Synonyms
pain in the lumbar region
definition
pain in the region of the lumbar spine, the entire region caudal of the dorsal ribs to lower border of the gluteal region on both sides can be included. (Low back pain). If the pain radiate from there in the leg, one speaks of the sciatica.
Clinical features (symptoms)
The clinical picture varies according to stage Pain cause (s) and pain intensity varied widely. With regard to the therapy particularly acute back pain should be distinguished from chronic low back pain. From chronic low back pain is when the pain (recurrent or persistent short-term) last for three months.
The many associated symptoms and findings in addition to the pain and the situations that lead to the pain in the lumbar region and to increase or decrease resulting, then the immediate diagnosis and differential diagnosis (see below) to distinguish
are:
a) specific low back pain: 15%; here are clear causes and correlations with imaging techniques, such as Fractures, tumors, inflammation, disc events, olistheses, spinal stenosis, etc.
b) nonspecific low back pain: about 85%, functional status, and myofascial pain, etc. legamentäre
pain in the region of the lumbar spine, the entire region caudal of the dorsal ribs to lower border of the gluteal region on both sides can be included. (Low back pain). If the pain radiate from there in the leg, one speaks of the sciatica.
Clinical features (symptoms)
The clinical picture varies according to stage Pain cause (s) and pain intensity varied widely. With regard to the therapy particularly acute back pain should be distinguished from chronic low back pain. From chronic low back pain is when the pain (recurrent or persistent short-term) last for three months.
The many associated symptoms and findings in addition to the pain and the situations that lead to the pain in the lumbar region and to increase or decrease resulting, then the immediate diagnosis and differential diagnosis (see below) to distinguish
are:
a) specific low back pain: 15%; here are clear causes and correlations with imaging techniques, such as Fractures, tumors, inflammation, disc events, olistheses, spinal stenosis, etc.
b) nonspecific low back pain: about 85%, functional status, and myofascial pain, etc. legamentäre
It provides an essential and indispensable part of the diagnostic dar. A systematic approach is recommended. First the question:
• WO the pain is localized and whether a broadcast is in the leg, one or both sides. -> sciatica
• HOW LONG the pain already exist to meet the essential differential diagnosis between acute and chronic back pain can (> 3 months: chronic). have
• HOW started the complaints, so suddenly or slowly increasing, after an accident or a wrong movement, etc.
• BEING worsen the pain or facilitate
eg standing, lying, walking, sitting, and, in Gehleistung terms of spinal stenosis, etc.
- Daily temporal existence, night pain as an indication of inflammation or systemic process, morning stiffness less than half an hour as a reference for disco own pain or spondylarthrosis activated, over an hour as rheumatic Done
- increase in pain when sneezing and crunches when reproducible may be taken as a sign of a disco
own pain - pain of the stress dependence
- response to previous treatments: Success? Side effects?
- General history with evidence of tumor or infection, two so-called specific low back pain forms, cardio - vascular and / or gastrointestinal disorders with regard to the tolerance of physical therapy and NSAIDs
- Social history - occupational history
- mental history and in particular with regard to depression and anxiety.
• WO the pain is localized and whether a broadcast is in the leg, one or both sides. -> sciatica
• HOW LONG the pain already exist to meet the essential differential diagnosis between acute and chronic back pain can (> 3 months: chronic). have
• HOW started the complaints, so suddenly or slowly increasing, after an accident or a wrong movement, etc.
• BEING worsen the pain or facilitate
eg standing, lying, walking, sitting, and, in Gehleistung terms of spinal stenosis, etc.
- Daily temporal existence, night pain as an indication of inflammation or systemic process, morning stiffness less than half an hour as a reference for disco own pain or spondylarthrosis activated, over an hour as rheumatic Done
- increase in pain when sneezing and crunches when reproducible may be taken as a sign of a disco
own pain - pain of the stress dependence
- response to previous treatments: Success? Side effects?
- General history with evidence of tumor or infection, two so-called specific low back pain forms, cardio - vascular and / or gastrointestinal disorders with regard to the tolerance of physical therapy and NSAIDs
- Social history - occupational history
- mental history and in particular with regard to depression and anxiety.
comprises addition to the history of the diagnosis
clinical examination, after the hearing (history), and seeing the keys, and various tests.
observation of the attitude - asymmetry? Increased or decreased kyphosis?, Lumbar lordosis?, Pelvic tilt?, Scoliosis?
observation of the Ganges - limp?
examination of mobility - regional and segmental, in the sagittal plane - flexion and extension and in the frontal plane, the side slope region on both sides (each side comparison!)
Tests
- straight leg raising test (leg lift test) if positive, then the shortening of the posterior leg muscles (Pseudolasegue) or the nervous strain pain is to differentiate (true Lasegue);
- modified Schober'Test: provides information on the mobility of the lumbar spine in the sagittal plane
- Test the trunk muscles: abdominals and back extensors
- Segmental function tests for disorders: Hypo Mobility - Hypermobility - instability of the lumbar segments and / or the sacroiliac joints
(manual medicine see) - mobility tests of the hip joints with regard to the rotation, Flexion, Extension, Ab- und Adduktion
– Prüfung auf Schwächen und Hypertonus der hüftgelenksbewegenden Muskulatur, einschließlich Musculus Piriformis Tests (Priformissyndrom)
Weitere Muskeltests bei Lumboischialgie, insbesondere bei der radikuläre Läsion siehe Lumboischialgie
Untersuchung der kinetischen Kette (Muskelfunktion und Muskelmuster von craniocaudalen Muskelketten)
Bildgebende Verfahren
– Röntgen sofern kein Hinweis auf spezifischen Kreuzschmerz, erst bei Therapieresistenz innerhalb drei Wochen und zwar
Röntgen der LWS im Stehen, ap und seitlich und Beckenübersicht ap
– CT and MRI and Knochenszintigrafie on specific issues, in particular the specific back pain (tumor, fracture, inflammation, scarring, status post disc surgery) in spondylolisthesis functional images, sacroiliac joint inspection images or CT in suspected Sacroileitis - ankylosing spondylitis
Laboratory:
- especially with questions regarding specific low back pain such as inflammation, infection, tumor, rheumatic events, etc. hyperuricemia
clinical examination, after the hearing (history), and seeing the keys, and various tests.
observation of the attitude - asymmetry? Increased or decreased kyphosis?, Lumbar lordosis?, Pelvic tilt?, Scoliosis?
observation of the Ganges - limp?
examination of mobility - regional and segmental, in the sagittal plane - flexion and extension and in the frontal plane, the side slope region on both sides (each side comparison!)
Tests
- straight leg raising test (leg lift test) if positive, then the shortening of the posterior leg muscles (Pseudolasegue) or the nervous strain pain is to differentiate (true Lasegue);
- modified Schober'Test: provides information on the mobility of the lumbar spine in the sagittal plane
- Test the trunk muscles: abdominals and back extensors
- Segmental function tests for disorders: Hypo Mobility - Hypermobility - instability of the lumbar segments and / or the sacroiliac joints
(manual medicine see) - mobility tests of the hip joints with regard to the rotation, Flexion, Extension, Ab- und Adduktion
– Prüfung auf Schwächen und Hypertonus der hüftgelenksbewegenden Muskulatur, einschließlich Musculus Piriformis Tests (Priformissyndrom)
Weitere Muskeltests bei Lumboischialgie, insbesondere bei der radikuläre Läsion siehe Lumboischialgie
Untersuchung der kinetischen Kette (Muskelfunktion und Muskelmuster von craniocaudalen Muskelketten)
Bildgebende Verfahren
– Röntgen sofern kein Hinweis auf spezifischen Kreuzschmerz, erst bei Therapieresistenz innerhalb drei Wochen und zwar
Röntgen der LWS im Stehen, ap und seitlich und Beckenübersicht ap
– CT and MRI and Knochenszintigrafie on specific issues, in particular the specific back pain (tumor, fracture, inflammation, scarring, status post disc surgery) in spondylolisthesis functional images, sacroiliac joint inspection images or CT in suspected Sacroileitis - ankylosing spondylitis
Laboratory:
- especially with questions regarding specific low back pain such as inflammation, infection, tumor, rheumatic events, etc. hyperuricemia
The differential diagnosis is not only targeting the big Number of different causes of back pain and their combinations, but also diseases of other organ systems, which go hand in hand with low back pain, such as the rare back pain on the basis of an aortic aneurysm or the rare purely psychogenic back pain.
specific low back pain (only about 15%), injury - fracture, tumor, inflammation, in addition to the symptomatic and specific therapy
The treatment of nonspecific low back pain whose symptoms at 45 % of patients within one week and 85 - 90% within 6 improve to 12 weeks, findings and stage dependent.
Acute low back pain: are secured
Evidence based medicine
- resume normal activities as possible, so no lasting bed rest
- analgesics according to WHO - Scheme ( analgesics, NSAIDs , rarely weak or strong opioids) and muscle relaxants administer
- No therapeutic exercise, including stretching and aerobics
- limited effect according to EBM have targeted infiltration, Back School, Transcutaneous electrical nerve stimulation (TENS ) Traction, manual therapy, physical therapy, such as cold or heat
Chronic low back pain:
- When the pure analgesic medication lose importance, however, gain pain-medications such as antidepressants .
- The treatment plan includes acupuncture, manual therapy, infiltration, behavior therapy, occasional panty supply for pressure situations and occupational therapy.
- EBM status physiotherapy as part of multidisciplinary treatment programs, manual therapy, psychosocial treatment approaches with behavioral therapy, Cooping strategies, biofeedback, etc.
- The physiotherapy is mainly aimed at the diagnosis-oriented individual deficits of the patient: endurance, fitness, flexibility and coordination.
- The successful treatment of chronic low back pain requires intensive and prolonged interdisciplinary care led by a physician, including compliance http://www.schmerznetz.at/view.php?name=IndikationenLumbalgie promotions
of
Bei Lumboischialgie an M. piriformis denken! http://www.forumgesundheit.at/esvapps/Document/PrintView.jsp?p_pageid=226&p_menuid=63348&pub_id=120871&p_id=4
The treatment of nonspecific low back pain whose symptoms at 45 % of patients within one week and 85 - 90% within 6 improve to 12 weeks, findings and stage dependent.
Acute low back pain: are secured
Evidence based medicine
- resume normal activities as possible, so no lasting bed rest
- analgesics according to WHO - Scheme ( analgesics, NSAIDs , rarely weak or strong opioids) and muscle relaxants administer
- No therapeutic exercise, including stretching and aerobics
- limited effect according to EBM have targeted infiltration, Back School, Transcutaneous electrical nerve stimulation (TENS ) Traction, manual therapy, physical therapy, such as cold or heat
Chronic low back pain:
- When the pure analgesic medication lose importance, however, gain pain-medications such as antidepressants .
- The treatment plan includes acupuncture, manual therapy, infiltration, behavior therapy, occasional panty supply for pressure situations and occupational therapy.
- EBM status physiotherapy as part of multidisciplinary treatment programs, manual therapy, psychosocial treatment approaches with behavioral therapy, Cooping strategies, biofeedback, etc.
- The physiotherapy is mainly aimed at the diagnosis-oriented individual deficits of the patient: endurance, fitness, flexibility and coordination.
- The successful treatment of chronic low back pain requires intensive and prolonged interdisciplinary care led by a physician, including compliance http://www.schmerznetz.at/view.php?name=IndikationenLumbalgie promotions
of
When Schober test a point 10 cm cranial marked by S1, then measuring the length differences are at max. Flexion and extension. Normal values betragen hierbei ca. 7/10/14-17.
The modified Schober method : a technique for assessing spinal motion. Although the technique is reliable (Moll & Wright, 1971), its primary usefulness may be in screening for the very limited mobility that patients exhibit who have diseases like ankylosing spondylitis.
Bild: http://www.gvle.de/kompendium/allgemein/03/03.html
The modified Schober method : a technique for assessing spinal motion. Although the technique is reliable (Moll & Wright, 1971), its primary usefulness may be in screening for the very limited mobility that patients exhibit who have diseases like ankylosing spondylitis.
Use a pen to mark the midpoint between the posterior superior iliac spines (PSIS). Then use your tape measure to identify and mark two points: (1) one that is 10 cm superior to the PSIS, and (2) one that is 5 cm inferior to the PSIS.
As your partner flexes the spine as far as possible, measure and record the distance between the superior and inferior marks.
Similarly, measure and record the distance between the superior and inferior marks as your partner extends the spine as far as possible.
Bei Lumboischialgie an M. piriformis denken! http://www.forumgesundheit.at/esvapps/Document/PrintView.jsp?p_pageid=226&p_menuid=63348&pub_id=120871&p_id=4
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