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Back Assessment

Learn about the structure, functions, and common problems of the spine, including back pain causes, evaluations, classifications, and relevant conditions like spondylolisthesis and ligament disorders. Explore biomechanics, assessment techniques, and McKenzie classification.

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Back Assessment

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  1. Back Assessment BY Alaa Balbaa Ph.D., PT

  2. THE SPINE 1.The number of the vertebrae are about 32 (-/+ 1). Between them there are 23 intervertebral discs (since there isn’t disc in every vertebral level. For example the four coccygeal vertebrae have no discs, also no disc between occiput and atlas, atlas and axis. 2-there are 4 normal (anterio-posterior) curves (2 lordotic, 2 kyphotic), the 2 lordotic curves are more mobile which makes them more susceptible to injury.

  3. What are the main functions of the spine ? 1-Stability 2-Flexibility 3-Protection THE SPINE

  4. LBP: STATISTICS OF THEPROBLEM 80% population suffer from at least one attack of LBP in their lifetime. Second problem after heart diseases. 5th reason for hospitalization. 3rd reason for surgical intervention. Direct medical costs of spinal disorders was $27 billion (1997) in USA LBP represents 25% of all lost workdays in USA.

  5. Biomechanics

  6. Fryett's laws of spinal motion 1st law In neutral position (in the lumbar and thoracic segments) When you make side bending, it is associated with rotation in the opposite direction.

  7. Fryett's laws of spinal motion 2nd law During flexion or extension side bending is associated with rotation toward the same direction. 3rd law If there is movement in one plane, there will be limitation in all other planes.

  8. BACK PAIN Sources of back pain : 1- Muscle 2- Ligament 3- Bone 4- Facet joint 5- Inter vertebral disc 6- Vascular 7- Fascia 8- Gluteal fat

  9. Causes of back pain 1- Bad habits 2- Deformity 3- Trauma 4- Pregnancy 5- occupation 6- Obesity 7- Hyper-mobility 8- Hypo-mobility

  10. Causes of back pain 9- Muscle weakness or tightness 10- Stress 11- Poor posture 12- Smoking 13- Infection 14- Psychogenic 15-Lack of exercise

  11. Causes of back pain 16- Chronic constipation 17- Diseases of the spine 18- Metabolic disorder 19- Pain of related area 20- Poor general health

  12. Examination of the spine • The purpose of examination is to correctly identifies those patients who will benefit from a physical therapy intervention.

  13. Spinal Assessment should include • Age • History of malignant disease • Unexplained weight loss • Duration of symptoms • Responsiveness to previous therapy • Pain that is worse at rest • History of drug use or abuse • Urinary and other infection

  14. The correct identification of a diagnosis requires the use of evidence-based measuring tools that are valid, specific and sensitive.

  15. The Traditional Classification System of Assessment The criteria used to categories a syndrome include: -Pathoanatomy Presence or absence of radiculopathy -Pain assessment -Duration of the symptoms (acute, subacute or chronic) -Activity or work status -Impairment identified during physical examination -Direction of motion that reproduce, peripheralizes or centralizes the symptoms.

  16. Osteopathic classification of LBP • Position Testing • 1- In extension • 2- in flexion • 3- in neutral position

  17. Facet joint Malalignment O.A. (Degenerative joint disease) Inflammation

  18. Malalignment It means blockage or impingement of the facet joint Normal feeling, spinous processes at the same line with the same space in between Two spinous processes are at the same line but near to each other Spinous process is moved toward the right or the left Two spinous processes are away from each other

  19. Spondylolisthesis Describes the anterior displacement of a vertebra or the vertebral column in relation to the vertebrae below caused by bilateral defects in the pars interarticularis

  20. Spondylolysis Is a defect in the pars interarticularis of a vertebra, caused by stress fracture

  21. Spondylolisthesis is graded in this manner: ○Grade 1: vertebral body above subtends up to 25% of the AP diameter of the vertebral body below ○Grade 2: vertebral body above subtends up to 50% of the AP diameter of the vertebral body below ○Grade 3: vertebral body above subtends up to 75% of the AP diameter of the vertebral body below ○Grade 4: vertebral body above subtends up to the full AP diameter of the vertebral body below

  22. Bone Tumor Fracture Tuberculosis Osteoperosis Osteomylitis

  23. Ligaments Ankylosing spondylitis It is auto-immune disease starts with chronic degenerative inflammatory arthritis affecting the sacro-iliac joints, the spine & costo-vertebral joints, causing ossification of the anterior and posterior longitudinal ligaments

  24. McKenzie classification of Mechanical LBP • 1- Posture syndrome • Result from sustained end-range position and posture pain is: gradual, dull, local, midline, symmetric and never referred. Prolonged posture worsen the pain which decreased by movement. No spinal deformities, loss of rang or function.

  25. Pain Muscle spasm Restriction of movements Poor circulation Stagnation of metabolites Accumulation of lactic acid Myositis

  26. 2-Dysfunction syndrome • Results from adaptive shortening of some soft tissues and an over stretching of others. The pain is intermittent, local adjacent to the midline and not referred. With exception in adherent nerve root where the pain radiate to the buttocks, thigh or calf. Loss of motion and function distinguish this syndrome from the postural one.

  27. MUSCLES Muscle problem could be Muscle spasm Muscle sprain Myositis Muscle problem as a cause of back pain Muscle tightness Muscle weakness

  28. My back hurts many days ago I was carrying a heavy weight, then my back cracked and I felt a great pain. (After violent contraction) Shortening of the muscle Tear of the muscle Assessed by palpation of the paraspinal muscles bilaterally from weight bearing position Assessed by the same method Unilateral gap in the muscle and signs of inflammation (swelling, hotness, redness & tenderness) Tenderness and hotness of the muscle Passive movement relieves the pain while active movement aggravates it Active movement is very painful

  29. Grades of muscle trauma: Stress Strain Sprain Partial tear Complete tear

  30. C) MYOSITIS It is muscle inflammation which usually resulted from air daft or prolonged muscle spasm

  31. Hamstrings

  32. Quadratus lumborum

  33. iliopsoas

  34. Piriformis

  35. 3-Derangement syndrome • Results from a displacement, or an alteration in the position of joint structures (IVD). Pain of sudden onset, paresthesia or numbness, dull or sharp and can be either central, symmetric or asymmetric. It might also referred to the buttocks, thigh, leg or foot. Loss of motion and function. Some motion centralize and other prepheralize the symptoms • Anterior drainage Walking and standing worsen the pain, patient fells better in sitting and other flexed position • Posterior drainage Bending, sitting and sustained position worsen the pain, patients feel better with walking and lying

  36. Severity of IDD & Disc Herniation Zones

  37. Internal Disc Disruption (IDD)

  38. OP OP OP Lumbar Disc Prolapse Long term disc degenerative changes

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