Flashcards in L-Spine classification systems Deck (61)
What percentage of patients in primary care that have LBP cannot reliably be attributed to specific disease or spinal abnormality?
What are 7 specific disorders that CAN be a source of back pain?
Cancer = 0.7%
Compression fracture = 4%
Spinal infection = 0.01%
Ankylosing spondylitis = 0.3 – 5%
Spinal stenosis = 3%
Herniated disc = 4%
Cauda equina syndrome = 0.04%
What are 4 non-spinal sources of back pain?
- Nephrolithiasis (kidney stones)
- Aortic aneurysm
- Viral syndromes
What is Level I of an exam?
- Are they appropriate for PT
- Yellow Flags: refer to psycho-social issues
- Red Flags: Refer for medical work-up
What is Level II of the exam?
- Determine the disability stage
What is Stage 1 disability? (4 aspects)
- Acute/ recent onset
- Pain dominates
- Function is significantly affected (mostly by pain)
- ODI > 25 %
What are the 3 factors of Stage 2 disability?
- ODI a little higher than 20 %
- Impairments dominate
- Function moderately affected
What are the 3 factors of Stage 3 disability?
- ODI < 20 %
- Only lacking high level function
What should be kept in mind when assessing stages?
- They are not distinct
What stage is the treatment based classification applied to?
What is the main goal of stage 2?
- Work on impairments and how they affect function
What is the main goal of stage 3?
- Return the patient to a high level of functional activity
What 2 stages are the most likely to blend?
1 and 2
Who were the 3 authors of the KEY article in treatment based classification acute LBP?
- Fritz JM
- Cleland JA
- Childs JD
Who came up with the first treatment based classification system?
- Delitto et al
What is the 3 step process of classification?
- Screen for red flags
- Confirm that the L-spine is the soruces of the problem, and not another musculoskeletal impairment (strain, bursitis, etc...)
- Categorize into: Manip, Spec Exercise, Stabilization, or Traction
What led to the development of the CPR for manipulation?
- Some studies showed it was superior to placebo, while others said it was not
- Wanted to determine what specific patients would benefit from the treatment
What 2 things can be determined by a CPR?
- Determines who is likely to benefit
- Determines who may require a different approach
What is the CPR for spinal manipulation?
4/5 of the following
- No symptoms distal to the knee
- Symptoms < 16 days
- FABQ score < 19
- L-spine hypomobility as determined by PA assessment
- IR of at least one hip > 35 degrees
How was success determined when creating the CPR for manipulation?
Symptoms 50 % better within 2 treatments
What are the 4 contraindications/ strong precautions for manipulation of the L-spine?
- > 60 years old
- Osteoporosis or other bony abnormalities/ weakening
- Signs of nerve root compression
Have the lumbar CPR been validated?
Has non-thrust mobilization been proven be as effective as HVLAs?
Should the patient receive a lumbopelvic manip or a lumbar neutral gap manip?
It doesn't matter.
What 4 exercises made up the HEP following manipulations/ mobilizations in Cleland's study?
- Cat & Camel
- Crunch in neutral
- Side plank
- Quadriped arm and leg
What exercise typically directly follows a lumbar manipulation?
- Active ROM exercises
What are the 3 effects of a manipulation?
- "Safe", pain free ROM
- Normalize muscle activity, and motor control
- Analgesia, and autonomic effects
According to Dr B, how many sessions are the manipulations typically performed?
< 3 - 4 sessions
What are the 2 most important indicators for lumbar manipulation?
- < 16 days
- No pain below the knee