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