What is the most common cause of disability and lost work time?
Low back pain
What are major factors in determining patient success?
psychological and environmental factors
Is it common to have nerve involvement with low back pain patents?
Yes, it is very common
What all influences the lumbar spine?
thoracic spine, sacrum, and lower extremities
What are the red flags for the lumbar spine and pelvis?
- history of cancer
- night pain and pain at rest
- unexplained weight loss
- failure to improve with treatment
- prolonged use of corticosteroids
- violent trauma
- age over 50 or under 17
- unexplained pain
- severe ROM deficit
- saddle anesthesia (medical emergency)
What is the red flag if someone has unexplained weight loss?
cancer
What are the red flag if someone is over 50 or under 17?
- cancer
- tumor
- fracture
Why is prolonged use of corticosteroids a red flag?
corticosteroids compromise the immune system
What is the reg flag if someone has a severe ROM deficit?
ossification
What are things to ask the patient with low back pain in the interview?
- pain (at night, better or worse)
- bowel or bladder changes
- what can/can’t you do because of pain
- MOI (mechanism of injury)
- pain with coughing or sneezing
- past medical history (MPHx)
- N/T or radicular pain
- any imaging
- change in sensation or balance
- change in activity
- does pain change during the day
- what activities are painful (sitting, standing, walking, sleeping, driving)
What do you make sure you observe with a patient with low back pain?
- posture
- movement in clinic (getting out of chair, etc)
- gait pattern
- lumbar alignment
- sacrum alignment
- scoliosis
- body type (where they carry their weight)
What do you ALWAYS look at with someone with low back pain?
thoracic, sacrum, hips (strength and mobility), gait pattern
