Mind map

Lower Back

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Lower Back

Anatomy
- Bones
  - Atlas
  - Cervical
  - Thoracic
  - Lumbar
  - Sacrum
- Muscles
  - Erector Spinae
    - Spinalis
    - Longismuss
    - Iliocostalis
- Ligaments
  - Post. long. ligament
  - Ant. long. ligament
  - Supraspinous ligament
  - Interspinous ligament
  - Ligamentum flavum
  - Intertransverse ligament
- Joints
  - Facet Joint
  - Atlanto Occipital Joint
  - Atlanto Axial Joint
Movements of the back
Curvatures of the back
- Abnormal Spine Curvature
  - Scoliosis
    - Scoliosis is a disorder in which there is an abnormal curving of the spine.
    - Causes
      - Idiopathic
      - Congenital
      - Neuromuscular
      - Injury
    - Clinical Presentation
      - Backache or low-back pain.
      - Tired feeling in the spine after sitting or standing for a long time.
      - Spine curves more to one side
      - One shoulder blade that appears more prominent than the other.
    - Treatment
      - Brace
      - Surgery
Dermatomes
Referred Pain
- Radiating Pain
  - starts in one place but travels to another, usually along the path of a nerve.
- referred pain tends to be pain that is less focal and contained to a general area, an area usually close to the source of the pain.
  - Dermatomal Rule
  - Convergence Rule
Pain of the Lower Back
- lumbar strain
- disc herniation
- Lumbar radiculopathy
- nerve irritation
- Joint and bones problems
Physical Exam
- inspection
  - posture
  - Swelling
  - skin
    - trauma
    - discoloration
  - wasting
- Tests
  - Straight leg test
  - Crossed SLRT
VAS
Sciatica
- Sciatica is pain in the lower extremity resulting from irritation of the sciatic nerve
- Causes
  - Herniated disc
  - Stenosis
  - Tumor
- Clinical Presentation
  - Shooting pain from the lower back
  - mild soreness to a sharp pain
Management
- Prevention
- Stretching and exercise
- Take a break
- Bed rest
- Surgery
  - Indications of surgery
    - herniated disk
    - Symptoms are getting worse
    - Significant muscle weakness
    - neurological deficit
    - Bowel or bladder dysfunction
- NSAIDs
- Physiotherapy
  - The Schroth Method
- Epidural
  - Epidural anesthesia can be used as a sole anesthetic for procedures involving the lower limbs, pelvis, perineum and lower abdomen
  - Space between L3 and L4 is ideal for performing lumbar puncture and epidural
  - Efficiency for lower back pain
    - Temp. relief before surgery
    - Temp. relief to start exercise
- Spinal manipulation
  - Practiced using hands or special devices to apply a controlled force to a joint of the spine