lumbar evaluation/treatment Flashcards
(20 cards)
What are the three types of low back pain (LBP)?
Acute, Chronic, Post-operative
What is the goal of the Treatment-Based Classification (TBC) system?
To classify patients with LBP based on initial assessment including PMH, clinical presentation, and physical exam.
Name the six classification systems for LBP.
TBC, MDT (McKenzie), MSI, CFT, Prognostic Risk Stratification, Pathoanatomic Classification
What are the three phases in TBC and their corresponding symptom characteristics?
- Symptom Modulation: high disability, volatile symptoms, high-mod pain
- Movement Control: moderate disability, stable symptoms, mod-low pain
- Functional Optimization: low disability, controlled symptoms, low-absent pain
List the CPR for manipulation/mobilization TBC.
FABQ-W < 19, <16 days onset, no distal symptoms, ≥1 hypomobile segment, ≥1 hip IR > 35°
What are key signs of spondylosis?
AM stiffness <30 mins, decreased ROM, crepitus, older age, OA/DDD
When is extension directional preference most common?
Disc pathology (age ≤ 50, traumatic onset, radicular pain, ↑ pain with flexion, ↓ pain with extension)
What are the signs of spinal stenosis (flexion preference)?
Age > 50, gradual onset, ↓ pain with flexion (e.g. sitting), ↑ pain with standing/walking, neurogenic claudication
Name the CPR criteria for spinal stenosis.
Bilateral symptoms, leg > back pain, pain relief with sitting, pain with walking/standing, age > 48
When is traction typically used for LBP?
Rarely; typically not recommended especially in chronic cases.
What CPR indicates stabilization TBC?
Age < 40, SLR > 91°, aberrant movement, positive prone instability test
What are the 6 types of spondylolisthesis?
Isthmic, Degenerative, Traumatic, Pathologic, Dysplastic, Iatrogenic
What are the 4 criteria for central sensitization?
Disproportionate pain, unpredictable/mechanical pattern, maladaptive psychosocial factors, diffuse pain
What is required to diagnose CRPS?
Disproportionate pain, ≥1 sign in 2+ categories, ≥1 symptom in 3+ categories, no better diagnosis
What are recommended treatments for acute LBP?
Exercise, manual therapy, classification system use, education
What exercises are best for chronic LBP?
General exercise, trunk activation, aerobic, multimodal, manual therapy, active education
What is the role of dry needling in LBP?
Adjunct for reducing chronic LBP pain/disability
Name the components of cognitive functional therapy (CFT).
Making sense of pain, exposure with control, lifestyle changes
What is emphasized in LBP patient education?
Spine is strong, pain ≠ damage, early activity return, function over pain
List the 5 education messages PTs should convey to LBP patients.
What’s going on, what patient does, what PT does, how long it takes, cost info
