Interventions

Question 1

List the 4 groups of ICF Classifications for LBP

Answer 1

1. Acute/Subacute with MOBILITY deficits
2. Acute/subacute/chronic with MVMT COORDINATION impairment
3. Acute with REFERRED LE pain
4. Acute/subacute/chronic with RADIATING pain

Question 2

(manual therapy, strong evidence)
What group of pts is THRUST manipulation good for?

Answer 2

acute LBP, pt with mobility deficits and back-related buttock or thigh pain

Question 3

(manual therapy, strong evidence)
What group of pts is THRUST and NONTHRUST mobilization good for?

Answer 3

Subacute/chronic LBP pts with mobility deficits

Question 4

What type of manual therapy is recommended for pts with acute LBP?

Answer 4

thrust AND nonthrust to reduce pain and disability
soft tissue mob and massage for short term pain relief

Question 4

What type of manual therapy is recommended for pts with chronic LBP?

Answer 4

thrust OR nonthrust joint mob to reduce pain and disability
soft tissue mob, massage, and DN for short term pain relief

Question 5

What type of manual therapy is recommended for pts with chronic LBP with leg pain?

Answer 5

(mod evidence) thrust OR nonthrust mob to reduce pain and disability
nerve mob + other treatments to improve pain and disability

Question 5

What type of manual therapy is recommended for pts with chronic LBP with leg pain?

Answer 5

(mod evidence) thrust OR nonthrust mob to reduce pain and disability
nerve mob + other treatments to improve pain and disability

Question 6

What patients would benefit from trunk coordination, strengthening and endurance exercises?

Answer 6

pts with subacute and chronic LBP with coordination impairment and pts post lumbar microdiscectomy

Question 7

which pts would benefit from mod-high intensity exercises and incorporating progressive, low intensity submaximal fitness and endurance activity into the pain management and health promotion strategies?

Answer 7

Chronic LBP without generalized pain

Question 8

Repeated movements for promoting centralization to reduce symptoms in pts is good for…

Answer 8

acute LBP with related LE pain

Question 9

Repeated exercises in a specific direction for improving mobility and reducing symptoms is good for pts with…

Answer 9

acute, subacute and chronic LBP with MOBILITY deficits

Question 10

(mod evidence)
use of specific trunk muscle activation and trunk mobility exercises to reduce pain is good for

Answer 10

Acute LBP

Question 11

(Mod evidence)
trunk muscle strengthening, endurance, and specific trunk muscle activation to reduce pain is good for

Answer 11

acute LBP with leg pain

Question 12

Exercise recommendations for general CHRONIC LBP

Answer 12

trunk muscle strengthening and endurance, multimodal exercise interventions, specific trunk muscle activation, aerobic exercise or general exercise

Question 13

Exercise recommendations for older adults CHRONIC LBP

Answer 13

trunk m strengthening (spinal stabilization) and endurance exercise or general exercise

Question 14

Specific trunk m activation and movement control is good for
1. strong evidence
2. mod evidence

Answer 14

1. chronic LBP with movement control impairment
2. chronic LBP with leg pain

Question 15

What 6 things should pt education and counseling emphasize?

Answer 15

promotion of understanding the anatomical/structural strength of the spine
neuroscience that explains pain perception
favorable prognosis
active pain coping strategies that decrease fear
early resumption of normal activities
importance of improving activity level, not just pain level

Question 16

What pt education is good for Acute LBP? (mod)

Answer 16

active education strategies

Question 17

What pt education is good for chronic LBP

Answer 17

pain neuroscience education and PT interventions (manual therapy)

Question 18

What pts should you NOT use traction on

Answer 18

acute/subacute pts w/o radicular LBP or pts with CLBP

Question 19

What pts can you use traction on? (weak evidence)

Answer 19

intermittent traction for signs of n root compression and peripheralization

Question 20

What are the 5 clinical prediction rules for pts who are likely to respond to SPINAL MANIPULATION?

Answer 20

1. duration of symptoms < 16 days (ACUTE)
2. FABQ work subscale < 19 (not afraid of movement)
3. at least one hip > 35 degrees of IR (don’t have OA)
4. hypomobility in L spine
5. NO symptoms distal to knee

Question 21

Evidence for SPINAL STENOSIS recommendation:

Answer 21

manipulation + exercise

Question 22

Evidence for pts with CLBP – spinal manip, back school and exsc therapy

Answer 22

spinal manip is best

Question 23

evidence for specific stabilization exercises (MF)

Answer 23

lower recurrence of LBP

Question 24

Clinical prediction rules for stabilization exercise program

Answer 24

3 or more to predict success with program - age < 40 - avg SLR > 91 degrees (losey goosey) - aberrant mvmnt present - positive prone instability test

Question 25

clinical prediction rule for radiographic instability

Answer 25

2 or more to rule in - are < 37 - lumbar flexion ROM > 53 deg - total ext ROM > 26 - beighton scale of general laxity > 2 - segmental intervertebral testing (PA) lack of hypomobility )not excessive, not restricted)

Question 26

Rhythmic stabilization and combined isotonic exsc (alternating conc/ecc contraction) both showed sig improvement in static endurance and lumbar mobility in what pts?

Answer 26

chronic LBP

Question 27

extension oriented centralization and directional preference is good for what pts?

Answer 27

LBP + referred LE pain EOTA better than strengthening for THIS pt population

Question 28

Spinal stenosis evidence for excs...

Answer 28

flexion oriented! alone it is not enough, must combine with MT, impairment specific excs

Question 29

Slump stretching > lumbar mob + exsc is better for what pts?

Answer 29

LBP + REFERRED pain, not radiculopathy

Question 30

Distraction manip and nerve mob is effective and safe in what pts?

Answer 30

Lumbar stenosis + leg pain w or w/o LBP

Question 31

- No diff in pain intensity, pain pressure threshold and disability in motor control group and nerve mob + motor control group - Nerve mob pt improved in SLR / neuropathic symptoms What pts?

Answer 31

Lumbar radiculopathy due to disc herniation

Question 32

Traction in FLEXION vs EXTENSION

Answer 32

flexion: greater separation of IV foramen (stenosis) extension: greater separation of disc space

Question 33

INDICATIONS for traction

Answer 33

HNP/Disc DJD/DDD Joint Hypomobility Facet Impingement M spasm

Question 34

CONTRAINDICATIONS for traction

Answer 34

Hyperacute joint Tumor Infection Systemic Disease Vascular Compromise

Question 35

RELATIVE CONTRAINDICATIONS for traction

Answer 35

Spinal joint instability Osteoporosis Pregnancy Hiatal Hernia Claustrophobia

Question 36

Force of traction:

Answer 36

50% BW

Question 37

how effective is traction for LBP w and w/o radiculopathy

Answer 37

little or no impact w or w/o other treatment

Question 38

how effective is traction for LBP+leg pain +signs of n root compression

Answer 38

- Traction = greater improvements in disability and fear after 2 wks - SHORT TERM EFFECTS for those with fear of mvmt - NO diff at 6wks

Question 39

how effective is traction for pt with disc hernation

Answer 39

- Continuous lumbar traction for decreasing size of material

Question 40

position/direction of pull for mechanical traction in pts with DJD/DDD and lateral stenosis

Answer 40

supine, ant pull (flexion)

Question 41

position/direction of pull for mechanical traction in pts with HNP

Answer 41

prone post pull (ext)