prevention and care low back
what individuals are susceptible to spondylitic conditions?
female gymnasts, inferior football lineman, weight lifters, volleyball players, wrestlers, rowers
decrease in lumbar lordosis (20*)
flat back
sensitive to mechanical stress and deformation
free nerve endings
sense intra ligamentous stretch
golgi receptors
what does no radiating LBP mean?
no nerves involved; all muscular or structural
do spondylitic conditions heal with time?
not typically; no
what can cervical radiculopathy be associated with?
numbness, weakness, loss of reflexes
what is the age rule for spondylosis fracture?
occurs <8; asymptomatic until 10-15
sensitive to pressure and vibration
pacinian corpuscles
what are s&s of facet joint pathology?
pain may radiate to posterior thigh but not below knee; increased pain with trunk rotation, stretching into full extension; lateral bleeding
area between superior and inferior facets - weakest part of the vertebrae
pars interarticularis
eccentric nucleus produces a definite deformity as it works its way through fibers of annulus fibrosis
prolapsed disc
eccentric accumulation of nucleus with slight deformity of annulus - nucleus starts to push through layers and wear them down through micro tears
protruded disc
sense intraarticular pressure
ruffini's corpuscles
what is cauda equina issues caused by?
ruptured disc; stenosis, malignant tumor, spinal infection, inflammation, fracture
what is a ddx for cauda equina?
sciatic
nuclear material form intervertebral disc is separated from disc itself and potentially migrates into spinal cord
sequestered disc
what are s&s of lumbar disc conditions?
sharp pain and spasm at sight of herniation - pain shoots down extremity
how do individuals with a disc condition walk?
slightly crouched position leaning away from the side that causes pain
bilateral fracture of pars interarticularis accompanied by anterior slippage of involved vertebrae; anterior displacement of vertebrae
spondylolisthesis
stress fracture of the pars interarticularis; repeated weight loading in flexion, hyperextension, or rotation
spondylosis fracture
increased lordotic curve and kyphosis
sway back
what are clinical signs for flat back?
tendency to lean forward when walking or standing
how is low back pain diagnosised?
through patient history, exam, and imaging
what is LBP in runners come from?
tightness of hip flexors and hamstrings
what is the age rule for spondylolisthesis?
10-15 years
what does flat back impact?
COG
what does sway back impact?
COG
what are ddx for facet joint pathology?
LBP, muscle spaces, SI joint sprain
single truama involving bending/twisting, repetive lifting, fall on butt, excessive side or up/down motion, etc.
SI joint sprain
what are special tests for LBP in runners?
SLR - removes hamstrings to test herniated disks Thomas test - knee to chest
what are potential clinical findings for facet joint pathology?
abnormal pelvic tilt and hip rotation secondary to tight hamstrings; weak erector spinae
strain overuse or cervical whiplash
acute cervical pain
what does intervertebral disk issues developing into arthrits in facet joints come from?
aging and degeneration
what other pathology can be linked to low back pain?
autoimmune disease
because cauda equina is hard to diagnose, what can happen if not diagnosed early enough?
bladder/bowel permanent changes or oaralysis
what herniation will only report neck, trapezial and/or inter scapular pain?
c5-c6
though the spinal cord ends at L1 or L2 - fracture below this point is not a serious threat but should be handled with care; caused by narrowing of space or compression of the nerves in lumbar region
cauda equina
pain radiating into arm and neck may be caused by?
cervical nerve root
neurogengenic pain in distribution of cervical nerve roots
cervical radiculopathy
what causes lordosis?
cogenital deformities weak abdominal musculature poor posture activites with excessive hyperextension
brought on by beer belly, weight out front causes tilt hips and increase in lbp
diffuse idiopathic skeletal hypertonic (DISH)
nuclear material bulges into spinal canal and runs the risk of impinging adjacent nerve roots
extruded disc
subluxation, dislocation; facet joint syndrome; degeneration of the facet itself
facet joint pathology
abnormal exaggeration of lumbar curve
lordosis
what conditions are associated with low back pain?
lumbar strain, herniated disk, lumbar spinal stenosis, degenerative spondylolisthesis
where does spondylolisthesis commonly occur?
lumbosacral
what gender and age does DISH affect?
men and can be symptomatic after age 50
what is sway back caused by?
muscle weakness and compensatory tightness
what are ddx for SI joint sprain?
myogenic or muscle related disease, piriformis syndrome, facet pathology
