Lumbago

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

• 724.2 Lumbago
• 847.2 Lumbar sprain

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

• 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated With Spinal Disorders1

Description

• Occurs in up to 80% of population
• Most episodes are self-limiting
• Leading cause of disability for people under the age of 45

Essentials of Diagnosis

• 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)

General Considerations

• Presentation can vary significantly based on anatomical structures and psychosocial factors
• Often difficult to determine patho-anatomical cause of pain

Demographics

• Variable based on specific condition

Signs and Symptoms

• 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

Functional Implications

• Leading cause of occupational disability
• May impede ability to perform ADLs/IADLs
• May impede participation in sports and other social activities

Possible Contributing Causes

• 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

Differential Diagnosis

• 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

Imaging

• 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

• Physical Examination
  • Algorithm for examination of the lumbar spine
  • Passive physiological intervertebral mobility testing (PPIVM)
  • Lower extremity screening exam
  • Postural examination
  • Muscle length testing, including hamstrings, hip flexors, calf muscles
  • Quadrant test
  • Straight leg raise test
  • Slump test
  • Lower limb nerve tension ...