Low Back Pain and Young Athletes: Difference between revisions
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=== Neurological exam === | === Neurological exam === | ||
A neurological exam should include trunk and lower limb sensation<span style="line-height: 19.9200000762939px;">, </span><span style="line-height: 1.5em;">strength, proprioception and deep tendon reflexes to investigate whether there is any neural involvement in the low back pain.</span> | A neurological exam should include trunk and lower limb sensation<span style="line-height: 19.9200000762939px;">, </span><span style="line-height: 1.5em;">strength, proprioception and deep tendon reflexes to investigate whether there is any neural involvement in the low back pain.</span> | ||
<u><span style="line-height: 19.9200000762939px;">Dermatomes</span></u> | <u><span style="line-height: 19.9200000762939px;">Dermatomes</span></u> | ||
(IMAGE) | |||
<u>Myotomes</u> | |||
<u></u>(IMAGE) | <u></u>(IMAGE) | ||
<u>Deep tendon reflex tests</u> | |||
Patellar (L2, 3, 4), | Patellar (L2, 3, 4), | ||
Achilles (S1)<br><br> | Achilles (S1)<br><br> | ||
.(IMAGE) or (VIDEO)<br> | .(IMAGE) or (VIDEO)<br> |
Revision as of 17:35, 11 January 2015
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Introduction[edit | edit source]
8) Taking Part 2013/14 Annual Child Report
Low back pain (LBP) occurs in approximately 10% to 15% of young athletes (d’Hemecourt, Gerbino and Micheli, 2000). Schmidt et al 2014 found that competitive adolescent athletes compared to aged matched individuals have increased prevalence of back pain
Epidemiology
[edit | edit source]
Growth and Development of the Spine[edit | edit source]
Risk Factors[edit | edit source]
Prevention[edit | edit source]
Assessment[edit | edit source]
Subjective assessment[edit | edit source]
There is usually poorly localized lumbar pain without any associated neurologic symptoms.
Specific area of pain and neurologic symptoms are more likely to show an underlying pathology.
Knowing the onset of symptoms can help distinguish between acute or chronic overuse injury, and postural and developmental abnormalities.
The clinical history of a patient should include an in depth description of:
Specific questions | |
Pain |
Location |
Trauma | Repetitive/overuse microtrauma Acute macrotrauma Specific movement of trauma Body positioning in trauma |
Mechanical symptoms | Is the pain worse on movement? What specific movement? Does the pain cease during rest? |
Inflammatory symptoms | Is there any morning stiffness? Does it get better with movement? |
Neurological symptoms | Radiculopathy Pins and needles Bowel or bladder dysfunction Weakness |
Systemic symptoms | Does the patient have a fever, night sweats or recent weight loss? |
Gait | Does the patient suffer from foot drop |
Previous Treatments | Has the patient had previous treatment for the same or similar condition? Was the treatment successful? |
Lifestyle | Does the pain have any effect on their psychosocial well-being? Does it interfere with school or interests? |
Past Medical History | Does the patient suffer from any medical conditions such neurological disorders, scoliosis, malignancy, osteoporosis, chronic inflammatory joint disease or has any treatment of immunosuppressive agents? Has the patient had any previous injury or surgery? |
Family History |
Is there any of family history of orthopaedic, rheumatic or neurologic conditions? |
Objective assessment[edit | edit source]
Observation[edit | edit source]
Observation begins as soons as you see the patient. The examiner should observe the patients gait and posture as they walk in and note down any abnormalities. To observe the patients posture in more detail it is best appreciated if the examiner is able to see specific bony land marks and areas on the patients back.
Standing Posture
Anterior/Posterior view
- Both Shoulders should be level
- Both anterior superior iliac spines (ASIS) and posterior superior iliac spines should be level
- Symmetry of soft tissue and bony landmarks either side of the midline
Lateral view
- Foot arch cavus/planus?
- There should be a gentle cervical lordosis, thoracic kyphosis and lumbar lordosis (excess lumbar lordosis may be caused by weak abdominal muscles or a hip flexion contracture)
Palpation[edit | edit source]
(IMAGES)
[edit | edit source]
Range of movement[edit | edit source]
To test active movements of the thoracolumbar spine patients need to be in a standing position with their pelvis stabilised. Here some examples how to measure the range movement in the thoracolumbar spine (IMAGES)
Flexion
Ask the patient to bend forward and try to touch their toes with their knees straight (measure the distance from their fingertips to the floor).
Extension
Ask the patient to bend as far backward as possible with knees straight, whilst supporting their lumbar spine (measure the degrees of movement).
Lateral flexion
Ask the patient to bend as far to the side as possible (the patient should be able to touch their fibular head).
Lateral rotation
As well as stabilising the pelvis, place a hand on the opposite shoulder to prevent compensatory movements. Ask the patient to rotate their trunk as far as possible (measure the degrees of movement).
Flexibility[edit | edit source]
The patients back and hip range of movement should be measured passively and activiely. By the measuring the patients popliteal angle it determines their hamstring flexibility.[edit | edit source]
Strength[edit | edit source]
The patients core and lower limb strength should be examined. Lower limb strength can be measured using the MRC scale.
Neurological exam[edit | edit source]
A neurological exam should include trunk and lower limb sensation, strength, proprioception and deep tendon reflexes to investigate whether there is any neural involvement in the low back pain.
Dermatomes
(IMAGE)
Myotomes
(IMAGE)
Deep tendon reflex tests
Patellar (L2, 3, 4),
Achilles (S1)
.(IMAGE) or (VIDEO)
Pain and proprioception.[edit | edit source]
Special tests[edit | edit source]
- Scoliosis test (Adams Forward Bend Test)
- Modified Schober’s test
- Straight leg raise
- FABER or Patrick test
- Trendelenburg Test
- (LINKS)
Abdominal, pelvic and hip exam[edit | edit source]
Back pain can be referred from abdomen, pelvic or hip pathologies and injuries, so it is important to rule out all of these before carrying on with any treatment.
[abdomen and pelvis pathology may refer pain to the back]
Investigations[edit | edit source]
Laboratory tests are necessary in evaluating patients with back pain and a high suspicion of infection or systemic disease. CBC, ESR or CRP, blood and joint cultures should be done if infection is suspected. Arthritis is a clinical diagnosis; ANA, rheumatoid factor and
HLA-B27 are helpful in classification and treatment but not diagnosis. CBC, peripheral smear should be done if hematological malignancy is suspected.
Imaging
Radiographs
Standard thoracolumbar views include the standing
anteroposterior (AP) and lateral projections.
Technetium bone scan
Bone scan identifies areas of increased osteoblastic activity
and can help localize subtle areas of bone injury that
may not be visible on radiographs. SPECT (singlephoton
emission computed tomography) is recommended
for imaging the spine in patients who have
negative radiographs and no neurological findings.
SPECT is especially useful in identifying stress fractures
and spondylolysis [8].
Computed (CT)
CT provides additional bony and cartilage detail. CT is
useful in further characterizing lesions identified on
bone scan, including fractures, spondylolysis and tumors
[11].
Magnetic resonance imaging (MRI)
MRI provides increased soft tissue contrast allowing
evaluation of the spinal cord and paraspinal structures.
MRI is useful in the diagnosis of back pain with neurologic
findings but anatomic localization on clinical exam
is necessary to increase the specificity of imaging.
[edit | edit source]
Specific Conditions[edit | edit source]
Spondylolysis and Spondylolisthesis[edit | edit source]
Links to relevant Physiopedia pages:
http://www.physio-pedia.com/Spondylolysis
http://www.physio-pedia.com/Lumbosacral_spondylolysis
Posterior Element Overuse Syndrome[edit | edit source]
Vertebral Body Apophyseal Avulsion Fracture[edit | edit source]
Disc Herniation[edit | edit source]
Scheuermann's Kyphosis[edit | edit source]
Link to relevant physiopedia page: