Wednesday, December 18, 2019

Lower back pain notes


Here are my quick and dirty notes on Low back pain (LBP) mostly seen in ambulatory medicine! I will not be going into evidence-based medicine (EBM) physical examination (PE) findings but I have put a quick note for conditions you can test on PE so you can look them up.

LBP classification on distribution of pain:
- Axial (pain localized to the low back area)
- Radicular (pain radiating to the lower extremities in a dermatomal distribution with or without accompanying LBP)

Common sources of axial LBP:
- Intervertebral disc
- Facet joint
- Sacroiliac joint
- Paraspinal musculature

Common sources of radicular pain:
- Herniated intervertebral disc
- Spinal stenosis

Discogenic LBP:
- Intervertebral disc is source of pain
- Younger patients
- Worsened by activities that load the spine
- Sitting intolerance
- Improvement of pain with recumbency
- Midline tenderness

Lumbar facet pain:
- Insidious
- Older adults
- Worsened by prolonged standing
- Relieved with sitting or recumbency

Sacroiliac joint pain:
- Worsened during transitional movements, such as rising from a sitting position
- Pain in the gluteal or paraspinal (below the fifth lumbar vertebra)

Paraspinal muscle or ligament strain:
- Hypomobility due to muscle spasm or guarding
- Pain reproduced with palpation of the paraspinal musculature

Herniated Intervertebral Disc:
- Worsened by forward bending, coughing, sneezing, or prolonged sitting
- Improved with recumbency
- Dermatomal pattern of pain

Lumbar Spinal Stenosis:
- Onset or worsening of radicular pain when standing and walking
- Rapid improvement in pain with sitting
- Positive “shopping cart sign” (relief of pain when leaning forward as if pushing a shopping cart)
- Radiation of pain into the buttocks, thighs, and/or legs in the distribution of 1 or more dermatomes

That's all for now!

I am glad you read this post :) LBP is a BORING topic but you will be surprised on how many patients I see in the clinic on a day to day basis with LBP! Knowing about it and making an accurate diagnosis is important.


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