Term
|
Definition
| pain, muscle tension, or stiffness localized below the ribs and above the inferior gluteal folds, with or without leg pain. Can be specific or non-specific. |
|
|
Term
| about what percentage of low back pain is specific |
|
Definition
|
|
Term
| what are some obvious sources of specific low back pain |
|
Definition
| tumor, fracture, cancer, infection, rheumatoid arthritis, disc herniated nucleus pulposis |
|
|
Term
| about what percentage of low back pain is non-specific |
|
Definition
|
|
Term
| about how many patients with non-specific LBP stop seeking care after 6 weeks because they are better |
|
Definition
|
|
Term
| about how many patients with non-specific LBP stop seeking care after 3 months because they are better |
|
Definition
|
|
Term
| can a patient with LBP get better without treatment |
|
Definition
| yes, sometimes. It depends. :) |
|
|
Term
| about how many patients who have non-specific LBP return to work within 1 week (after the pain first caused them to miss work) |
|
Definition
|
|
Term
| about how many patients who have non-specific LBP return to work within 2 months(after the pain first caused them to miss work) |
|
Definition
|
|
Term
| about how many patients who have non-specific LBP who are out of work because of the pain for > 6 months will ever return to work? |
|
Definition
|
|
Term
| about how many patients who have non-specific LBP who are out of work because of the pain for > 2 years will ever return to work? |
|
Definition
|
|
Term
| about how many patients with LBP will have recurrence again in their lifetime |
|
Definition
|
|
Term
| about how many patients with LBP will have recurrence within 1 year |
|
Definition
|
|
Term
| is incidence of acute LBP greater in men or women |
|
Definition
|
|
Term
| is incidence of chronic LBP greater in men or women |
|
Definition
|
|
Term
| how does prevalence of LBP change with age |
|
Definition
|
|
Term
| why does the prevalence of acute LBP decrease with age |
|
Definition
| reduction in physical activity and reduced spine mobility |
|
|
Term
| what are 3 groups of risk factors for occurrence and chronicity of LBP |
|
Definition
| individual factors, psychosocial factors, occupational facotrs |
|
|
Term
| is bedrest helpful for LBP |
|
Definition
|
|
Term
| is visceral pain a common pain complaint in general medical practice? |
|
Definition
| yes, one of the most common |
|
|
Term
| can visceral pain be misleading and lead you to an incorrect diagnosis? |
|
Definition
|
|
Term
| do all viscera evoke pain |
|
Definition
|
|
Term
| describe the localization of visceral pain |
|
Definition
| diffuse; hard to localize |
|
|
Term
| can visceral pain be referred |
|
Definition
|
|
Term
| what might accompany visceral pain |
|
Definition
| motor and autonomic reflexes such as nausea, vomiting, and lower back muscle tension |
|
|
Term
| what are 4 important clinical characteristics of visceral pain |
|
Definition
| 1. not all viscera evokes pain; 2. visceral pain is effuse and poorly localized; 3. visceral pain can be referred to other locations; 4. visceral pain can be accompanied by motor and autonomic reflexes such as nausea, vomiting, and lower back muscle tnesion |
|
|
Term
| what is the convergence-projection theory |
|
Definition
| Visceral and somatic afferents converge on the same neurons at the spinal cord. Input to the cord from viscera may be misconstrued as originating from a somatic site or vice versa. |
|
|
Term
| what are viscerogenic sources of lumbo-pelvic pain |
|
Definition
| ovarian cancer, testicular cancer, pancreas, kidney stones, abdominal aortic aneurysm, duodenal ulcer |
|
|
Term
| what are warning signs for LBP |
|
Definition
| insidious onset of symptoms; symptoms that come and go regardless of posture or time of day; strong and painless muscle around a joint with full ROM despite being the primary site of symptoms |
|
|
Term
| what to include in screening in order to rule out red flags |
|
Definition
| blood pressure, heart rate, respiration rate, look for edema, infections |
|
|
Term
| what are risk factors that you will get from history |
|
Definition
| smoking, drinking, obesity, family history of disease |
|
|
Term
| describe lumbar spine vertebral bodies |
|
Definition
|
|
Term
| describe lumbar spine vertebral laminae (weak or sturdy) |
|
Definition
|
|
Term
| are lumbar vertebrae large or small |
|
Definition
|
|
Term
| do lumbar vertebrae have costal facets |
|
Definition
|
|
Term
| how are articular facets of lumbar spine aligned |
|
Definition
|
|
Term
| describe the anterior pillar of lumbar spine |
|
Definition
| vertebral bodies offer passive support |
|
|
Term
| describe the posterior pillar of lumbar vertebrae |
|
Definition
| disc, IV foramen, articular processes, ligamentum flavum, and interspinous ligament provide dynamic support |
|
|
Term
| what is the functional purpose of the articular processes |
|
Definition
|
|
Term
| through what part of the vertebrae is the axial compression |
|
Definition
| through the bodies/anterior column |
|
|
Term
| what kind of absorption occurs at IV disc (direct or indirect? Active or passive?) |
|
Definition
|
|
Term
| what kind of absorption occurs at paravertebral muscles |
|
Definition
|
|
Term
| why is the most anterior portion of the vertebral bodies weak? |
|
Definition
| trabeculae are aligned vertically |
|
|
Term
| how many articular processes are on a lumbar vertebrae |
|
Definition
|
|
Term
| how many transverse processes are on a lumbar vertebrae |
|
Definition
|
|
Term
| where is the basivertebral vein |
|
Definition
| passes through anterior and posterior foramen |
|
|
Term
| what are 3 functions of the IV disc |
|
Definition
| provide the strongest attachment between IV bodies; plays a leading role in weightbearing and shock absorption; provides mobility to the spine |
|
|
Term
| is the IV disc vascular or avascular |
|
Definition
|
|
Term
| how is the IV disc innervated |
|
Definition
| nucleus is not innervated. Annulus may have a few sinuvertebral fibers. Lateral aspect innervated by anterior rami and gray rami communicantes. |
|
|
Term
| what are pain sensitive structures around the IV discs |
|
Definition
| anterior longitudinal ligament, posterior longitudinal ligament, vertebral body, nerve root, facet joint cartilage |
|
|
Term
| what is the anterior longitudinal ligament and where is it |
|
Definition
| strong, broad fibrous band connecting the anterior aspects of vertebral bodies and discs. Extends from pelvic surface of the sacrum to the anterior tubercle of C1 and the occipital bone anterior to the foramen magnum |
|
|
Term
| what is the function of the anterior longitudinal ligament |
|
Definition
| maintains the stability of the joints between the vetebral bodies and helps prevent hyperextension of the vertebral column |
|
|
Term
| is the posterior longitudinal ligament weaker or stronger than the anterior longitudinal ligament |
|
Definition
|
|
Term
| is the posterior longitudinal ligament wider or more narrow than the anterior longitudinal ligament |
|
Definition
|
|
Term
| where is the posterior longitudinal ligament |
|
Definition
| runs along posterior aspect of the vertebral bodies; within the vertebral canal |
|
|
Term
| where is the posterior longitudinal ligament broadest |
|
Definition
| superiorly where it is continuous with the tectorial membrane/attaches to the occipital bone on internal aspect of the foramen magnum. Also broad in the thoracic and and lumbar regions where it is related to the IV discs |
|
|
Term
| what are the functions of the posterior longitudinal ligament |
|
Definition
| helps prevent hyper flexion of the vertebral column; helps prevent posterior protrusion of the nucleus pulposus of the disc |
|
|
Term
| what does ligamentum flavum mean |
|
Definition
|
|
Term
| where is the ligamentum flavum |
|
Definition
| attached superiorly to the anterior surfaces of the inferior borders ofa pair of laminae and attached inferiorly to the posterior surfaces of the superior border of the next vertebra's pair of laminae. Some ligamentum flavum fibers extend to the articular capsules of the facet joints |
|
|
Term
| what are the functions of the ligamentum flavum |
|
Definition
| helps preserve the normal curvature of the vertebral column; helps straighten the column after it has been flexed |
|
|
Term
| is the interspinous ligament weak or stron |
|
Definition
|
|
Term
| function of the interspinous ligament |
|
Definition
| joins adjacent spinous processes |
|
|
Term
| describe the supraspinous ligament |
|
Definition
| strong, cord-like ligament |
|
|
Term
| what is the shape of the iliolumbar ligament |
|
Definition
|
|
Term
| is the iliolumbar ligament strong or weak |
|
Definition
|
|
Term
| what are the attachments of the iliolumbar ligament |
|
Definition
| connects the tip of the transverse process of L5 and sometimes L4 to the iliac crest posteriorly. Inferior fibers are attached to the lateral part of the sacrum. |
|
|
Term
| what is the function of the iliolumbar ligament |
|
Definition
| limit rotation of the L5 vertebra on the sacrum; assist the vertebral articular processes in preventing anterior gliding of L5 on the sacrum |
|
|
Term
| what is the origin of the psoas major |
|
Definition
|
|
Term
| what is the insertion of the psoas major |
|
Definition
|
|
Term
| what muscle is often weak with unilateral back pain and why |
|
Definition
| ipsilateral psoas major because they flex toward that side. The psoas major attaches to the 5 bones that hurt in the lower back. You're going to avoid using/inhibit that muscle because when you use it, it hurts. |
|
|
Term
| why do many patients have back pain when flexing their hip |
|
Definition
| psoas major pulls on the painful lumbar vertebrae |
|
|
Term
| what are the actions of the psoas major |
|
Definition
| flex and outwardly rotate (a little) femur; hip stability; when femur is fixed, it flexes and ipsilaterally sidebends lumbar spine |
|
|
Term
| what is the principle vertical muscle of the anterior abdominal wall |
|
Definition
|
|
Term
| describe the rectus abdominis |
|
Definition
|
|
Term
| what is the origin of the rectus abdominis |
|
Definition
| xiphoid process and 5-7 costal cartilages |
|
|
Term
| what is the insertion of the rectus abdominis |
|
Definition
| pubic symphysis and pubic crest |
|
|
Term
| what are the actions of the rectus abdominis |
|
Definition
| compres abdominal viscera; depress ribs; stabilize pelvis |
|
|
Term
| what is the largest and most superficial of the 3 flat abdominal muscles |
|
Definition
| external oblique abdominis |
|
|
Term
| in what direction do the fibers of the external oblique abdominis run |
|
Definition
| infero-anteriorly and medially |
|
|
Term
| what is the orgin of the external oblique abdominis |
|
Definition
| external surfaces of ribs 5-12 |
|
|
Term
| what is the insertion of the external oblique abdominis |
|
Definition
| linea abla, pubic tubercle, anterior half of iliac crest |
|
|
Term
| what are the actions of the external oblique abdominis |
|
Definition
| compress and support abdominal viscera; flex and rotate trunk |
|
|
Term
| what is the intermediate of the 3 flat abdominal muscles/ |
|
Definition
| internal oblique abdominis |
|
|
Term
| in what direction do the fibers of the internal oblique abdominis run |
|
Definition
|
|
Term
| what is the origin of the internal oblique abdominis |
|
Definition
| thoracolumbar fascia, anterior 2/3 iliac crest, lateral half of inguinal ligament |
|
|
Term
| what is the insertion of the internal oblique abdominis |
|
Definition
| inferior borders of ribs 10-12; linea alba, pubis |
|
|
Term
| what are the actions of the internal oblique abdominis |
|
Definition
| compress and support abdominal viscera; flex and rotate trunk |
|
|
Term
| what is the innermost of the 3 flat abdominal muscles |
|
Definition
|
|
Term
| in what direction do fibers of the transverese abdominis |
|
Definition
|
|
Term
| what are the origins of transverse abdominis |
|
Definition
| internal surfaces of costal cartilages 7-12; thoracolumbar fascia; ilica crest; lateral inguinal ligament |
|
|
Term
| what are the insertions of transverse abdomins |
|
Definition
| linea abla, pubic crest, pubis |
|
|
Term
| what are the actions of the transverse abdominis |
|
Definition
| compresses and supports abdominal viscera; tightens thoracolumbar fascia; increases intra-abdominal pressure; contributes to spinal stiffness/intersegmental control |
|
|
Term
| is the quadratus thick or thin |
|
Definition
|
|
Term
| where is the quadratus lumborum |
|
Definition
| posterior abdominal wall; adjacent to the transverse processes of the lumbar vertebrae |
|
|
Term
| what is the origin of the quadratus lumborum |
|
Definition
| medial half of inferior border of the 12th rib, tips of lumbar transverse processes |
|
|
Term
| what is the insertion of the quadratus lumborum |
|
Definition
| iliolumbar ligament and internal lip of iliac crest |
|
|
Term
| what are the actions of the quadratus lumborum |
|
Definition
| extends and laterally flexes vertebral column; fixes 12th rib during inspiration |
|
|
Term
| are the intertransversarii and interspinales muscles large or small |
|
Definition
|
|
Term
| where are the intertransversarii and interspinales well developed (what part of the vertebral column) |
|
Definition
|
|
Term
| where are interspinales muscles |
|
Definition
| between the spinous processes of consecutive vertebrae |
|
|
Term
| where are intertransversarii muscles |
|
Definition
| between the transverse processes of consecutive vertebrae |
|
|
Term
| what do interspinales muscles do |
|
Definition
| aid in extension of the spine |
|
|
Term
| what do intertransversarii muscles do |
|
Definition
| unilaterally produce lateral flexion of superior vertebra; bilaterally aid with extension |
|
|
Term
| what are the attachments of the multifidi |
|
Definition
| fibers pass superomedially from vertebral arches to spinous process, spanning one to 3 vertebrae |
|
|
Term
| which vertebrae have multifidi |
|
Definition
|
|
Term
| what are the unilateral actions of multifidi |
|
Definition
| laterally flexes trunk and rotates to opposite side |
|
|
Term
| what are the bilateral actions of the multifid |
|
Definition
| extend trunk, stabilize, vertebral column |
|
|
Term
| what are multifidi important for |
|
Definition
| segmental stability of lumbar spine |
|
|
Term
| is there evidence that the multifidus is dysfunctinoal in patients with LBP |
|
Definition
|
|
Term
|
Definition
| short, deep muscles in the groove between the spinous and transverse processes throughout the spinal column |
|
|
Term
| what are the attachments/what is the path of the rotatores |
|
Definition
| transverse processes of one vertebra to the base of the spinous process of the vertebra superior to it. |
|
|
Term
| what are the actions of the rotatores |
|
Definition
| rotate the superior vertebra to the opposite side; aid in stabilizing vertebral segments |
|
|
Term
| at what vertebral level does the spinal cord end |
|
Definition
|
|
Term
| where do the sinuvertebral nerves branch from |
|
Definition
| recurrent from ventral ramus |
|
|
Term
| what type of nerve is the sinuvertebral nerve |
|
Definition
| mixed: somatic, autonomic |
|
|
Term
| from where do the somatic nerves in the sinuvertebral nerve come from |
|
Definition
|
|
Term
| from where do the autonomic nerves in the sinuvertebral nerve come from |
|
Definition
|
|
Term
| what does the sinuvertebral nerve innervate |
|
Definition
| innervates outer third of annulus fibrosus, posterior longitudinal ligament, basivertebral vein of vertebral canal, ventral dura mater to disc at its level and one above |
|
|
Term
| which part of the IV discs is innervated |
|
Definition
| outer annulus fibrosus, greater innervation laterally |
|
|
Term
| what innervates the lumbar intervertebral discs |
|
Definition
| sinuvertebral nerve, gray rami communicantes |
|
|
Term
| what part of the IV disc does the sinuvertebral nerve innervate |
|
Definition
| outer annulus fibrosus at level and one above |
|
|
Term
| what part of the IV disc does the gray rami communicantes innervate |
|
Definition
| lateral disc, also Anterior Longitudinal Ligament |
|
|
Term
| is innervation to lumbar intervertebral discs more affected by mechanical or chemical noxious stimuli associated with disc degeneration or from the actual connection to the disc |
|
Definition
| innervation to lumbar intervertebral discs is more affected by mechanical and chemical noxious stimuli associated with disc degeneration |
|
|
Term
| how are the ventral rami of all spinal nerves connected to the sympathetic trunk |
|
Definition
| through gray rami communicantes and through white rami communicantes |
|
|
Term
| when does a patient need an MRI |
|
Definition
| if they're losing baldder and bowel or if they're a surgical candidate |
|
|
Term
| when might there be abnormal innervation of lumbar intervertebral discs in the form of nerve ingrowths into the nucleus pulposus |
|
Definition
| after damage to the annulus fibrosus |
|
|
Term
| what is supposed to be the purpose of nerve ingrowths into the nucleus pulposus following damage to the annulus fibrosus |
|
Definition
| pain and subsequent immobilization to promote healing |
|
|
Term
| what is the actual result of nerve ingrowths into the nucleus pulposus following damage to the annulus fibrosus and why |
|
Definition
| poor healing in this area results in unproductive nerve ingrowths resulting only in pain. |
|
|
Term
| what prevents further anterior translation in flexion |
|
Definition
|
|
Term
| what part of the disc is compressed in flexion |
|
Definition
|
|
Term
| what are the movements of each segment in flexion |
|
Definition
| anterior rotation and anterior translatio |
|
|
Term
| what does the inferior facet of the superior vertebra do in flexion (what movements) |
|
Definition
| glides up and slightly backwards |
|
|
Term
| does the IV foramen get wider or more narrow in flexion |
|
Definition
|
|
Term
| what is the movement of vertebral bodies in extension |
|
Definition
| posterior sagittal rotation, posterior translation |
|
|
Term
| what is the motion of the inferior facet of the superior vertebra in extension |
|
Definition
|
|
Term
| is the intervertebral foramen widened or narrowed in extension |
|
Definition
|
|
Term
| what is the motion of spinous processes in extension |
|
Definition
|
|
Term
| when does the facet joint become weightbearing |
|
Definition
|
|
Term
| what happens to the disc in axial rotation |
|
Definition
|
|
Term
| with axial rotation to the left, what will happen to the right inferior facet |
|
Definition
| it will impact with the right superior facet of the vertebra below |
|
|
Term
| how much motion in axial rotation occurs before impaction of facets |
|
Definition
|
|
Term
| where is the annulus fibrosus compressed in lateral flexion |
|
Definition
| on the concavity of the curve |
|
|
Term
| where is the annulus fibrosus stretched in lateral flexion |
|
Definition
| on the convexity of the curv |
|
|
Term
| lateral flexion is coupled with what other movement |
|
Definition
|
|
