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 (+) Gowers 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

Diagnosis Ankylosing Spondylitis (Marie Stuumpells disease)

History, 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, spinal extension exercises, breathing exercises, 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, rest, pain relief postures that provide comfort, and avoidance of positions/postures that cause pain modalities such as heat, ice spinal manipulations, mobilizations NSAIDs exercises to relax muscles, 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)

Diagnosis Osteoporosis

Type 1 (post menopausal) Type 2 (involutional, generally seen in elderly population) Sciatica

History, 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, carpenters, office workers Radiating pain in a neural pattern

Signs or Physical Therapy Treatment Tests & Measures Dowagers 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, strengthening pain radiating anterior along costal exercises, balance, posture margins ex: walking, stair climbing, fragile skin tennis, dance, aerobics, x-ray doesnt 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

Diagnosis Lumbar Strain

History, 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, 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

Diagnosis Lumbar Compression Fractures

Spinal Stenosis

History, Risk Factors & Symptoms More common in women due to osteoporosis In younger pts due to trauma, older pts more due to degeneration/osteoporosi s Pt. c/o of severe back pain that gets worse with movement >50 years old Pt. 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, such as MVA, fall from height, sports accident, gunshot wound, etc.

Treatment Stabilization brace REFER OUT!

(+) Lumbar extension (+) Lumbar rotation-extension (+) Quadrant test (+) SLR False (+) H/I Test Pt. 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

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

Signs or Physical Therapy Tests & Measures -DX of recurrent or persistent disc herniation, spinal stenosis, post op infection, epidural post op fibrosis, adhesive arachnoiditis, or nerve injury. -???

Treatment -PT & rehab exercises (conservative) -another surgery

Diagnosis Aortoiliac Occlusive Syndrome

History, Risk Factors & Symptoms -leg pain or fatigue that worsens with use, relieved by rest

-pain, cramping, numbness, or fatigue involving the low back, Aortoiliac occlusive buttocks, hips, or thighs that disease is the obstruction occurs with exercise and is relieved by rest. 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. occlusion of arteries in the thigh and leg. -More diffuse disease is most prevalent in older men. -Erectile dysfunction, due to compromised blood supply, occurs in up to 50% of men with aortoiliac occlusive disease. -Risk factors for aortoiliac occlusive disease include diabetes, smoking, high blood pressure, and high cholesterol.

Signs or Physical Therapy Tests & Measures -femoral pulse weak or absent -Patients may also have wasting of the muscles in the lower extremities. -More severe disease may cause other changes in the feet and lower legs including altered growth of hair and nails, coldness, or numbness.

Treatment -surgical emergency. Self-care at home is not appropriate for this condition

Diagnosis Cauda Equina Syndrome OR conus medullaris

History, Risk Factors & Symptoms -Urinary retention is the most common manifestation of cauda equina syndrome. -result from a variety of conditions including trauma, disk herniations, spinal infections, spinal tumors, and hemorrhage within the spinal canal. -often cause low back pain, which may radiate into one or both lower extremities.

Signs or Physical Therapy Tests & Measures -A loss of sensation in the area of the genitals, anus, buttocks, and upper thighs (saddle anesthesia) is the most common sensory deficit associated with cauda equina syndrome. -Saddle anesthesia can also be caused by conus medullaris syndrome. -Hypoactive Achilles & patellar reflexes. -decreased anal sphincter tone -can cause sensory deficits in the lower extremities -Conus medullaris syndrome can also cause diminished bulbocavernosus & anal reflexes.

Treatment Cauda equina syndrome is a surgical emergency. Self-care at home is not appropriate for this condition

The conus medullaris is the tapered, lowermost part of the spinal cord. Injury to this structure can cause sensory, urinary, & other symptoms collectively called conus medullaris syndrome. The cauda equina is a bundle of nerves that begins just below the conus medullaris. Injury to the cauda equina causes a similar set of symptoms called cauda equina syndrome. Cauda equina syndrome & conus medullaris syndrome often occur together & produce similar signs & symptoms.