History
What are the three major categories of back pain?
Mechanical
Visceral
Non-mechanical
What are the three components of the back exam?
Standing
Sitting
Supine
Are labs needed in evaluation of acute low back pain?
NO
Can cause referred LBP in men?
Prostatitis
NSAIDS, tylenol, muscle relaxants
What are the three most common causes of Back Pain and what category do they fall under?
Degenerative Joint Disease
Disc Herniation
Lumbar strain
All mechanical
What are the components of standing portion of the PE
Inspection
Palpation
Range of motion
Gait
Stoop Test
when should a CBC be ordered?
if tumor or infection is suspected
Occurs when a large mass effect (such as an acute disc herniation or a tumor) compresses a portion of the spine, causing pain radiating down the leg and can be accompanied by weakness and numbness of the leg.
cauda equina syndrome
What is included in the conservative therapy for acute low back pain?
Pharmacologic therapy (Aspirin/NSAIDS/Muscle relaxants)
Local therapy (heat/cold compress)
Activity
What are three risk factors for low back pain
Prolonged sitting
Deconditioning
Sub-optimal lifting and carrying habits
Repetitive bending and lifting
Spondylolysis
Obesity
Prolonged use of steroids
Intravenous drug use
Psycho-social factors
What are the components of testing the sensation
Test for sharp and light touch along dermatomal distribution, great toe (L5), lateral malleolus, and posteriolateral foot (S1)
When do you order an X-ray?
History of trauma
Strenuous lifting in patient with osteoporosis
Prolonged steroid use
Osteoporosis Age <20 and >70
History of cancer
Fever/chills/weight loss
Pain worse when supine or severe at night
Spinal fracture, tumor, or infection
Has an insidious onset and is increasingly common with advancing age
Disc Herniation
When should you refer to a surgeon or for advanced imaging?
If pain has not improved after four to six weeks or if progression of neurologic deficits is demonstrated
Name three Red flags when encountering back pain
Fever
Unexplained weight loss
Pain at night
Bowel or bladder incontinence
Urinary retention
Neurologic symptoms
Saddle anesthesia
Trauma
The test is performed by flexing the hip and placing the foot of the tested leg on the opposite knee. Pressure is then placed on the tested knee while stabilizing the opposite hip
FABER test
When is an MRI indicated?
Worsening or unremitting neurologic deficit or radiculopathy
Progressive major motor weakness
Cauda equina compression (sudden bowel/bladder disturbance)
Suspected systemic disorder (metastatic or infectious disease)
Failed six weeks of conservative care
Typically has an acute or sub-acute onset after an injury or precipitating activity.
Lumbar strain
Compared to control, patients with LBP who had PT showed what level of improvement in a 100 point disability score?
10 point improvement
Mechanical lower back pain involves what three anatomical strucutres
Bones of the spine
Muscles and ligaments surrounding the spine
Nerves
At what degree can the normal leg be raised?
80 degrees
what test is useful to confirm the existence of radiculopathy (level of nerve involvement) and to exclude the presence of other peripheral nerve disorders
Electrodiagnostic/electromyographic tests
Associated with HLA-B27 gene
Ankylosing spondylitis
When should you use cold compress versus hot compress
When your back pain is acute (less than a 4-week duration) and/or occurs due to a direct injury, use cold therapy first. Lowering the body temperature will help constrict the blood vessels, reduce swelling, decrease inflammation, and cause a numbing effect. Once the inflammation has subsided, use heat therapy