Lower Back

Question 1

4 common lower back pathologies

Answer 1

Non-specific lower back pain
Radicular symptoms
Serious pathologies
Visceral referred pain (vascular problems)

Question 2

Non-specific lower back pain

Answer 2

Unable to identify a specific nociceptive cause or specific pathology
3 subtypes - acute, sub-acute and chronic
Causes - traumatic injury, lumbar sprain or strain, postural strain
Structures involved - muscles, ligaments, nerve roots, zygopophyseal joints, vertebrae

Question 3

Non-specific lower back pain: clinical presentation

Answer 3

All age groups
Reoccuring lower back pain
Self-limiting and not associated with serious pathologies
Overweight and obesity increases risk
Multi factorial; psychological, social and biological factors

Question 4

Radicular symptoms: Radicular pain

Answer 4

Pain from a nerve root
Sharp, radiating sensation caused by compression or inflammation of the nerve
Due to disc herniation, spinal stenosis or bony spurs
Leg pain is normally worse than the back pain

Question 5

Radicular symptoms: radiculopathy

Answer 5

Pinched or damaged nerve root in the spine causes pain, numbness, tingling, weakness and/or loss of reflexes
Causes - herniated discs, bony spurs, spinal stenosis

Question 6

Radicular symptoms: spinal stenosis

Answer 6

Pain and altered sensation in lower limbs
Caused by narrowing of the central spinal canal, lateral recess or steaming
Aggravated with walking or standing
Eased with bending forwards or sitting down

Question 7

Serious pathologies

Answer 7

Fractures
Spinal infection
Cauda equina
Cancer

Question 8

Red flags for serious pathologies

Answer 8

History of cancer
Progressive neurological deficits
Gait ataxia
Bladder or bowel dysfunction
Saddle anaesthesia
Fever
Unexplained weight loss
Night and/or resting pain
Trauma

Question 9

Visceral referred pain: peripheral arterial disease (PAD)

Answer 9

Cardiovascular condition caused by atherosclerosis which restricts blood glow, typically to the legs
Causes - leg pain, weakness, numbness, tingling, muscle wasting, coldness in skin, changes to hair growth, unhealed sores, changes to the skin
Exam - colour, temperature, swelling of limbs, pulses (femoral, posterior tibial, dorsalis pedis, popliteal)

Question 10

Management of lower back pain

Answer 10

Promote healthy lifestyles
Stay active
Remain at work or supported early return to work
Early identification and appropriate education of patient at risk of persistent pain and disability
Address comorbidities

Question 11

Pacing in treating lower back pain

Answer 11

Dividing the day into periods of relative rest and activity
Maintain an even level of activity over the day and week
Activities and behaviours are time dependent rather than symptom dependent

Question 12

Grades of passive movement

Answer 12

All grades relate to resistance
Can be applied to physiological or accessory movements

Question 13

Grade I

Answer 13

Small amplitude movement performed at the beginning of range
Out of resistance

Question 14

Grade II

Answer 14

Large amplitude movement in a resistance free part of range

Question 15

Grade III

Answer 15

Large amplitude movements performed into resistance

Question 16

Grade IV

Answer 16

Small amplitude movement performed into resistance