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51 Cards in this Set
- Front
- Back
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Intraspinous radicular pain
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Neurofibroma, Ependymoma, Meningioma, Disc, Spinal stenosis, AVM of cord, Spinal AV fistula
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Extraspinous radicular pain
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piriformis, vascular disease, nerve root irritation, neoplasms, plexitis, polyneuropathy, trauma with neuropraxis, shingles
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What is the major role in risk of acute LBP?
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occupation
-nursing, garbage collection, warehouse, airlines |
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Non-Radicular pain
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Traumatic, Chronic/sub acute, DJD, Referred pain, infection, neoplasm, rheumatologic
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Alarm symptoms of LBP
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age >50
prior cancer history unexplained fevers, night sweats, weight loss pain lasting more than one month often intractable and unrelieved with rest no improvement following conservative therapy |
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Discogenic (radicular) pain
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often acute,
constant, sharp, shooting dermatomal radiation, unilateral increased by cough, sneezing, sitting improved with lying down |
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Risk factors for HNP
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repetitive lifting activity
prolonged sitting twisting/rotational movement chronic cough prior spinal injury or disc disease tobacco use exposure to prolonged vibratory forces |
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HNP characteristics
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posterior lateral location
L4-L5, L5-S1 males more than females pain worse with increasing intrathecal pressure |
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Cauda Equina syndrome
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impingement of caudal equina
50% secondary to tumor EMERGENT surgical decompression |
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Facet Trophism
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asymmetry of facet joint which predispose patients to early degenerative joint disease and pain
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Sacralization
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deformity in which L5 fuses with sacrum, can predispose patient to pain and early disc herniation
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Lumbarization
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deformity in which S1 segment fuses to lumbar spine
less common |
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Spina Bifida Occulta
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no herniation through defect
only physical sign is course hair over site no neurological defects |
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Spina Bifida Meningocele
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a herniation of meninges through defect
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Spina Bifida Meningomyelocele
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herniation of meninges and nerve roots through defect
associated with neurological deficits |
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Lumbosacral angle
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angle formed by intersection of horizontal line with sacral base line
normal: 25-35 degress increased: increased lumbosacral joint shear and LBP |
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Postural/ Tonic muscles respond to dysfunction how?
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by becoming hypertonic, shortened, sometimes spastic
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Dynamic/phasic muscles respond to dysfunction how?
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by inhibition, hypotonicity and weakness
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Motion of lumbar spine?
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flexion and extension
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Psoas muscle spasm (flexion contracture)
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somatic dysfunction of L1 and L2
rotated to same side as spasm |
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Low back horizontal platforms
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Thoraco-Abdominal Diaphragm
Pelvic Diaphragm Meniscus of knee plantar fascia of foot |
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Low back cables
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erector spinae
Iliopsoas & QL Quads & Hamstrings TFL/ITB & hip adductors gastroc/soleus & tibialis anterior |
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Lumbar spine xray, AP view
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lumbar scoliosis
unlevel sacral base functional short leg |
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Lumbar spine xray, Lateral view
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loss of lumbar lordosis
DDD, facet syndrome |
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Lumbar spine xray, L-S Jctn spot view
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Spondylolisthesis L5-S1
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Straight leg test
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raise leg 20-60 degrees
positive test reproduced radicular pain below knee nerve root lesion |
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Test L1-L2 motor nerve root
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psoas muscle,
flex hip up |
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Test L3 motor nerve root
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quadriceps muscle
extend leg |
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L4 motor nerve root
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Tibialis anterior muscle
dorsiflex foot |
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L5 motor nerve root
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extensor hallucis longus
extend great toe |
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Si motor nerve root
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gastrocnemius muscle
plantarflex foor |
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Grades of muscle strength
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0=no tone, flaccid
1=tone w/o movement 2= movement without gravity, not against gravity 3= movement against gravity, not against resistance 4= slightly diminished strength 5= full strength against resistance |
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Patellar reflex
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L4
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Achilles reflex
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S1
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Grading deep tendon reflexes
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0=no response
1=minimal response 2=mid-range normal response 3= slightly hyperactive response 4= hyperactive response with clonus |
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Patrick's Test
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positive test reproduces pain in SI joint and anterior groin crease
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FABERE
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flexion, abduction, external rotation, extension (patricks test)
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Thomas test
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tight hip flexor, psoas
look for gap in politeal fossa (psoas) |
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Flexed lumbar segment-- still technique
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flex to segment-- ADduct-- compress-- ABduct
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Extended lumbar segment-- still technique
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flex to segment-- ABduct -- compress-- ADduct leg
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Treatment of ABL2
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counterstrain by standing on ipsilateral side, flexing hip 90degrees, bringing knees together, rotating towards tender point--SB away
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AL1
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internal oblique mm
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AL2
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External oblique mm
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AL3/4
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Iliopsoas mm
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AL5
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Rectus abdominus mm
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Charles Hazard D.O.
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student of Dr. Still in 1897
teacher at American School of Osteopathy |
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Still similar to FPR
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positioning and use of compression
Type 1/2 not needed for FPR (neutral) not through barrier (Still is) |
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Force vector
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point of compression to and through the dysfunctional tissue
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Two types of FPR
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directed at normalization of palpable abnormal tissue texture
modified to influence deeper muscles involved in joint mobility |
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FPR for dummies
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put into neutral-- add compression--balance--hold-- return to neural
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What is the order of treatment for still technique
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lumbar spine and pelvic dysfunctions are treated BEFORE sacral dysfunction
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