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Oh See Ess > Low Back CPG > Flashcards

Low Back CPG Flashcards

1
Q

Factors that increase prevalence of LBP

A
  • women
  • age (until 60/65)
  • lower educational status
  • physically demanding job
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2
Q

Risk Factors for LBP

A
  • Operating Heavy equipment
  • HTN (for sciatica)
  • Lifestyle (smoking, overweight - for sciatica)
  • psychological factors

inconclusive evidence for trunk muscle strength and mobility of lumbar spine

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3
Q

Prognostic Factors for the development of recurrent pain

A
  1. hx of previous episode
  2. excessive spine mobility
  3. excessive mobility in other joints
  4. pain of high intensity
  5. passive coping style
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4
Q

What are the subgroups of TBC?

A
  1. mobilization
  2. specific exercise
  3. immobilization
  4. traction

Fritz

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5
Q

ICF diagnosis of : acute low back pain with mobility deficits

A
  • Acute low back, buttock, or thigh pain (duration of 1 month
    or less)
  • Restricted lumbar range of motion and segmental mobility
  • Low back and low back–related lower extremity symptoms
    reproduced with provocation of the involved lower thorac-
    ic, lumbar, or sacroiliac segments
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6
Q

ICF Dx of subacute low back pain with mobility deficits

A
  • Subacute, unilateral, low back, buttock, or thigh pain
  • Symptoms reproduced with end-range spinal motions and
    provocation of the involved lower thoracic, lumbar, or sac-
    roiliac segments
  • Presence of thoracic, lumbar, pelvic girdle, or hip active,
    segmental, or accessory mobility deficits
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7
Q

ICF diagnosis of acute low back pain with movement coordination impairments

A
  • Acute exacerbation of recurring low back pain that is com-
    monly associated with referred lower extremity pain
  • Symptoms produced with initial to mid-range spinal move-
    ments and provocation of the involved lumbar segment(s)
  • Movement coordination impairments of the lumbopelvic
    region with low back flexion and extension movements
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8
Q

ICF diagnosis of subacute low back pain with movement coordination impairments

A
  • Subacute exacerbation of recurring low back pain that is
    commonly associated with referred lower extremity pain
  • Symptoms produced with mid-range motions that worsen
    with end-range movements or positions and provocation of
    the involved lumbar segment(s)
  • Lumbar segmental hypermobility may be present
  • Mobility deficits of the thorax and pelvic/hip regions may
    be present
  • Diminished trunk or pelvic region muscle strength and
    endurance
  • Movement coordination impairments while performing
    self-care/home management activities
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9
Q

ICF diagnosis of chronic low back pain with movement coordination impairments

A

Chronic, recurring low back pain that is commonly associ-
ated with referred lower extremity pain

Low back and/or low back–related lower extremity pain
that worsens with sustained end-range movements or
positions
-
Lumbar hypermobility with segmental motion
assessment
-
Mobility deficits of the thorax and lumbopelvic/hip
regions
-
Diminished trunk or pelvic region muscle strength and
endurance
-
Movement coordination impairments while performing
community/work-related recreational or occupational
activities

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10
Q

ICF diagnosis of acute low back pain with related (referred) lower extremity pain

A

Low back pain, commonly associated with referred but-
tock, thigh, or leg pain, that worsens with flexion activities
and sitting
*
Low back and lower extremity pain that can be centralized
and diminished with positioning, manual procedures, and/
or repeated movements
*
Lateral trunk shift, reduced lumbar lordosis, limited lum-
bar extension mobility, and clinical findings associated
with the subacute or chronic low back pain with movement
coordination impairments category are commonly present

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11
Q

ICF diagnosis of acute low back pain with radiating pain

A

Acute low back pain with associated radiating pain in the
involved lower extremity
*
Lower extremity paresthesias, numbness, and weakness
may be reported
*
Symptoms are reproduced or aggravated with initial to
mid-range spinal mobility, lower limb tension/straight leg
raising, and/or slump tests
*
Signs of nerve root involvement (sensory, strength, or reflex
deficits) may be present

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12
Q

ICF diagnosis of subacute low back pain with radiating pain

A

Subacute, recurring, mid-back and/or low back pain with
associated radiating pain and potential sensory, strength,
or reflex deficits in the involved lower extremity
*
Symptoms are reproduced or aggravated with mid-range
and worsen with end-range lower-limb nerve tension/
straight leg raising and/or slump tests

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13
Q

ICF diagnosis of chronic low back pain with radiating pain

A

Chronic, recurring, mid-back and/or low back pain with
associated radiating pain and potential sensory, strength,
or reflex deficits in the involved lower extremity
*
Symptoms are reproduced or aggravated with sustained
end-range lower-limb nerve tension/straight leg raise and/
or slump tests

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14
Q

ICF diagnosis of acute or subacute low back pain with related cognitive or affective tendencies

A

Acute or subacute low back and/or low back–related lower
extremity pain
*
Presence of 1 or more of the following:
-
Two positive responses to Primary Care Evaluation of
Mental Disorders for depressive symptoms
-
High scores on the Fear-Avoidance Beliefs Question-
naire and behavior consistent with an individual who
has excessive anxiety or fear
-
High scores on the Pain Catastrophizing Scale and cogni-
tive processes consistent with individuals with high help-
lessness, rumination, or pessimism about low back pain

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15
Q

ICF diagnosis of chronic low back pain with related generalized pain

A

Low back and/or low back–related lower extremity pain
with symptom duration of more than 3 months
*
Generalized pain not consistent with other impairment-
based classification criteria presented in these clinical
guidelines
*
Presence of depression, fear-avoidance beliefs, and/or pain
catastrophizing

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16
Q

Diagnostic Prediction Rule for spinal fx

A

female
age > 70
trauma
prolonged use of corticosteroids (>3 months)

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17
Q

Back related tumor physical findings

A

age > 50
constant pain not affected by position
hx of cancer ( +LR 23)
failure to improve within 30 days
no relief with bed rest

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18
Q

Cauda Equina history and physical findings

A

urine retention (+LR 18)
fecal incont
saddle anesthesia
sensory or motor deficits in feet (L4,L5,S1)

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19
Q

Back Related infection

A

Fever +LR 13,25,41
recent infection
deep constant pain
concurrent immunosuppressant use
spine rigidity

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20
Q

Abdominal aneurysm

A

back pain
PVD or other cardio risk factors
smoking
family hx
not being white
female
sx not related to mvmt
abdominal girth < 100cm
presence of a bruit in the central epigastric region
palpation of ab aortic pulse
pulse being > 4 cm

21
Q

Whats the purpose of imaging studies in the low back?

A

interventional and/or surgical planning or in determining the presence of serious medical conditions.

22
Q

What is the MCID for the ODI? Is higher or lower better?

A

10; higher means more disability

23
Q

MCID of the Roland and Morris?

A

5 points or 30% ; test is out of 24

24
Q

CPR for manipulation and what are the 2 most important to have to be successful?

A

sx less than 16 days **
no sx distal to knee **
lumbar hypomobility
hip Ir > 35
FABQ W < 19

4 or more = 95% success rate/ + LR of 13

25
Q

CPR for stabilization exercises

A

age less than 40
positive prone instability
aberrant movements with motion testing
SLR > 91

26
Q

When should clinicians consider using trunk coordination, strengthening and endurance exercises?

A

subacute / chronis LBP with movement coordination impairments

s/p microdiscectomy

27
Q

This treatment should be performed when the patient presents with low back pain with related (referred) lower extremity pain.

A

Mackenzie Method / centralization & directional preference exercises

28
Q

Whats the best method of treatment for spinal stenosis or chronic LBP with radiating pain?

A

Flexion exercises and Walking and lower quarter nerve mobilization

29
Q

IF you are going to use traction, who should get it and what position?

A

signs of nerve root compression with peripheralization of sx or a + Crossed SLR test

prone traction

30
Q

Patient has chronic low back pain without generalized pain, what exercise type are you doing?

A

mod to high intense exercise

31
Q

Patient has chronic low back pain with generalized pain, what exercise type are you doing?

A

progressive, low intensity, submaximal fitness and endurance activities

32
Q

Red Flags for Cancer

A

H/o cancer
Night pain or pain at rest
Unexplained weight loss
Age > 50 or < 17
Failure to improve with conservative management

33
Q

Red Flags for Infections within the Disc or Vertebrae

A

Immunosuppressed
Prolonged temp over 100.4
H/o IV drug use
Recent UTI, cellulitis, or pneumonia

34
Q

Red Flags for Vertebral Fracture

A

Prolonged corticosteroid use
Mild trauma > 50 yo
Age > 70
Osteoporosis
Recent trauma (MVC or fall greater than 5ft)
Bruising over spine following trauma

35
Q

Red Flags for AAA

A

Pulsating mass in abdomen
History of atherosclerotic disease
Throbbing, pulsing back pain at rest or with recumbency
Age >60

36
Q

Treatment for acute LBP w mobility deficits

A

Manual therapy procedures(thrust and non thrust manipulation) to diminish pain and improve segmental spinal or lumbopelvic motion

37
Q

Treatment for acute LBP w mobility deficits

A

Manual therapy procedures(thrust and non thrust manipulation) to diminish pain and improve segmental spinal or lumbopelvic motion

TE to improve or maintain spinal mobility

Patient education that encourages the patient to remain active

38
Q

Treatment for subacute LBP with mobility deficits

A

Manual to improve segmental spinal, lumbopelvic and hip mobility

TE to improve and maintain spinal/hip mobility

Focus on preventing reoccuring LBP episodes through the use of 1. TE that address coexisting coordination impairments, strength deficits and endurance deficits 2. education that encouraged the patient to remain active

39
Q

Treatment for acute LBP with movement coordination impairments

A

NM re ed to promote dynamic stability to maintain the involved lumbosacral structures in less symptomatic mid range positions

consider the use of temporary external devices to provide support

self care/home management including 1. postures and motions that maintain the involved spinal structures in neutral sx free positions 2. education on staying active

40
Q

Treatment for subacute LBP with movement coordination impairments

A

NM reducation

manual and TE to address deficits

self care/home training to keep sx down via mid range positions

initiate work/community reintegration

41
Q

Treatment for chronic LBP with movement coordination impairments

A

NM reeducation to provide dynamic stability to maintain the involved structures in less symptomatic, mid range positions during activities

manual and TE to address deficits

pain management strategies while returning to community/work activities

42
Q

Treatment for Acute LBP with related(referred) LE pain

A

TE, manual or traction that promote centralization and improve lumbar extension mobility

Patient education in positions that promote centralization

progress to interventions consistent with the subacute or chronic LBP with movement coordination impairments intervention strategies

43
Q

Treatment for acute LBP with radiating pain

A

Patient education in positions that reduce strain on nerve roots

traction

manual therapy to mobilize the soft tissue adjacent to the involved nerve roots

nerve mobility exercises in pain free ranges

44
Q

Subacute LBP with radiating pain

A

manual to mobilize the soft tissue adjacent to the involved nerve roots

traction

nerve mobility exercises in mid to end ranges

44
Q

Subacute LBP with radiating pain

A

manual to mobilize the soft tissue adjacent to the involved nerve roots

traction

nerve mobility exercises in mid to end ranges

45
Q

Treatment for chronic LBP with radiating pain

A

manual therapy and TE to address thoracolumbar and lower quarter nerve mobility deficits

patient education pain management strategies

46
Q

treatment for acute or subacute low back pain with related cognitive or affective tendencies

A

Patient education and counseling to address specific classifcation exhibited by the patient (depression, fear avoidance, pain castrophizing)

47
Q

treatment for Chronic low back pain with related generalized pain

A

Patient education and counseling to address specific classifcation exhibited by the patient (depression, fear avoidance, pain castrophizing)

low intensity prolonged (aerobic) exercise

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