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Questions and Answers
What is the definition of low back pain?
What is radicular syndrome?
What is a red flag for low back pain?
What is the estimated sensitivity of the sacroiliac joint pain tests?
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What is the percentage of patients with low back pain who have discogenic pain?
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What is centralization of symptoms?
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What is the name of the test that suggests sacroiliac joint pain when 3 or more of 6 positive tests are present?
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What is the definition of neuropathic pain?
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Which of the following is a characteristic of mechanical low back pain?
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What is a key feature of discogenic pain?
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Which of the following is NOT a red flag for low back pain?
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What is the significance of centralization of symptoms in low back pain?
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Which of the following tests is used to suggest sacroiliac joint pain?
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What is the estimated specificity of the sacroiliac joint pain tests?
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Which of the following is a characteristic of radicular syndrome?
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What is the significance of nerve roots disorders in low back pain?
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What is a characteristic of myofascial pain?
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What is the result of clinical instability in the spine?
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Which of the following is associated with functional instability?
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What is the purpose of the positive passive lumbar extension test?
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What is the result of centralization in low back pain?
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What is a contributing factor to other sources of low back pain or a primary cause by itself?
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What is the definition of clinical instability?
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What type of pain is characterized by the presence of trigger points?
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What is the purpose of the positive passive lumbar extension test?
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What is associated with an increase in the size of the neutral zone?
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Study Notes
Low Back Pain
- Pain and discomfort localized below the costal margins and above the inferior gluteal folds, with or without referred leg pain.
Global Diagnostic Triage (International Guidelines)
- Serious pathology (red flags) prioritized over radicular syndrome and non-specific/mechanical low back pain.
Non-Specific/Mechanical Low Back Pain
- Not attributable to a objectively recognizable, known specific pathology (e.g., infection, tumor, osteoporosis).
- Different underlying causes, including:
- Myofascial
- Discogenic
- Sacroiliac
Red Flags
Spinal Fractures
- Major trauma
- Osteoporotic fracture
- Osteoporosis
Cancer
- History of cancer
- Multiple cancer risk factors
- Strong clinical suspicion
Infection
- Immunocompromised status
- Urinary tract infection
- Intravenous drug use
Neurophatic Pain
- Pain arising from injury or disease directly affecting the nerve roots that innervate the spine and lower limbs.
- No gold-standard approach for diagnosis.
- Distribution of pain and associated sensory or motor signs, including:
- Sensory loss
- Hyperalgesia, allodynia
- Weakness
- Numbness, tingling, electricity type pain
Nerve Roots Disorders
- Dorsal flexion worsens pain, plantar flexion makes it better.
- Flexion of head worsens pain, extension relieves it.
Mechanical Low Back Pain
- Sacroiliac joint pain suggested when 3 or more of 6 positive tests (Gaenslen's left and right, thigh thrust, sacral thrust, distraction, and iliac compression).
- Estimated sensitivity of 93.8%, specificity of 78.1%.
- Discogenic pain:
- 26%-42% of patients with low back pain
- Annular disruption and inflammatory response
- Centralization of symptoms: progressive resolution, reduction, or retreat of pain toward midline
Low Back Pain
- Pain and discomfort localized below the costal margins and above the inferior gluteal folds, with or without referred leg pain.
Global Diagnostic Triage (International Guidelines)
- Serious pathology (red flags) prioritized over radicular syndrome and non-specific/mechanical low back pain.
Non-Specific/Mechanical Low Back Pain
- Not attributable to a objectively recognizable, known specific pathology (e.g., infection, tumor, osteoporosis).
- Different underlying causes, including:
- Myofascial
- Discogenic
- Sacroiliac
Red Flags
Spinal Fractures
- Major trauma
- Osteoporotic fracture
- Osteoporosis
Cancer
- History of cancer
- Multiple cancer risk factors
- Strong clinical suspicion
Infection
- Immunocompromised status
- Urinary tract infection
- Intravenous drug use
Neurophatic Pain
- Pain arising from injury or disease directly affecting the nerve roots that innervate the spine and lower limbs.
- No gold-standard approach for diagnosis.
- Distribution of pain and associated sensory or motor signs, including:
- Sensory loss
- Hyperalgesia, allodynia
- Weakness
- Numbness, tingling, electricity type pain
Nerve Roots Disorders
- Dorsal flexion worsens pain, plantar flexion makes it better.
- Flexion of head worsens pain, extension relieves it.
Mechanical Low Back Pain
- Sacroiliac joint pain suggested when 3 or more of 6 positive tests (Gaenslen's left and right, thigh thrust, sacral thrust, distraction, and iliac compression).
- Estimated sensitivity of 93.8%, specificity of 78.1%.
- Discogenic pain:
- 26%-42% of patients with low back pain
- Annular disruption and inflammatory response
- Centralization of symptoms: progressive resolution, reduction, or retreat of pain toward midline
Centralization
- Defined as the phenomenon where a movement or position leads to the abolition of pain or the migration of symptoms from a more distal or lateral area in the buttocks and lower extremity to a more proximal location near the midline of the lumbar spine.
- Indicates a good prognosis.
Myofascial Pain
- Can be a contributing factor to other sources of low back pain (LBP) or a primary cause in itself.
- No gold standard for evaluating myofascial pain.
- Characterized by the presence of trigger points.
Lumbopelvic Instability
- Results from dysfunction in one or more of the stabilizing subsystems, leading to an increase in the size of the neutral zone.
- Comprises three subsystems:
- Passive subsystem
- Active subsystem
- Clinical instability is defined as the clinical signs and symptoms created by dysfunction of one or more of the stabilizing subsystems of the spine.
Functional Instability
- Associated with altered intervertebral discs and ligamentous support of the spine.
- Can be identified using the positive passive lumbar extension test (also known as the Prone instability test).
Centralization
- Defined as the phenomenon where a movement or position leads to the abolition of pain or the migration of symptoms from a more distal or lateral area in the buttocks and lower extremity to a more proximal location near the midline of the lumbar spine.
- Indicates a good prognosis.
Myofascial Pain
- Can be a contributing factor to other sources of low back pain (LBP) or a primary cause in itself.
- No gold standard for evaluating myofascial pain.
- Characterized by the presence of trigger points.
Lumbopelvic Instability
- Results from dysfunction in one or more of the stabilizing subsystems, leading to an increase in the size of the neutral zone.
- Comprises three subsystems:
- Passive subsystem
- Active subsystem
- Clinical instability is defined as the clinical signs and symptoms created by dysfunction of one or more of the stabilizing subsystems of the spine.
Functional Instability
- Associated with altered intervertebral discs and ligamentous support of the spine.
- Can be identified using the positive passive lumbar extension test (also known as the Prone instability test).
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Description
This quiz assesses knowledge of the dorso-lumbar spine and low back pain, including global diagnostic triage, serious pathology, and mechanical low back pain.
