LOW BACK PAIN

1
LOW BACK PAIN

• Arnold E. Cuenca
• MS-III
• Western University of Health Sciences
• College of Osteopathic Medicine of the Pacific

2
DIFFERENTIAL DIAGNOSIS

• Musculoskeletal
• Musculoligamentous injury
• Herniated disk
• Spinal stenosis
• Vertebral compression fracture
• Spondylosis/spondylolisthesis
• Systemic
• Malignancy
• Vertebral osteomyelitis
• Epidural abscess
• spondyloarthropathy
• Referred Pain
• Pyelonephritis
• prostatitis

3
IS IT REAL?

• Waddells Tests (3 or more suggests psychosocial
  issues)
• Tenderness superficial, nonanatomic tenderness
  to light touch
• Axial loading vertical loading on a standing
  pt.s skull producing LBP
• Rotation passive rotation of shoulders and
  pelvis in same plane producing LBP (standing)
• Distraction discrepancy between sitting and
  supine straight leg raising
• Weakness cogwheel (give-way) weakness
• Sensory nondermatomal sensory loss
• Overreaction disproportionate facial expression,
  verbalization, or tremor during examination

4
RED FLAGS

• History
• Cancer, Unexplained weight loss, Steroid use
• Bladder/Bowel incontinence
• Urinary retention
• Physical Examination
• Saddle anesthesia
• Fever
• Major motor weakness in LE
• Lab Tests
• CBC, ESR, HLA-B27, serum electrophoresis, U/A
• Radiography
• X-ray, CT, MRI

5
Physical Examination

• Gait
• Motor tests
• Sensation
• DTR
• T.A.R.T (acute v. chronic)
• Tenderness
• Asymmetry
• Restriction/R.O.M
• Tissue texture changes

6
Blueprints in Medicine, 2nd edition-2001
7
ADDITIONAL TESTS

• Thomas Test
• Iliopsoas syndrome
• Straight Leg Raise Test
• Hamstring tightness
• Bragard Stretch Test
• sciatica
• Heel-Toe Walk/Squat and Rise Test
• Cauda equina syndrome/neurologic compromise
• Piriformis Tenderness
• Piriformis syndrome
• Femoral Stretch Test
• L1-L4 nerve root irritation

8
Radiographic Evaluation

• According to the American Academy of Family
  Physicians
• plain radiographs are not recommended for the
  routine evaluation of acute low back pain within
  the first month unless a finding from the history
  and clinical examination raises concern
• This is because most people with acute LBP have
  resolution of symptoms between 2-6 weeks

9
Treatment Strategies

• NSAIDs
• acetaminophen
• Bed rest for 1-3 days
• Muscle relaxants
• Physical therapy
• Stretching/strengthening exercises
• Osteopathic manipulation

10
Osteopathic Manipulation Muscle Energy
Techniques

• Hamstring Muscle Energy
• Quadratus Lumborum Muscle Energy
• Piriformis Muscle Energy
• Psoas Muscle Energy

11
Stretching Exercises

• Stretching Exercises
• Iliopsoas stretch
• Quadratus Lumborum stretch
• Hamstring stretch
• Piriformis stretch

12
Strengthening Exercises

• Strengthening Exercises
• Wall slides
• Leg raises
• Sit-ups
• Leg swings