PART 2 CAUSES OF BACK PAIN

Although Huan has identified knee pain as her chief complaint for treatment, during your subjective
evaluation she shares with you that she has been experience back pain. She indicates that the pain is
affecting her throughout her day. You are curious about her back pain and
wonder whether it could be related to her knee pain or a safety consideration.
She shows you the location of her pain (image on the right) and your diagnostic
brain gets to work thinking about the cause.
a) Provide at least 2 potential musculoskeletal causes for her pain.
Thoroughly justify each of these hypotheses by providing the relevant
anatomical details involved in each scenario.
Excessive lordosis normally occurs because of a postural malalignment. This is an
anterior curvature of the spine. It causes tight back and quadriceps muscles and weak and lax
hamstrings and abdominals. This tightness in the hip flexors is often caused by prolonged sitting.
(fix-knee-pain.com, 2016). Since she is school, she is required to sit a lot of the time at a desk.
This combination of weak and lax muscles causes an anterior pelvic tilt which causes the femurs
and tibia to internally rotate. This posture can cause lower back, hip, knee, and foot pain.
Herniation of nucleus pulposus is a condition that is a result from a physical trauma to the
spine and can occur in one or more of the intervertebral discs. This condition is the result of the
annulus fibrosus followed by the spongy nucleus pulposus protruding through the annulus
(Marieb, 2014, pg. 195). This can cause pain or numbness in the back by the spinal cord or spinal
nerves that are exiting from the spinal cord (Marieb, 2014, pg. 195). Herniation of nucleus
pulposus can cause chronic pain in the spinal nerve roots and is mostly common in the lumbar
spine at the levels of L4-L5 or L5-S1 (Moore, 2015, pg. 286). In Huans case, we believe that
she has a herniation of nucleus pulposus because she is having back pain. Since this condition

has to do with the nerves of the spinal cord, which some of them travel down the leg/knee area
this could be why she is having knee pain as well.
b) Provide at least 2 causes for her pain that are linked to her internal organs. Provide a brief
justification for each hypothesis.
A kidney infection is caused by bacteria that travels up the urethra caused by improper
toilet habits or from sexual activity (drives bacteria from the vagina and external vaginal area
towards the urethra. Because the female urethra is very short, it is very easy for bacteria to travel
up to the bladder, if the infection is not treated, the infection can further travel up to the kidneys.
When this happens, inflammation of the bladder and kidneys is present causing low back pain,
painful, frequent, and urgent urination, as well as severe headaches. Urinary tract infections can
be treated with the use of antibiotics (Marieb, 2011, pg. 864). This would make sense in Huans
case because she places her hands bilaterally (where the kidneys are located), she is female
(happens in 40% of females), and she has a language and shyness barrier that prevents her from
seeking out treatment that could have stopped the infection before it reached the kidneys.
Since the patient is complaining of bilateral thoracic and lumbar pain, this could signify a
chronic tightness of the intermediate layer of the intrinsic back muscles and posterior abdominal
muscles such as Illiocostalis, Illiopsoas and Quadratus Lumborum. These muscles originate from
the T12-S1 vertebrae and 12th rib and Illiocostalis originates inferiorly on the posterior surface
of the sacrum. Quadratus Lumborum and Illiopsoas move inferiorly to the broad tendon to the
lesser trochanter and the iliolumbar ligament to the iliac crest which causes allow hip flexion and
can laterally flex the vertebral column (Moore, 2015, pg. 184). Iliocostalis (lumborum) muscle
fibers run superiorly laterally to the lower ribs which bilaterally extends the vertebral column and

unilaterally flexes the vertebral column (Moore, 2015, pg. 296). If these muscles are tight, this
may cause excessive lordosis and may cause increased hip flexion due to the prolonged seated
position she has during school - this causes shortening of these muscles. Which may inhibit the
glutes the activate to their optimal potential which may be a factor in the patients knee pain.

References
Fix-Knee-Pain.com. (2016). Basic postural problems at the hip: anterior pelvic tilt. Retrieved
from:http://www.fix-knee-pain.com/basic-postural-problems-at-the-hip-anterior-pelvic-til
t/

Marieb, E. N., & Hoehn, K. (2011). Anatomy & physiology (4th ed.). Glenview, IL: Pearson
Education, Inc.
Marieb, E. N., & Hoehn, K. (2014). Anatomy & physiology (5th ed.). Glenview, IL: Pearson
Education, Inc.
Moore, K. L., Agur, A. M. R., Dalley, A. F., II, & Moore, K. L. (2015). Essential clinical
anatomy (5th ed.). Philadelphia: Wolters Kluwer Health.

MARKING RUBRIC
Musculoskeletal Sources of Back Pain: Excellent submissions will include two reasonable causes for
Huans back pain that are related to her muscles and/or skeleton. Both proposed causes will be justified
with a comprehensive description of the relevant anatomical details. Submissions will be written in the
groups own words and will be supported by credible resources.
Cannot
mark

Poor

Average
2

Excellent
5

Back Pain Related to Internal Organs: Excellent submissions will include two reasonable causes for
Huans back pain that are related to her muscles and/or her internal organs. Both proposed causes will be
briefly justified, including a citation from a credible resource. Submissions will be written in the groups own
words.
Cannot
mark

Poor

Average
2

Excellent
5