SIJ + lumbar

53 important questions on SIJ + lumbar

What is the one-liner for facet-based and disc-based low back pain?

FACET-BASED LBP IS EXTENSION- AND ROTATION-PROVOKED, LOCAL AND MECHANICAL, WHEREAS DISC-BASED LBP IS FLEXION-PROVOKED, LOAD-SENSITIVE, AND OFTEN ASSOCIATED WITH CENTRALIZATION OR RADICULAR FEATURES.

What is the source of facet-based low back pain?

ZYGAPOPHYSEAL (FACET) JOINTS

What are the pathologies associated with facet-based low back pain?

Capsular strain, synovitis, OA
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How does load increase in facet-based low back pain?

Load increases in EXTENSION

What is the source of disc-based low back pain?

INTERVERTEBRAL DISC (ANNULUS)

What are the pathologies associated with disc-based low back pain?

Annular fissure, internal disc disruption, herniation

How does load increase in disc-based low back pain?

Load increases in FLEXION + COMPRESSION

What improves facet-based low back pain?

Flexion, unloading

What improves disc-based low back pain?

Standing, walking

What is the common pain location for facet-based low back pain?

Local/paraspinal

What is the common pain location for disc-based low back pain?

Central ± leg

What is the leg pain characteristic of facet-based low back pain?

Local/non-dermatomal

What is the leg pain characteristic of disc-based low back pain?

Dermatomal (if herniation)

What is the neuro deficit characteristic of facet-based low back pain?

Absent

What is the neuro deficit characteristic of disc-based low back pain?

Possible

What happens to pain with cough/sneeze in facet-based low back pain?

No change

What happens to pain with cough/sneeze in disc-based low back pain?

Worsens

What age group is typical for facet-based low back pain?

Older adults

What age group is typical for disc-based low back pain?

Younger–middle age

What is the degenerative link for facet-based low back pain?

Facet OA

What is the degenerative link for disc-based low back pain?

Annular disruption

What movement reproduces pain in facet-based low back pain?

Pain reproduced with: Extension, Extension + rotation (quadrant)

What movement reproduces pain in disc-based low back pain?

Pain reproduced with: Flexion, Repeated loading

What may happen with preferred direction in disc-based low back pain?

May CENTRALIZE with preferred direction

What does centralization strongly support?

Centralization strongly supports discogenic pain.

What is the centralization characteristic of facet-based low back pain?

❌ Rare

What is the centralization characteristic of disc-based low back pain?

✅ Common

What happens with peripheralization in facet-based low back pain?

What happens with peripheralization in disc-based low back pain?

✅ With wrong direction

What does failure to centralize indicate?

Failure to centralize → consider facet or stenosis.

What is common on MRI for disc changes?

DISC CHANGES common on MRI → often asymptomatic

What does imaging do in relation to diagnosis?

Imaging supports, not diagnoses.

What should be avoided in management of facet-based low back pain?

Avoid repeated end-range extension early

What should be improved in management of facet-based low back pain?

Improve hip/thoracic mobility

What should be done to reduce posterior loading in facet-based low back pain?

Motor control to reduce posterior loading

What should be gradually exposed in management of facet-based low back pain?

Gradual exposure to extension

What should be identified in management of disc-based low back pain?

Identify directional preference

What should be avoided in management of disc-based low back pain?

Avoid sustained flexion early

What is the logic for management according to Brukner & Khan?

Modify load → restore movement → build capacity.

What is worse with extension in the exam trap table?

Extension

What is worse with flexion in the exam trap table?

Flexion

What is worse with stenosis in the exam trap table?

Extension/walking

What is better with flexion in the exam trap table?

Flexion

What is better with flexion/sitting in the exam trap table?

Flexion/sitting

What is the typical age for facet in the exam trap table?

Older

What is the typical age for disc in the exam trap table?

Younger

What is the typical age for stenosis in the exam trap table?

Older

What is the centralization characteristic for facet in the exam trap table?

What is the centralization characteristic for disc in the exam trap table?

What is the centralization characteristic for stenosis in the exam trap table?

What indicates radicular pain + cough?

Disc

What indicates local pain, no neuro signs?

Facet

What is the one-page exam summary for facet-based and disc-based low back pain?

FACET-BASED LBP IS LOCAL, EXTENSION-PROVOKED, AND NON-NEUROLOGICAL, WHILE DISC-BASED LBP IS FLEXION-PROVOKED, LOAD-SENSITIVE, AND MAY CENTRALIZE OR PRODUCE RADICULAR SYMPTOMS DEPENDING ON NERVE INVOLVEMENT.

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