Back Pain Back Pain 4 — Questions and Answers
Question 1: A herniated disc at the L5-S1 level most commonly compresses which nerve root?
- S1 (Correct answer)
- L3
- L1
- T12
Correct answer: S1
A posterolateral L5-S1 herniation typically compresses the traversing S1 nerve root, causing pain to the lateral foot and a diminished ankle reflex.
Question 2: Which finding suggests back pain may be caused by a spinal infection such as discitis or osteomyelitis?
- Pain only during heavy lifting
- Fever with constant pain unrelieved by rest (Correct answer)
- Stiffness after long car rides
- Relief with over-the-counter NSAIDs
Correct answer: Fever with constant pain unrelieved by rest
Fever combined with unrelenting rest pain is a red flag for spinal infection.
Question 3: What is the primary goal of the McKenzie method in treating low back pain?
- Immobilizing the spine in a brace
- Strengthening only the arm muscles
- Centralizing pain using directional preference exercises (Correct answer)
- Numbing pain with ice massage alone
Correct answer: Centralizing pain using directional preference exercises
The McKenzie approach uses repeated movements, often extension, to move radiating pain toward the spinal midline.
Question 4: Which lifting technique best protects the lower back?
- Bending the knees, keeping the load close, and avoiding twisting (Correct answer)
- Bending at the waist with straight legs
- Holding the load at arm's length
- Twisting the torso while lifting quickly
Correct answer: Bending the knees, keeping the load close, and avoiding twisting
Squatting with the load close to the body minimizes lumbar disc pressure and shear forces.
Question 5: A patient with a history of cancer develops new, progressive back pain that is worse at night. What should be the primary concern?
- Simple muscle strain
- Poor mattress quality
- Spinal metastasis (Correct answer)
- Dehydration
Correct answer: Spinal metastasis
New back pain in a patient with cancer history, especially night pain, raises concern for vertebral metastases and warrants imaging.
Question 6: Which medication class carries the highest risk of dependence when used for chronic back pain?
- Opioids (Correct answer)
- Topical NSAIDs
- Acetaminophen
- Muscle rubs
Correct answer: Opioids
Opioids carry significant risks of tolerance, dependence, and overdose, and are not recommended as first-line therapy for chronic back pain.
Question 7: Piriformis syndrome causes buttock and leg pain by irritating which nerve?
- Femoral nerve
- Sciatic nerve (Correct answer)
- Ulnar nerve
- Phrenic nerve
Correct answer: Sciatic nerve
The sciatic nerve passes beneath (or sometimes through) the piriformis muscle, and muscle spasm can compress it.
Back Pain Back Pain 4
A herniated disc at the L5-S1 level most commonly compresses which nerve root?