. A non-narcotic analgesic regarded as having an analgesic effect, but little or no known anti-inflammatory mechanism.
Acupuncture/ Acupressure - Insertion of needles or applying dull point pressure at specific acupuncture points to reduce pain.
Acute back problem
. Episode of activity limitation(s) due to back symptoms (back pain or back-related leg pain) present less than 3 months. By definition, the onset of reduced activity tolerance can be the first ever, a repeat or recurrent episode of limitation, or an episode of new reduced activity tolerance for a chronic back problems.
Babinski Sign. An abnormal response to Plantar Reflex (rubbing blunt object without tickling from lateral heal across bottom of foot to ball of the great toe) where great toe dorsiflexes up and smaller toes to separate indicating spinal cord or brain disease compared to the normal plantar reflex of flexion of all toes curling under. The plantar reflex (Babinski) is tested by coarsely running a key or the end of the reflex hammer up the lateral aspect of the foot from heel to big toe.
. A structured educational program, usually in a group setting, designed to inform patients about low back problems and sometimes include supervised exercise.
Injection of radioactiveTc-99 Diphosphinate bone metabolite provides an sensitive indications of increased or decreased bone turnover from fracture or infection, dislocation or tumor and more than old fractures, normal aging changes or aseptic bone necrosis.
. The use of auditory and visual signals reflecting a patient's muscular activity to allow the patient to facilitate or extinguish this muscle action. In patients with low back pain, the objective is to reduce pain by reducing muscle tension.
Brief educational interventions - Individualized education about back pain problems without supervised exercise or other specific interventions different from back schools by not done in a group education or supervising exercise.
Cauda equina syndrome
. Compression (usually due to the extrinsic pressure of a massive, centrally herniated disc or severe spinal stensis) on a sheath of nerve roots from the lower cord segments, resulting in grades of bilateral motor weakness of the lower extremities, saddle anesthesia, and urine retention or incontinence from loss of sphincter function.
. The injection of a proteolytic enzyme (e.g., chymopapain) into the herniated nucleus pulposus of a disc.
or Randomized Controlled Trials
(RCTs). Highest level scientific study that tests a hypothesis (hypothesis is generally the product of observations or retrospective studies)). Prospective technique with least chance of undectible bias to be hidden from critical evaluation, compares similar population to test the impact of the study issue against the impact of a placebo or standard approach.
Scan or CAT Scan
). CT scans use multiple x-ray beams projected at different angles and levels to produce computer-generated axial cross-sectional body images (bone better than soft tissue).
. Computerized tomography done after contrast media has been injected into the dural sac to better display the spinal cord and nerves.
. Therapeutic elevation of the temperature of deep tissues by means of high frequency shortwave or microwaves.
- Part of the normal aging process when disk outer touch grizzle annulus fibrosis is confluent with the water filled nucleus pulposis
when we are young (below left
) which becomes becomes separate with aging (below right
) and distinct with nucleus becoming the texture of crab meat when aging strips the biochemical properties to retain water (young disk & old disk
also depicted by Discography below
). As disks degenerate they narrow and the body commonly forms osteophytes
to keep the spine stable. The Degenerated disk has not been proven a reliably detectable pain generator by discography or other methods.
. Normal teen age disk (Young) -----> Normal 70 year old disc (Degenerated)
When face like below, disk like above -----> When face like below, disk like above
. The injection of a water-soluble imaging material directly into the nucleus pulposus of a disc to assess the extent of disc damage and characterize the pain response.
Dye details Normal contained disc between vertebrae L3-L4 and aged leaking disk between L4-L5 discs.
. The surgical removal of all or part of a herniated intervertebral disc compressing a nerve root. When microscopic or visually aided surgical techniques are used, this procedure is referred to as microdiscectomy. The procedure can also proposed through a small incision using indirect visualization (percutaneous discectomy).
). An examination of the electrical activity of a motor unit, useful in determining the site of injury in a peripheral nerve and in detecting spinal nerve root lesions as well as primary muscle diseases. Needle EMG involves the insertion of a teflon coated needle electrodes into muscle. Surface EMG uses surface electrodes instead of needle insertion of questionable reliability for research. Reliable Needle EMG limb (rather than only paraspinal) findings are multiple Positive Sharp waves
and/ or Fibrillation Potentials
for each level and h-reflex slowing
for S1 nerve root.
. The study of the efficient use of the body in work and recreation, including the design and operations of machines in the physical environment.
Exercise - A supervised or formal home exercise regimen, ranging general physical fitness or aerobic exercise to strengthening, flexibility, or stretching, alone or in combination.
. The use of electrodiagnostic equipment to measure motor conduction through nerve roots, most frequently to assess proximal neuropathies but less reliable than h-reflex for lower extremities.
. Synovial joints formed by the facets on the posterior articular processes consisting of contiguous vertebrae.
Functional restoration (sometimes synonymous with physical conditioning, work hardening, or work conditioning) - Involves simulated or actual work tasks performed in a supervised environment to improve strength, endurance, flexibility, and cardiovascular fitness in injured workers specific to needed job performance skills.
. The use of electrodiagnostic equipment to measure sensory conduction of a stimulus through nerve roots that then evoke a motor reflex, commonly employed to assess S1 radiculopathy.
. Response elicited by supporting the relaxed patient's hand by holding the middle finger between the examiner''s thumb and index finger. Presses down on the patient's long finger fingernail with your thumb nail until it "flicks" over the end while supporting the relaxed hand by hoding the middle finger between the examiner's thumb and index finger. Repeated "flicks" over the long finger nail may cause the other fingers & thumb to flex hinting at upper motor neuron lesion. Normally, nothing occurs.
). Herniation of the central gelatinous material (nucleus pulposus) of an intervertebral disc through its fibrous outer covering (annulus fibrosis). Diagram figure - 6a
Intra-Discal Electrocaudery Therapy
). A wire coil is introduced percutaneously into the disk to burn the annulus fibrosis in the area of theorized internal disk disruption.
Interdisciplinary therapy (multidisciplinary therapy) - Coordinated physical, vocational, and behavioral components provided by multiple health care professionals with different clinical backgrounds with widely varied intensity and content impacting perception of pain but little effect on return to work.
Interferential therapy - Superficial modulation of a medium frequency of alternating current up to 150 Hz considered more comfortable for patients than transcutaneous electrical nerve stimulation.
Low-level laser therapy - Superficial lasers at wavelengths between 632 and 904 nm applied to the skin as electromagnetic energy to soft tissue of varied wavelength, dosage, dose-intensity, and type of laser.
Magnetic Resonance Imaging
). MRI scans use magnetic fields to produce computer-generated axial and sagittal cross-sectional body images (soft tissue and fluids better than bone).
Massage - Soft tissue hands or a mechanical device manipulation to apply pressure and intensity of greatly differentiating techniques.
. Injection of contrast media into the dural sac to better display the spinal cord and nerves than x-rays or CT scans.
Nerve conduction studies
. Tests of peripheral nerves performed by stimulating the nerve at one point and measuring the action potential either at another point along the nerve (sensory conduction) or of the muscle innervated by the nerve (motor conduction).
Neurogenic or Spinal claudication - Neuroclaudication. Symptoms of leg pain and weakness (
commonly symmetrical thus difficult to detect) on walking (especially down hill) or standing, relieved by sitting or spinal flexion, related to neural compression, usually spinal stenosis. It should be differentiated from vascular claudication
, a distinct pain or cramping in your calf that goes away a few minutes after not using the calf muscles by just standing still. With Neuroclaudication the spine usually needs to be flexed by sitting down for a longer rest period before continuing.
Neuroreflexotherapy - Spanish technique of temporary implantation of staples superficially into the skin over trigger points in the back and referred tender points in the ear thought to stimulate different acupuncture zones of the skin.
Non-Steroidal Anti-Inflamatory Drugs
) are a class of medications that have anti-inflammatory and analgesic properties as well as being prostaglandin inhibitors.
- or sometimes referred to as traction spurs where boney calcification extend lateral from bone above of below a joint to stabilize the motion segment as they extend from the vertebral body when disk aging decreases the thickness of the intervertebral disk. Thus, osteophytes are a part of aging of the disc or disc degeneration
. They can also develop in the facet joints of the body as in any joint in the body that has lost its normal young cartilagenous space. Bony osteophytes should be differentiated from syndesmophytes
. Early Osteophytes - L5-S1 narrowing Extreme Osteophytes
AP view Below
. Drawings by patients depicting the severity, type, and location of their pain as a technique for visually the anatomic expression of symptoms and in some cases can indicate embellishment of the pain complaints (Embellishments include emphasis with pain outside the figure, simply depicted from reasonable for sciatica on the left to more obvious embellishment right). Embellishment doe not mean faking only caution to clinician that non-physical issues
can cloud the response to care and treatment.
Percutaneous electrical nerve stimulation (PENS) - Insertion of acupuncture-like needles inserted for application of low-level electrical stimulation to target points target dermatomal levels for local pathology, rather than acupuncture points though some consider it a form of electroacupuncture.
Progressive relaxation - Deliberate tensing and relaxation of muscles to reduce muscle tension.
. Dysfunction of a nerve root often caused by compression of the root. Pain, sensory impairment, weakness or depression of deep tendon reflexes may be noticed in the distribution of nerves derived from the involved nerve root (s).
. Loss of sensation in the skin over the perineum indicative of dysfunction of sacral nerve roots indicative of cauda equina syndrome.
. Radiating leg(s) Pain below the knee in the distribution of the sciatic nerve, possibly a radiculopathy related to lumbosacral nerve roots mechanical pressure and/or inflammation (25-40% patients with pain below the gluteal fold, 5% some neurological exam findings beyond SLR, 2% reasonable surgical findings but half recover sufficiently by one month to not consider surgery).
Self-care book - Self-care educational material (books, booklets, or leaflets) for low back pain patients based on scientific principles intended to overcome fears of normal activity, encouraging a fitness, and a lifestyle of adapting coping strategies to manage back symptoms.
Sensory evoked potentials
). The use of electrical stimuli applied to specific nerves or dermatomes to assess the normalcy of nerve responses more sensitive but less specific than EMG.
Short-wave diathermy - Indirect deep tissues short wave electromagnetic radiation with a frequency range from 10 to 100 MHz.
Spa treatment - Mineral water bathing, usually with heated water, typically applied while staying at a spa resort.
. Manual back therapy for symptomatic relief in which loads are applied to the spine using short or long lever methods. The selected spinal joint is moved with sufficient velocity and force to take spinal joints beyond its end range of voluntary motion. Spinal mobilization, or low-velocity, passive movements within or at the limit of joint range, is also commonly referred to as spinal manipulation.
. A narrowing of the spinal canal (black canal depicted below left) that may produce a bony constriction of the cauda equina (as depicted on right below in Myelogram-CT) and the emerging nerve roots that can be the cause of neuroclaudication. Diagram figure - 6b
. Group of related inflammatory joint diseases where associated with HLA-B27 serolology blood testing. Commonly termed seronegative spondyloarthopathy
, as it is typically negative for rheumatoid factor (RhF - non-specific Rheumatoid Arthritis indicator). As a group of arthritic disorders it is most characterized by involvement of the axial skeleton where as Rheumatoid arthritis tends to exclude the spine.
Degenerative Spondylolisthesis Severe Spondolytic Spondylolisthesis >50% slip (Grade 3-4)
A fracture or cleft between the superior and inferior vertebral articulating facet through the posterior vertebral arch, loosening the spinous process with the inferior articular facets that are normally attached to pedicle and vertebral body that can allow spondylolisthesis.See the red collar on the famous "Scotty Dog"
Straight leg raising
). A procedure of stretching the sciatic nerve to see if radicular symptomatology is reproduced. Each hip is alternately flexed with the knee extended; the extent to which each leg can be lifted is noted. Reproduction of the patient's sciatica when the "unaffected" leg is lifted is evidence of a positive "crossed" straight leg raising test.
- flowing calcification of seronegative sponduloarthopathies or DISH (Diffuse Idiopathic Skeletal Hyperostosis) syndrome with calcification flowing over the joints along the ligaments distinct from osteophyte
or traction spurs where calcification extends lateral from the joint margins as extentions of the bone.
Systematic Literature Review
- An efficient scientific technique to identify and summarize the levels of evidence on the effectiveness of interventions or techniques that reveal the generalizable aspects and consistency of research findings to be assessed and determine inconsistencies in the data explored. Guidelines Methodology
is based on a consensus of expert opinion or unsystematic literature surveys have been criticized as being too liable to bias and not found to reflecting current medical knowledge.
. A procedure that images the infrared radiation (heat) emitted from body surfaces. In patients with low back problems, thermographic image patterns of the back and lower extremities are measured.
Transcutaneous electrical nerve stimulation
). A small battery operated device, worn by the patient, which provides continuous electrical pulses via surface electrodes with the goal of providing symptomatic relief by modifying pain perception.
. When used for low back problems, intermittent or continuous force is applied along the axis of the spine in an attempt to elongate the spine. The type most commonly used for low back problems is pelvic traction in which a girdle around the patient's pelvis is attached to weights hung at the foot of the bed. (Implied structural effect is doubtful considering the skin pressure tolerance limits the applied force to well below those that effect the spinal joints.)
. As well localized point of tenderness in low back problems, these points are usually located in the para-vertebral areas.
Yoga - Exercise therapy concentrating on specific body positions, breathing techniques, and mental focus of many varied styles practiced emphasizing different postures and techniques.
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