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  • Low back pain
  • Mechanical low back pain
  • Non-specific low back pain
  • Lumbar sprain

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  • 724.2 Lumbago
  • 847.2 Lumbar sprain

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  • M54.5 Low back pain
  • S33.5 Sprain of ligaments of lumbar spine

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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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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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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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