billion to 335.5 billion
-75% of total cost is attributed to less than 5% of pts
*excess of $100 bill in total costs/yr/US
What is the majority of back pain due to?
frequent site of: strain, pain disability
What are mechanical etiologies of LBP?
-Spondylosis / Spondylolisthesis
-Degenerative disc disease
What are the non-mechanical etiologies of LBP?
-Viscerogenic: renal colic, endometriosis
-Vasculogenic: abdominal aortic aneurysm
What are infection etiologies of LBP?
What are tumor etiologies of LBP?
What are metabolic etiologies of LBP?
What are immunologic/rheumatologic etiologies of LBP?
What does the anatomy of lumbar vertebrae allow for?
-Vertebrae built for
support of heavy loads
in fairly neutral plane
-Allows for fair amount
of flexion & extension
-Less of sidebending &
rotation due to sagittal
orientation of facets
L5 becomes part of the sacrum
S1 is apart of lumbar instead of sacrum
fracture in pars interarticularis
What are the mechanics of the lumbar vertebra?
Follow Type I
mechanics in neutral
Follow Type II
mechanics in nonneutral
This is the rule in
What are the lumbosacral mechanics?
Sacrum and lumbar
spine move in
Lumbar flexion -->
Lumbar extension --
> sacral flexion
Type 1 Mechanics-Group
Predominantly in the neutral
Sidebending & rotation occur in
the opposite directions
e.g., sidebent left, rotation right
Sidebending occurs first
*maintained by long restrictors
Type II mechanics-single
Predominantly in the
flexed or extended
Rotation & sidebending
occur in the same
i.e., rotation right,
Rotation occurs first
Maintained by short
What are the lumbar examination steps?
Range of motion
Screen with fingers
Note skin changes, tenderness and
Hip Drop test
Hone in on these areas
for further examination
Gross motion testing
Single segment motion
Segmental examination for lumbar
Patient either prone or
the right transverse
Inducing a left rotation
Then repeat for the left
Inducing right rotation
Repeat rotation test
with flexion, then
compare to neutral
What is the positional component of diagnosis?
flexion/extension->plane in which restriction is lessened->move more freely
What is it if motion is roughly the same in both flexion and extension?
neutral dysfunction->follows type 1 mechanics
What is it if motion is more restricted in flexion or extension?
- flexion/extension dysfunction->follows type II mechanics
History for back pain
Are there family members with similar
Timing (onset, frequency, duration)
What are the steps to the exam for back pain?
Evaluation for Somatic Dysfunction
What is the relationship between nerve root (L4-S1) and symptoms, etc.?
What are chapman's reflexes?
Frank Chapman, D.O.
Tender points clues used for dx of visceral dysfunction
Anterior and posterior points
Tender point is palpable as a small smooth firm nodule (2-3 mm)
Good interexaminer reliability and correlates with discharge
What are the anterior points for chapman's reflexes?
Periumbilical: adrenal, kidney, bladder
5th ICS : stomach(left), liver(right)
6th ICS: stomach(left), liver/gallbladder(right)
7th ICS: spleen(left), pancreas(right
What are the posterior points for chapman's reflexes?
Nerves for organs of the head?
Sympathetic = T1-4 & cervical sympathetic plexus Parasympathetic = C1,2 CN 3,7,9,10
T2-3, left 2nd rib for blood supply to left/right bronchus
T1-5 usually on left
Septal myocardial injury
anterior wall myocardial injuries
Posterior wall myocardial injury
Arrythmias myocardial injury
Chronic Cardiac Disease
T5-9 on left
T10 on right
T9 on right
T5-9 on right
T10-L1 on corresponding side
T10-L1 on corresponding side
T11-L2 right w/associated ribs
T11-L2 on right w/ associated ribs
Urinary bladder, prostate
T8-L2, ascending on Rt side, descending on Lt side
All viscera from pharynx to
Vagus Nerve (C2 and temporal bone restrictions)
Pelvic organs up to descending
Sacral Plexus (S2-4, think sacral / S-I dysfunctions)
compresses spinal nerve
What are red flags in low back pain
Major trauma mechanism
Age >50 or <20 years
History of cancer
Cauda equina symptoms
Cauda Equina symptoms
New onset bladder/bowel dysfunction
Severe or rapidly progressive neurological symptoms
Unexplained weight loss
Recent bacterial infection
IV drug abuse
Severe nighttime pain
What is the spinous process formed from?
What is a failure of fusion of the spinous process called?
what can decrease neural tube defects?
Spina bifida occulta
Common at L5-S1
May have patch of coarse hair over site
Small split in vertebra, no spinal cord protrusion
Usually incidental finding on radiograph
type of spina
of the spinal
spinal cord to
Spinal Canal characteristics
Contains the conus medullaris, filum terminale, cauda
Cord terminates at the level of L1-2
Diameter may be compromised
The diameter decreases with age normally
What are causes of spinal canal compromise?
Hypertrophy of posterior longitudinal
Thickening of ligamentum flavum
Cauda Equina Syndrome
Edema of the spinal canal
Places pressure on the cauda equina
Progressive weakness and paralysis of lower extremity
Bladder and bowel incontinence
How do you manage low back pain?
Address the cause
OMT to address mechanical causes and help in visceral causes
What are medical management options for back pain?
flow chart for low back pain