MSK 2 - LBP with Flexion Preference

common flexion preference postural syndromes

flatback, swayback, hyperlordosis

pathologies that often present with a flexion preference

spondylolisthesis (unstable), adherent root syndromes, post-surgical sequelae, adverse dural tension

T/F: common MOI of flexion preference is hyperextension

F, no common MOI (often a gradual onset)

typical flexion preference patient presentation

50+ (can vary though), stiff/achy back, radiating features, claudicant behavior (parasthesia/numbness and weakness when standing or walking)

what is spinal stenosis

narrowing of lumbar spinal canal/nerve root canal/intervertebral foramina that produces compression of neural elements

primary lumbar stenosis etiology

idiopathic narrowing, achondroplasia (dwarfism)

secondary lumbar stenosis etiolog

degeneration, post operative change, fracture, tumor, systemic diseases (paget's disease)

what can occur to cause degenerative lumbar stenosis

facet joint arthrosis, ligamentum flavum thickening, disc bulging, spondy

T1 MRI

time between pulses: ___

distinguishes ___ from ___

soft tissue appears ___

better for seeing

short

fat; CSF

grey

soft tissue, fat vs fluid

T2 MRI

time between pulses: ____

supresses ___

muscle injury appears ___ due to high ___

better for seeing ___

long

fat

bright

water content

discs/muscle injury

what runs through the spinal canal

spinal cord

what runs through intervertebral foramen

peripheral nerves

11-20% decrease in cross sectional area occurs with what motion?

extension and compression

decreases in structural cross sectional area with progressive stenosis result in ___

decreases in dynamic cross sectional area

grade 0 stenosis

no stenosis

grade 1 lumbar stenosis

mild stenosis

mild narrowing (<1/3)

cauda equina clearly separated from each other

grade 2 lumbar stenosis

moderate stenosis

moderate narrowing (1/3-2/3)

some cauda equina aggregation

grade 3 lumbar stenosis

severe stenosis

severe narrowing (>2/3)

compression of dural sac

cauda equina appears as 1 bundle

why is surgical intervention variable

geography (higher rates in urban settings), high complication/morbidity rates

non-surgical interventions for lumbar stenosis

stationary bike

lumbar flexion exercises

strengthening

stretching

manual therapy

patient education

LE strengthening (specifically hips)

non surgical intervention resulted in ___ improvement in disability

65%

why might unloaded treadmill walking have positive results with stenosis patients?

get some distraction of spine, less compression from gravity