Common Presentations of Back Pain

Once serious causes of back pain are ruled out, the next step is to determine if the patient has musculoskeletal back pain or nerve root pain. Back pain that is musculoskeletal or mechanical in nature varies with activity and presents predominantly in the lumbosacral area, buttocks, and thighs in a patient who is otherwise well or in stable health. Nerve root pain can arise from a prolapsed disk, spinal stenosis, or surgical scarring. The pain generally radiates to the foot or toes and may be associated with numbness or tingling and signs of nerve root irritation such as positive straight leg raising (Table 26.3).

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Figure 26.1 Innervation of the lumbar spine. VB-vertebral body, IVD-intervertebral disc, PM-psoas major, QL-quadratus lumborum, IL-iliocostalis lumborum, LT-longissimus thoracis, M-multifidus, p-periosteum, all-anterior longitudinal ligament, st-sympathetic trunk, grc-grey rami communicans, pll-posterior longitudinal ligament, svn-sinuvertebral nerve, vr-ventral ramus, dr-dorsal ramus, dsdural sac, zj-zygapophysial joint, l-lateral branch, i-intermediate branch, m-medial branch, esa-erector spinae aponeurosis, altlf-anterior layer of thoracolumbar fascia, pltlf-posterior layer of thoracolumbar fascia. Modified from Bogduk 1997 - with permission.

Figure 26.1 Innervation of the lumbar spine. VB-vertebral body, IVD-intervertebral disc, PM-psoas major, QL-quadratus lumborum, IL-iliocostalis lumborum, LT-longissimus thoracis, M-multifidus, p-periosteum, all-anterior longitudinal ligament, st-sympathetic trunk, grc-grey rami communicans, pll-posterior longitudinal ligament, svn-sinuvertebral nerve, vr-ventral ramus, dr-dorsal ramus, dsdural sac, zj-zygapophysial joint, l-lateral branch, i-intermediate branch, m-medial branch, esa-erector spinae aponeurosis, altlf-anterior layer of thoracolumbar fascia, pltlf-posterior layer of thoracolumbar fascia. Modified from Bogduk 1997 - with permission.

Back Pain Relief

Back Pain Relief

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