Flashcards in Lumbar Spine Treatment Deck (35):
What are the treatment options for the spine?
- Passive treatments
- Active treatments
- Lifestyle modifications
What should treatment selection be based on?
- Diagnosis: Triage, specific vs non-specific
- Stage: Actue, subacute, chronic
- Client problems & priorities/contributing factors
What is the back pain triage?
1. Simple musculoskeletal back pain (95% of LBP)
2. Spinal nerve root compression (4% of LBP)
3. Serous spinal pathology (1.5% of LBP)
What red flag conditions require urgent referral?
- Unstable, severe or progressive neuro signs
- Non-mechcanical symptoms with additional red flag findings
What red flag conditions require referral "very soon"?
- Ankylosing spondylitis
- Non-mechanical symptoms without other signs, not responding within a couple of sessions
- Significant yellow flags
- Neurogenic claudication
What are the patterns of back pain?
- Facet joint
- Leg pain dominant vs back pain dominant
- Centralisation & peripheralisation
What should patient education include?
- About the injury
- About contributing factors
- Expected recovery time frame
- About treatment options
- Reduce threat value of LBP
What are the common themes of pain-related fear?
- Predictability, controllability & intensity of pain
- Negative past personal experiences of pain
- Influence of societal back beliefs
- Process of seeking diagnostic certainty
What is the general prognosis for a patient with acute LBP?
90% of people recover in 6 weeks
What does research show regarding bed rest for the spine?
- Avoid completely or limit to < 2 day
- > 2 days detrimental to recovery
What are some of the passive interventions for LBP?
- Taping (early-on in acute LBP)
- Manual therapy
What is the physiological reasoning behind traction?
- Providing the nerve root with more room
- Relieving pressure
What does the evidence show regarding traction?
- Lots of evidence to show it doesn't work in short, medium or long term
- But may help some patients
What does manual therapy involve?
- Treat a pattern (e.g. open a facet joint) or
- Treat what you see
What is mobilisation?
Passive movement that can be controlled by the patient (PPIVM, PAIVM)
What is manipulation?
- Passive movement consisting of a high velocity, small amplitude thrust within the joint's limit
- Cannot be controlled by the patient
How are PAIVMs graded?
Maitland Joint Mobilisation Grading Scale
1: Small amplitude, early range
2: Large amplitude, early-mid range (back & forth)
3: Large amplitude, mid-end of range
4: Small amplitude, end of range
5: (Manipulation) Small amplitude, quick thrust at end of range
When should grade 1/2 and grade 3/4 mobilisations be used?
- If pain is primary complaint, grade 1-2
- If stiffness is primary complaint, grade 3-4
What are the indications for mobilisations?
Joint pain & dysfunction e.g. restricted AROM & PPVIM and/or painful restriction with PAIVM
What are the CIs for mobilisations?
- Acute inflammatory disease
- Spinal cord compromise
- Cauda equina syndrome
What are the precautions for mobilisations?
- Neurological changes
- Rheumatoid arthritis
- Ligament laxity
- Prolonged use of anticoagulants & corticosteroid
What are the active interventions for LBP?
- Exercise (general/specific)
- Behavioural therapy
- Back schools
- Lumbar supports
- Muscle energy techniques
What factors related to LBP does general exercise positively influence?
- Poor sleep
- Provides analgesic effects
What are the two types of specific exercise for LBP?
What does McKenzie exercise involve?
Uses directional preference to determine the movement that reduces pain (flexion, extension, lateral flexion etc) - treatment then focuses on this movement
What does evidence show regarding core exercise for LBP?
- Core muscles (multifidus, TA) work differently after an episode of LBP (turn on later)
- Patients with LBP don't turn on these muscle in preparation for movement
- May be beneficial to train these muscles
What are the ways of re-training the core muscles?
- Palpation with cues/ECG
- Real-time ultrasound
What does research show regarding posture in people with LBP?
- They tend to hold their spine more rigid, don't adjust their posture
- Can result in great muscle fatigue, loading of the facet joints
What is the optimal sitting posture for people with LBP?
- Neutral spine position with slight lumbar lordosis & relaxed thorax
- Avoid painful end-range positions
- Activate key trunk muscles
What is the general rule for treating acute LBP?
- Choose passive intervention to reduce pain & restore movement
- Education & early return to activity is essential
What is the general rule for treating subacute/chronic LBP?
Greater focus on active interventions & lifestyle modifications
What are the reasons for using outcome measures?
- Objectively record changes
- Compliance for third party payers (Work cover etc)
- Identify treatments that work & are cost-effective
- Early identification of people with high-risk of ongoing pain
What should be measured for outcome measures?
- Fear of movement (kinesiophobia)
- Fear-avoidance beliefs
What are the types of outcome measures?
- VAS/numerical rating scale
- Physical tests (ROM, pain-free ROM, muscle endurance tests)
- SMART evaluation