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Flashcards in Lumbar Spine Treatment Deck (35):

What are the treatment options for the spine?

- Education
- Passive treatments
- Active treatments
- Lifestyle modifications


What should treatment selection be based on?

- Diagnosis: Triage, specific vs non-specific
- Stage: Actue, subacute, chronic
- Irritability
- 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?

- CE
- Unstable, severe or progressive neuro signs
- Fractures
- 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
- Disc
- 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)
- Traction
- Manual therapy
- Mobilisation
- Manipulation


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
- Infection
- Tumours/cancer
- Atherosclerosis
- Aneurysms
- Spinal cord compromise
- Cauda equina syndrome


What are the precautions for mobilisations?

- Neurological changes
- Rheumatoid arthritis
- Osteoporosis
- Ligament laxity
- Pregnancy
- Prolonged use of anticoagulants & corticosteroid


What are the active interventions for LBP?

- Exercise (general/specific)
- Posture
- Behavioural therapy
- Back schools
- Lumbar supports
- Muscle energy techniques


What factors related to LBP does general exercise positively influence?

- Poor sleep
- Deconditioning
- Depression
- Anxiety/stress
- Provides analgesic effects


What are the two types of specific exercise for LBP?

- McKenzie
- Core


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?

- Symptoms
- Function
- Fear of movement (kinesiophobia)
- Fear-avoidance beliefs


What are the types of outcome measures?

- VAS/numerical rating scale
- Questionnaires
- Physical tests (ROM, pain-free ROM, muscle endurance tests)
- SMART evaluation


What are two outcome measures for lumbar flexion?

- Modified Schober
- Fingertips to floor
- Biering sorensen test (back endurance)