Lumbar spine pain, discogenic pain, SI joint, neurogenic pain, spinal stenosis

True or false: nociceptive referred pain comes from the nerves

false: it comes from various spinal structures but NOT the nerves

What are the pain generators of nociceptive referred pain?

muscles, ligaments, facet joints, SI joint, annulus fibrosus, thoracolumbar fascia, vertebrae

How would you define lumbar spine pain?

pain localized below the costal margin and above the gluteal folds with or without pain

What are some contractile tissue impairments?

atrophy, reduced activity with movement, decreased muscle strength, increased fatiguability, increase in fast twitch glycolytic fibers

What are some non-contractile tissue impairments?

facet joint pain, ligament trauma/overload, bone pain, SI pain

What is retrolisthesis?

backward displacement of one vertebrae on another

What are some degenerative changes that occur to the spine?

foraminal stenosis, central canal stenosis, facet joint degeneration, osteophytes

What is discogenic pain?

pain caused by the intervertebral discs due to degeneration, trauma, osteoporosis

True or false: discogenic pain can lead to neurogenic pain

true: discogenic pain can cause nerve root irritation

Where are nociceptive nerve fibers located?

outermost 1/3 of annulus fibrosus

What is a protrusion?

contained herniation where material bulges outward but does not escape annulus fibrosus

True or false: protrusions are common in asymptomatic people

true: extrusions and sequestrations are NOT common on MRIs

What is a prolapse?

when the outermost fibers of the annulus fibrosus contain the nucleus

What is extrusion?

when the annulus fibrosus is torn and discal material moves into the epidural space

What type of discogenic pain usually results in radicular pain?

extrusion due to material moving into the epidural space where the nerves are

What is sequestration?

nuclear material unattached and escapes contact with the disc entirely

For which type of discogenic pain is resorption most likely to occur?

extrusion or sequestration as it get reabsorbed

What are Schmorl’s Nodes?

upward and downward protrusion of spinal disc soft tissue into the bony tissue of adjacent vertebrae endplate

True or false: Schmorl’s nodes are a common radiographic finding

true

What is a discogenic pain presentation?

typically occurs between ages 15-50, aggravated by flexion based events but better with extension, pain radiates below the knee, centralization

What typically causes SI joint nociception?

trauma (spondyloarthropathy, falls, pregnancy)

What is another name for SI joint nociception when it is pregnancy related?

pelvic girdle pain sydrome

Why does SI joint nociception/pelvic girdle pain syndrome occur in pregnant/postpartum individuals?

hormonal changes affect the laxity of SI ligaments, which affects their ability to transfer loadsWha

What are some risk factors for pregnancy related SI joint pain?

BMI >25 before pregnancy, LBP before pregnancy, depression, belief that LBP will remain, heavy workload

What is the typical patient presentation for SI joint pain?

female younger than 40, sx located between posterior iliac crest & gluteal fold, pain aggravated by standing, walking, sitting

How can we treat SI joint pain?

exercise (core stabilization, but any exercise is great), education, overall symptom modulation

What is SI joint movement dysfunction?

SI related joint pain of unknown origin

True or false: Si joint pain is result of too little or too much movement, or an altered position of the sacrum

false: this is not scientifically backed and should not be told to patients

If the historical “causes” of SI joint pain are not true, then why does pain relief occur with its treatments?

pain relief is from neurophysiological effects

True or false: SI joint pain typically occurs with paresthesia, numbness, and tingling

false: these are usually not present

How can you determine if someone has SI joint related pain?

diagnosis by exclusion by screening the lumbar spine and hip first

True or false: leg pain is typically greater than LBP with neurogenic back pain

true: when the spinal nerve root is actively irritated it will reproduce sciatica

What can cause LBP with leg symptoms?

somatic referred pain, radicular pain, radiculopathy

True or false: patients with radicular pain/pathy experience milder pain and better outcomes

false: they experience MORE severe pain, greater disability, and worse outcomes

True or false: radicular pain causes changes in myotomes, dermatomes, and reflexes

false: radicular pain does not cause neurological changes, radiculopathy does

Is sciatic a diagnosis? why or why not

sciatica is considered a symptom that refers to back-related leg pain with radicular pain or radiculopathy

If the L4/L5 disc herniates, which root is involved?

L5 because lumbar roots emerge below the vertebrae

What structures lead to peripheral neurogenic pain?

dural sheath/meninges, dorsal root ganglion, nerve root, peripheral nerve

Where is lumbar spinal stenosis most common?

L4/L5

What causes the neurological symptoms in lumbar spinal stenosis?

ischemia of nerve roots due to compression and chemical irritation

True or false: lumbar stenosis affecting the peripheral nerve root results in bilateral symptoms

false: results in unilateral symptoms

What does neurogenic claudication look like?

increased pain with extension, improvement with flexion

When lumbar stenosis affects the central nerve structures, what are the symptoms?

bilateral leg symptoms: legs feel fatigued, heavy, weak, aching

How does the liklihood of lumbar spinal stenosis increase?

bilateral symptoms, leg pain > back pain, pain w/ walking/standing, pain relief w/ sitting, age >48