back pathology

Lumbar strain/sprain

Symptoms: sudden low back pain, spasms resulting in increased pain, pain w/ palpitation

ST: imaging tests

Management: PRICE, rehab focused on core strength/trunk stability, stretching as tolerated

Herniated disk

Signs: localized pain, pain with position changes, slow/deliberate gait, may have lateral shift, pain may radiate down leg, possible lumbar lordosis

ST: straight leg raise, slump test, valsalva test, well straight leg raise, Milgram test, lower quarter screen

Management: core and pelvic stabilization rehab, potential need for surgery

Sciatica

Signs; burning/shocking pain that radiates down affected leg, paresthesia, muscle weakness

ST: straight leg raise, bechrerews, milgram

Management: stretching and nerve glides, NSAIDs, ice/heat

Spondylolysis

Signs; localized LBP that increases with activity, aggravated with extension (walking, standing) and relieved with flexion (sitting), extension ROM limited by pain

ST: single leg stance test

Management: test, rehab focused used on pelvic control and resolving muscle tightness, lumbar brace

Spondylolisthesis

Signs; increased pain with extension, patient feels a catch when returning to upright position, pain more intense and constant, step off deformity, severe cases can result in flat butt

ST: single leg stance test

Management: rest, rehab for used in pelvic control and resolving muscle tightness, lumbar brace

Spinal stenosis

Signs; bilateral leg or buttock pain, absence of pain when seated, improvement or symptoms with forward flexion, wide based gait, decreased tolerance for standing or walking

ST: relevant orthopedic or imaging tests

Management: NSAIDs, rehab focused on core strengthening, surgical intervention when life affects

Facet joint dysfunction

Signs; pain with extension, rotation or lateral bending, increased pain with prolonged standing, radiating pain into butt, groin, or thought w/ hamstring tightness

ST: quadrant text

Management: NSAIDs, avoid irritating poster and movement

Sacroiliac joint dysfunction

Signs; referred pain to butt, groin, thighs, pain with palpitation over PSIS and SI joint, pain usually not above L5, may have anterior pain at pubic symphysis, decreased stride length, increased pain with hip abduction

ST: straight leg raise, FABER test, SI compression and distraction

Management: stabilization of lumbopelvic exercises, manual therapy, corticosteroid injections

Ankylosing spondylitis

Signs; hip pain, pain in butt, stiffness in hips/low back, fatigue

ST: imaging tests

Management: rehab focused on mobility of joint and spine, NSAIDs

Cauda equine syndrome

Signs; neurological symptoms radiating down affected leg, bilateral leg pain, absent deep tendon reflexes, possible changes in bowel or bladder function

ST: lower quarter screen

Management: referral to physician, medical emergency

Degenerative disc disease

Signs; pain that radiates down butt, pain worsens when sitting, bending, or lifting, pain can be sharp, aching, stiff, symptoms get worse over time

ST: straight leg, valsalva, well straight leg raise, milgram, lower quarter screen

Management: NSAIDs, steroid injection, rehab, possible surgery

Lumbar radiculopathy

Signs; LBP can be localized to exact nerve, neurological ax travel to butt, groin, hip, down leg, muscle spasms or weakness

ST: straight leg raise, slump test, bechterew

Management: NSAIDs, limit painful activity, rehab focused on stretching and core stability

Muscle imbalance/weak core

Signs; viable difference in muscles, unexplained lumbar spine pain, lordotic curve in LB

ST: imaging, MMT

Management: rehab focused on strengthening core and muscle imbalance corrections

Mechanical LBP

Signs; regional LBP, stiffness and limited ROM, muscle spasms, pain worsens with activity

ST: lower quarter screen

Management: rest and activity modifications, rehab focused on strengthening core, improving posture, and increasing flexibility