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Location of Pain and Symptoms back pain
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Lumbar Spine
- 80% prevalence rate in the adult population
- Mechanical pain with or without radiating leg pain
- Treatment-based classification system (Fritz 2007 JOSPT)
- ----Mobilization/manipulation (Likely had recent injury)
- ----Stabilization (General laxity)
- ----Specific exercise (directional preference)
- ----Traction
- --------Distal referral of pain
- --------Numbness or weakness
- --------Mixed results
- Impairment-based treatment
- ----1st tx impairments then tx using above method
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Sacroilitis
- Forten sign: point to SI as painful spot
- Clinical Prediction Rule:
- ----Thigh thrust/POSH test
- ----Compression
- ----Distraction
- ----Sacral thrust
- ----Gaenslan
- 3 out of 5 is positive
- Sn: 91 Sp: 87
- Look at pelvic rotation is not accurate
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SI dysfunction common in
- Pregnant: laxity
- Erlors Danlos
- Marfans
- Fall (shearing)
- Otherwise it is a very stable jt compared to L/S and hip
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Neuromuscular Causes of Hip Pain
- 1. Slipped Capital Femoral Epiphysis
- 2. Hernia
- 3.Athletic pubalgia
- 4. Legg-Calve-Perthes disease
- 5. Osteitis pubis
- 6. Meralgia Paresthetica
- 7. Scaiatica
- 8. Hip OA
- 9. Lumbar spine, SI joint, knee
- 10. Bursistis/Tendinosis
- 11. Femoral acetabular impingement
- 12. Fracture
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Hip OA
- Altman’s Criteria for Hip OA à The American College of Rheumatology
- ----Hip pain
- ----IR < 15
- ----Morning stiffness up to 60 minutes
- ----Age > 50 (just like CA)
- Sn: 86, Sp: 75
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Femoral acetabular impingement
- CAM vs Pincer will show either a pos FABER or FADDIR
- Active individual
- Hurt when sit bc getting impinged but usually active
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Hernia
- Inguinal
- ----Through inguinal ring
- Femoral
- ----Fossa ovale
- ----Less common but more common after delivery
- Portion of abdomen/ hip already weak
- Content extruded from structure
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What can cause hernia
- Lifting
- Valsalva : bowel (if constipation)
- After delivery
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Athletic pubalgia (sportsman hernia)
- Not true hernia
- Rectus abdomins tearing from pubic bone
- In highly athletic individuals
- Dx of exclusion
- ----Usually sent with adductor/hip flexor strain and those tests will be pos
- ----But if true adductor strain then they should not have pain with hip flexion
- Will have pain if ask to crunch but planking better bc really getting lower abs
- Tx
- ----Rest or surgery depending on severity
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Osteitis pubis
- Inflammation of pubic symphysis
- In highly athletic or If have had Suprapubic surgery
- Multiple muscles pos bc of the torque being applied on the pubis
- How to differentiate btwn oscietis pubis and athletic pubalgia
- Imaging
- From PT standpoint: our tx isn’t going to change: strength, ROM, mobility,
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Fracture
- 1. Insufficiency: normal stresses on abnormal bone
- ----Osteoporotic bone
- ----Bone insufficient to handle normal daily stresses of life
- 2. Fatigue: abnormal stresses on normal bone
- ----Excessive running
- 3. Pathologic: generally refers to focal region of metastases
- ----Bone has started to metastasize
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Meralgia Paresthetica
- Compression over the lateral femoral cutaneous nerve
- No weakness or motor impairment
- Non traumatic pops
- ----Athletic field: hit of field, bruised on field
- ----Nerve is being compressed by a heavy belt (construction or law enforcement)
- ----Pt has to modify
- Traumatic
- ----Have to wait for it to get better
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Legg-Calve-Perthes disease
- Idiopathic avascular necrosis of the hip
- Most common in boys ages 4-8 (ages vary depending on sources)
- ROM limitations into extension, abduction, and IR
- Painful limp to bear weight
- When blood supply returns they will start to see return
- Return dependent on how long they were without blood
- Loss ROM non-capsular
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