Lumbar Spinal Condition Chapter 12

Lordosis

- abnormal exaggeration of the lumbar curve - often associated with weakened abdominal muscles in combination of tight muscles (hip flexor, tensor fasciae latae and deep lumbar extensors)

Spondylolisthesis

- bilateral separation in the pars interarticularis - results in the anterior displacemtn of a vertebra with respect to the vertebra below it - common site is the lumbosacral joint (L5 through S1) - diagnosed between age 10 to 15

Spondylolysis

- defect of a vertebra - defect in the pars interarticularis of the vertebral arch - occur in the lowest of the lumbar vertebrae (L5)

Prolapsed Disk

- eccentric nucleus produces a definite deformity as it works its way through the fibers of the annulus

Extruded Disk

- material moves into the spinal canal, where it runs the risk of impinging on adjacent nerve roots

Sequestrated Disk

- nuclear material has separated from the disk itself and potentially can migrate

Sciatica

Etiology - an inflammatory condition of the sciatic nerve, classified into four levels of severity Signs - related to herniated disk, radiating leg pain is greater than back pain and increases with sitting and leaning forward, coughing, sneezing and straining Management - referral to physician to check for potential serious underlying conditions - bed rest is not indicated, lying on side with knees flexed

Lumbar Spinal Stenosis

Etiology - involves narrowing of the spinal canal with cord or nerve impingement resulting in symptoms of radiculopathy Signs - low back pain, pain or numbness in the lower extremities and neurogenic claudication Management - analgesics, therapeutic exercise, treadmill walking, ultrasound or epidural steroid injuections

Conditions of the Lumbar Disk

Etiology - prolonged mechanical loading of the spin can lead to microruptures in the annulus fibrosus Signs - pain occurs when surrounding structures are impinged Management - minimizing load on spine by avoiding activities that involve impact, lifting, bending, twisting and prolonged sitting - ice/ heat treatments, NSAIDS, relaxants, TENS

Lumbar Contusions, Strains and Sprains

Etiology - reduced spinal flexibility, repeated stress and activities that require maximal extension of the lumbar spine - muscle strains result from a sudden extension action with trunk rotation on an overtaxed unprepared or undeveloped spine Signs - pain and discomfort can range from diffuse to localized - muscle strain, pain will increase with passive flexion and with active or resisted extension - pain doesn't radiate into the butt or posterior thigh and no sign of neural involvement, muscle weakness Management - acute is to follow to control pain and hemorrhage - following cold treatment, passive stretching of the low back can help relieve a muscle spasm - corset type brace

Sacroiliac Joint Sprain

Etiology - result from a single traumatic episode that involves bending or twisting, repetitive stress from lifting

Low Back Pain in Runners

Etiology - tightness around hip flexor and hamstrings - tight hip flexor leads to forward body lean, which leads to anterior pelvic tilt and hyperlordosis Signs - localized pain that increase with active and resisted back exercise but radiating pain and neurologic deficits are not present Management - avoiding excessive flexion activities and a sedentary posture - flexion causes the mobile nucleus pulposus to shift posteriorly and press against the annulus fibrosus - ice NSAIDS, muscle relaxants, transcutanqous electrical nerve stimulation (TENS)

What criteria should be used to determine whether an individual who reports low back pain should be referred to a physician?

If assessment of a low back injury reveals signs of nerve root involvement (ie sensory or motor deficits and diminished reflexes) or disk injury, physician referral is warranted