Ortho - Lumbar

lumbar facet presentation

LBP

• usually one side but can be both

• pain can be sharp or dull, often worse with certain movements (bending/extension)

stiffness/limited mobility

• ROM reduced, flexion/extension or twisting

• pain may be worse in morning or after inactivity

radiating pain

• can radiate to buttock/thigh but usually not past knees to differ from sciatica

aggravation’s

• prolonged sitting or standing

• relief is usually changing positions

• physical activity, running/bending

spinal instability

• may feel back locks

• sensation of weakness/loss of control

muscle spasms

• muscles around facet tighten to compensate

causes of Lx facet px

• chronic poor posture

• degenerative changes

• trauma or injury

• repetitive movements

lumbar facet joint prov tests

Kemps/standing Kemps

lumbar nerve root tension

Localised LBP

• can start in low back but usually radiates down the leg

• often described as deep aching pain in back

dermatomal pattern

• follows path of nerve root, changing the distribution described as sharp, burning, pins and needles

• weakness in affected leg

• numbness and tingling

• diminished reflexes

pain worse with movements

• extension may inc symptoms while flexion may relieve them is caused by foraminal stenosis

• coughing/sneezing- valsalva movements

common causes

• herniated disc

• spinal stenosis

• degenerative disc disease

• spondylolthesis

• bony spurs

• trauma/injury

lumbar nerve root testing

SLR = 0-30 (hip), 30-70 (sciatic)

leagues = hip flexion with SLR then extend the knee

well leg raise = SLR on asymptomatic leg if pain on other leg +ve

lumbar - piriformis syndrome

buttock pain

• deep aching pain in buttock, sometimes sharp/throbbing

• often worse with sitting or after activity

radiating leg pain

• pain travels down back of thigh, calf and sometimes foot

• electric shock, burning/tingling sensation

pain with sitting

• sitting long time, especially on hard surfaces

• getting up after sitting often makes pain worse

pain with hip rotation

• twisting/rotating hip can trigger pain

• climbing stairs/squatting aggravate

weakness

• severe cases may cause leg to feel weak

causes

• tight or spasms in piriformis

• injury/trauma to hip/buttock

• sitting too long/poor posture

• overuse of hip muscles

• anatomical variations

• structural issues

piriformis syndrome testing

Bonnets = after +ve SLR lower leg then add IR/ADD

FAIR = side lying, max flex, adduct and internal rotate leg

lumbar - neurodynamic tension

occurs when lumbar spine nerves stretched or compressed usually from irritation/pressure on nerve roots

general nerve symptoms

• radiations

• numbness/tingling

• muscle weakness

• pain changing positions

causes

• herniated disc/spinal stenosis

• nerve irritation - muscle tightness, scar tissue, inflammation

• poor posture

• overuse or repetitive movements

neurodynamic tension testing

slumps = patient slumped, bring foot to dorsi flex and flex neck downward

TED = eversion + dorsi flex of foot with flex of hip

PERONEAL = inv + plantar flex or foot with flex of hip

SURAL = inv + dorsi flexion with flex of hip

lumbar - stenosis/provocation

is when space in spinal canal is narrowed putting pressure on nerve roots that exit spine

LBP

• often dull, achy or sharp worse with activity or long periods of standing/walking

leg (neurogenic claudication)

• pain, numb or weakness in leg which gets worse with walking or standing, pain feels cramping, heaviness or aching in legs

relief with sitting or leaning forward

• improves when sitting down or flexing spine

numb/tingling

• in legs especially when walking

difficulty walking (neurogenic claudication)

• trouble walking long distance because pain, cramping or weak in legs builds with activity, often relieved by bending forward/sitting

causes

• degen disc disease

• bony spurs

lumbar stenosis/prov testing

pheasants = patient prone, passive knee flexion, palpate lumbar to see for lordosis, hold for 30seconds or till pain

H pheasants = same test but add Achilles reflex

shear prov test = patient edge of bench, palpate SP then patient lifts legs off floor and palp again, +ve is pain on rest