Lumbar DD[1] | Back Pain | Osteoporosis

Diagnosis Lumbar Hypermobility

History, Risk Factors & Symptoms -Females > Males -LBP w/ or w/o referred pain -Pt. c/o “recurrent,” “constant,” “locking,” “giving way,” and/or feelings of instability -Pt. self-reports condition as “worsening” -Pt. c/o of pain w/ sustained positions -No gender difference -20-50 years of age -Pt. c/o of pain that starts centrally and may progress down the leg, usually below the knee -Pt. c/o pain when rising from sitting -Pt. c/o pain in sitting

Signs or Physical Therapy Tests & Measures -Palpation of mal-alignment -PT will observe catching with return from flexed posture -Excessive passive intervertebral motion (+) Gower’s Sign (+) Posterior Shear Test (+) Prone Instability Test *Possible Beighton Ligamentous Laxity Scale Observation: -Decreased lumbar lordosis -Posterior pelvic tilt -Pt. sits in slumped position -Pt. uses hands to take weight of low back -Decreased lumbar extension ROM (+) SLR (+) Crossed SLR

Treatment -Pt. education -Pain Control -Abdominal bracing -Strengthening exercises for the transverse abdominis and multifidi

Discogenic LBP

-Pt. education Pain Control -Specific exercises to correct movement impairment (lateral shift, extension, etc.) -Traction -Maintain lumbar lordosis

spinal extension exercises. mobilizations NSAIDs exercises to relax muscles. Risk Factors & Signs or Physical Therapy Symptoms Tests & Measures involves anterior longitudinal • postural changes • ligament & ossification of disk & • cervical hyperextension thoracic zygapophyseal joints • thoracic kyphosis most common in 15-40 year • decreased lumbar lordosis olds • hip & knee flexion contractures• males greater than females • decreased rib expansion night pain • 5 screening questions • morning stiffness > 30 minutes • • improvement with exercise • onset of back pain before 40 yo • slow onset • symptoms > 3 months • • (4 + questions = highly correlated with AS) • Treatment exercises to maintain mobility of the spine and involved joints for as long as possible exercises to prevent the spine from stiffening in kyphotic position exercises that include positioning. breathing exercises. pain relief postures that provide comfort. and peripheral joints several times a day patient should lie prone for 5 minutes should be encouraged to sleep on a hard mattress and avoid side lying position • swimming is a good exercise • • education. reduce pain Lumbar Facet Syndrome • MOI: • result of isolated or cumulative trauma • DDD • aging • postural imbalances • pain referred to gluteals or thigh • morning stiffness • • • muscle guarding pain primarily with compression pain decreases with forward bending • pain increases with back bend & ipsilateral side bend • difficulty standing straight • x-ray may show osteophytes (spondylosis) • • • • . ice spinal manipulations. and avoidance of positions/postures that cause pain modalities such as heat.Diagnosis Ankylosing Spondylitis • (Marie Stuumpell’s disease) • • • History. rest.

posture margins • ex: walking. strengthening pain radiating anterior along costal exercises. balance. stair climbing. dance. x-ray doesn’t show bone loss but swimming will reveal fracture bone scan needed for confirmation • • • (+) SLR (+) Crossed SLR (+) Piriformis Test • • • • • Heat Piriformis stretching Muscle release Steroid injection NSAIDS . Risk Factors & Symptoms results from insufficient • formation or excessive resorption • of bone • occurs with increased age low body fat • low Ca++ intake high caffeine intake • bed rest • alcoholism steroid use • • • • Most frequently occurs between 40-60 Male machine operators. fragile skin tennis. carpenters.Diagnosis Osteoporosis • Type 1 (post menopausal) • Type 2 (involutional. aerobics. • generally seen in elderly • population) • • • • Sciatica History. office workers Radiating pain in a neural pattern Signs or Physical Therapy Treatment Tests & Measures Dowager’s hump (dorsal kyphosis) • adequate intake of CA++ and loss of height (2-4 cm/fracture) Vit D acute regional back pain (low • exercises that involve weight thoracic/high lumbar) bearing.

Diagnosis Lumbar Strain History. low back. hip) Peptic Ulcer • • • • • • • Referred pain to the lateral border of the right scapula Previous history of ulcers Long term use of NSAIDS Nausea Loss of appetite Weight loss Steady midline pain in thoracic spine from T6 to T10 • ??? • • • • • Antimicrobials PPI Antacids H2-blocking agents Avoid aggravating foods . Risk Factors & Symptoms • Broad area of pain • Pain increases with activity or while sleeping • History of trauma in the area • Football players and gymnasts Signs or Physical Therapy Tests & Measures • Pain with rotation-flexion • Pain with flexion • Unable to extend from flexed position • Schober test (less than 5cm) Treatment • • • • • Rest for first 48 hours Ice for first 48 hours Heat NSAIDs Lumbar stretching and strengthening (Abdominal.

such as MVA. older pt’s more due to degeneration/osteoporosi s • Pt. fall from height. Treatment • • Stabilization brace REFER OUT! • • • • • • • • • • • (+) Lumbar extension (+) Lumbar rotation-extension (+) Quadrant test (+) SLR False (+) H/I Test Pt. c/o of severe back pain that gets worse with movement • • >50 years old • Pt. gunshot wound. etc. sports accident. presents with wide based gait pattern and/or poor balance Decreased LE muscle reflexes Decreased LE MMT strength Pain relieved with lumbar flexion Decreased LE sensation along a dermatome pattern Diminished pedal pulse • • • • • Strengthening exercises to stabilize lumbar spine Flexion METs or mobilizations Stationary bicycle Stretching Cold/hot packs .Diagnosis Lumbar Compression Fractures Spinal Stenosis History. Risk Factors & Symptoms • More common in women due to osteoporosis • In younger pt’s due to trauma. c/o lumbar back pain with progression of LE pain (either unilateral or bilateral) • Increased pain when in lumbar extension • Sitting helps relieve pain • LE numbness or tingling • LE muscle cramping Signs or Physical Therapy Tests & Measures • (+) Vibration • Visible deformity or step-off sign • History of (high velocity) trauma.

adhesive arachnoiditis. development of a subsequent diagnosis (for -smoking is a huge RF example. Signs or Physical Therapy Tests & Measures -DX of recurrent or persistent disc herniation. benefit following one or persistent post-operative pressure more LB surgeries. anxiety.sle fusion) or it may be eplessness and spinal caused by the muscular deconditioning. joint problem directly related hypermobility with instability. -??? Treatment -PT & rehab exercises (conservative) -another surgery . FBSS on a spinal nerve.Contributing factors include Nonspecific term but are not limited to residual or referring to a lack of recurrent disc herniation. depression. chronic spinal . to a surgical procedure scar tissue (ie. dull and aching pain arachnoiditis) following a involving the back and/or legs surgical procedure.Diagnosis History.diffuse. inadequate spinal (fibrosis). spinal stenosis. post op infection. or nerve injury. epidural post op fibrosis. altered joint may result from a mobility. Risk Factors & Symptoms Failed Back Surgery -persistent low back pain after low back surgery Syndrome .

Aortoiliac occlusive buttocks. Treatment -surgical emergency. hips. of the abdominal aorta and its main branches by -Isolated involvement of the aorta and iliac arteries is more atherosclerosis. It may common in younger patients who occur along with are smokers. or fatigue involving the low back. or thighs that disease is the obstruction occurs with exercise and is relieved by rest. relieved by rest -pain. Risk Factors & Symptoms -leg pain or fatigue that worsens with use. Signs or Physical Therapy Tests & Measures -femoral pulse weak or absent -Patients may also have wasting of the muscles in the lower extremities. -More diffuse disease is most prevalent in older men. -More severe disease may cause other changes in the feet and lower legs including altered growth of hair and nails. or numbness. coldness. high blood pressure. occurs in up to 50% of men with aortoiliac occlusive disease. smoking.Diagnosis Aortoiliac Occlusive Syndrome History. -Erectile dysfunction. cramping. and high cholesterol. occlusion of arteries in the thigh and leg. due to compromised blood supply. Self-care at home is not appropriate for this condition . -Risk factors for aortoiliac occlusive disease include diabetes. numbness.

-decreased anal sphincter tone -can cause sensory deficits in the lower extremities -Conus medullaris syndrome can also cause diminished bulbocavernosus & anal reflexes. Cauda equina syndrome & conus medullaris syndrome often occur together & produce similar signs & symptoms. Injury to this structure can cause sensory. Injury to the cauda equina causes a similar set of symptoms called cauda equina syndrome. and upper thighs (saddle anesthesia) is the most common sensory deficit associated with cauda equina syndrome. anus. spinal tumors. which may radiate into one or both lower extremities. -Saddle anesthesia can also be caused by conus medullaris syndrome. Self-care at home is not appropriate for this condition The conus medullaris is the tapered. Signs or Physical Therapy Tests & Measures -A loss of sensation in the area of the genitals. Treatment Cauda equina syndrome is a surgical emergency. The cauda equina is a bundle of nerves that begins just below the conus medullaris. spinal infections. lowermost part of the spinal cord. urinary. -result from a variety of conditions including trauma. . and hemorrhage within the spinal canal. -often cause low back pain. buttocks. disk herniations. & other symptoms collectively called conus medullaris syndrome. -Hypoactive Achilles & patellar reflexes. Risk Factors & Symptoms -Urinary retention is the most common manifestation of cauda equina syndrome.Diagnosis Cauda Equina Syndrome OR conus medullaris History.

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