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Condition/Disorder Synonyms

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  • Low back pain

  • Mechanical low back pain

  • Non-specific low back pain

  • Lumbar sprain

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ICD-9-CM Codes

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  • 724.2 Lumbago

  • 847.2 Lumbar sprain

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ICD-10-CM Codes

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  • M54.5 Low back pain

  • S33.5 Sprain of ligaments of lumbar spine

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Preferred Practice Pattern

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Key Features

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Description

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  • Occurs in up to 80% of population

  • Most episodes are self-limiting

  • Leading cause of disability for people under the age of 45

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Essentials of Diagnosis

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  • Diagnosis made by clinical examination

  • Use of treatment (Impairment) based classification system is useful to determine evidence-based practice treatment plan

  • Reproduction of symptoms in specific postures and activities

  • Rule out disease (red and yellow flags)

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General Considerations

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  • Presentation can vary significantly based on anatomical structures and psychosocial factors

  • Often difficult to determine patho-anatomical cause of pain

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Demographics

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  • Variable based on specific condition

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Clinical Findings

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Signs and Symptoms

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  • Pain in lumbar or sacral area that can be mechanically reproduced

  • Unilateral or bilateral referred or radiating pain in lower extremities possible

  • Altered sensation, motor control, reflexes in the distribution of involved nerve roots indicates nerve-root compression (see lumbar radiculopathy)

  • Pain may centralize or become peripheralized with repeated movement

  • Lumbar segmental hypomobility may be present and indicate instability

  • Often associated with poor core-muscle strength and postural deviations

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Functional Implications

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  • Leading cause of occupational disability

  • May impede ability to perform ADLs/IADLs

  • May impede participation in sports and other social activities

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Possible Contributing Causes

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  • Occupational factors

  • Congenital anomalies

  • Physical condition

  • Smoking

  • Obesity

  • Socio-economic factors

  • Psychosocial and behavioral factors

  • Postural changes

  • Weakness of core musculature

  • Tightness of hip flexors, external rotators, hamstrings

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Differential Diagnosis

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  • Vascular insufficiency

  • Peripheral nerve impairment

  • Hip pathology with radiating pain pattern

  • Malignant spinal tumor or metastasis

  • Referred pain from visceral structures

  • Systematic auto-immune diseases (RA, Reiter's)

  • Ankylosing spondylitis

  • Abdominal aortic aneurism

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Means of Confirmation or Diagnosis

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Imaging

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  • Not necessary in most cases; only with persistent symptoms that do not respond to conservative management or if red/yellow flags are present

  • MRI helpful in diagnosis to visualize compressed or inflamed nerve root/disc pathology

  • X-ray/plain-film radiograph helps to assess alignment, fractures, stability (flexion/extension radiograph)

  • CT to show herniation compressing the spinal canal or nerves or rule out abdominal pathology

  • Electrodiagnostic/nerve conduction testing can help determine specific impaired nerve function

  • Doppler ultrasound to examine vascular function

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Findings and Interpretation

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  • Physical Examination ...

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