Low Back Pain & Pathology + Physio

a. Disc Pathologies

Discogenic Lower Back Pain

  • Pain arising from the intervertebral discs (annulus) or surrounding structures (nerve roots) of the lower back

It presents like this:

  • Often people will attribute the problem to a single episode à “my back went out when I bent over to tie my shoelaces”
  • Severe pain and/or pins and needles and/or numbness in the lower back, gluteal region or leg may develop quite quickly or progress over several hours true radiculopathy (nerve root impingement) will have worse symptoms (particularly weakness) in the leg and often no major pain in the back

It feels like this at rest:

  • Pain and symptoms are most often aggravated by sitting and bending
  • Muscle spasm often makes movement difficult and people may adopt a position of compensation to try and avoid increasing symptoms

 


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b. Facet Joint Arthropathy

Facet Joint Arthropathy

  • Pain arising from the facet joint(s) of the lower back

It presents like this:

  • Often a history of localised pain at one or more of the facet joints, unilateral or bilateral symptoms.
  • Reproduction of symptoms often in extension, rotation, side flexion, or a combination of these positions.

It feels like this at rest:

  • Pain and symptoms are most often aggravated by twisting, bending or extending
  • Muscle spasm often makes movement difficult and people may adopt a position of compensation to try and avoid increasing symptoms

 


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c. Radiculopathy

Radiculopathy

It presents like this to us:

  • Radiculopathy present with symptoms associated with impairment of the nerve, these are pain (known as radicular pain), weakness in the affected limbs, changes in sensation (numbness/paraesthesia) and difficulty in controlling specific muscles.

It feels like this at rest and sport to you:

  • You most commonly will pain numbness or pins and needles in one or both your legs depending on the nerve that is affected.
  • You may also have localised lower back pain however sometimes leg symptoms can exist without lower back symptoms

We look for this in the assessment

  • The physiotherapist will be performing a neurological exam which includes testing reflexes, strength and sensation to confirm a diagnosis of radiculopathy. Neurological exams are  also beneficial to isolate which nerve root is being affected.
  • They will assess your movement and movement patterns to look for what movements increase your symptoms and if there is any movements or positions which help with the symptoms.
  • The therapist will perform a hands-on assessment assessing your specific joints to see which joints are being affected and what these joints are doing in comparison to surrounding.

 


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d. Stress Fracture Pars Interarticularis & Spondylolisthesis

Stress Fracture at Pars Interarticularis & Spondylolisthesis

  • Pars Interarticularis fracture is a defect through the vertebrae in the area where the vertebrae adjoin the adjacent vertebrae. This area is known as the ‘pars.’
  • Spondylolisthesis is when this fracture separates and we see a shift of the vertebra on the level below it.

It presents like this to us:

  • Stress fractures or spondylolisthesis may be acute (occur with a particular time and mechanism) such as an extension injury (arching at the lower back)
  • However more commonly they occur over a period of time with repeated extended movements combined with rotation. (think fast bowlers in cricket or landing after jumping from a height)
  • This repetitive load or specific movement creates a change in the pars area.

It feels like this at rest and sport to you:

  • Pain and stiffness in the lower back which limits activities.
  • Pain with movement in particular when extending (arching) your back.
  • You may get pain with activity and sport which decreases with rest.
  • You may experience muscle spasm and weakness around the area of pain.

 


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