Week 3 - Treatment of Specific Disorders of Lumbar Spine Flashcards
What are the four causes of radiculopathy?
Mechanical irritation - from repeated movements
Compression - stenosis
Chemical Irritation
Hypoxia/ischaemia - also stenosis
Guidlelines for physical examination of acute nerve root.
Gentle, to P1 only
Position of ease - do some active movements to find it, e.g. rotation, lateral flexion away
Only examine enough to get a diagnosis
What must you do on day 1 of acute nerve root examination?
4
Neurological examination!!
Gentle SLR to examine mechanosensitivity of the system
Manual exam to determine level
Gentle, non-provocative isometric muscle assessment
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What is the treatment for acute nerve root day 1?
Offer reassurance Education that the condition takes time to settle, but it will Openers - traction (may need to treat in a position of ease) TENS Advice about pain relief and meds Rest Possibly gentle sliders .
What are options for acute nerve root in subsequent treatments?
Rotation and other openers
Address the muscle system - core stability??
Ergonomic advice
Reassurance that the condition is slow to respond
If no response in 2-3 weeks, GP
What would your examination for chronic nerve root include?
Full examination is okay
Active movement - look for provocation and restriction
Neuro exam - minor changes
Manual examination (does this mean PPIVMs, PAIVMs)
Examine muscle system
How might you treat chronic nerve root?
Opening techniques e.g. rotation Slider if NTPTs are positive Therapeutic exercises (neuro glides etc) Self help e.g. SNAGs, Extension in lying Ergonomics
How do you treat neural mechanosensitivity?
- Open the interface
- Move the nerve - sliders etc (start distal)
- If the gliders help, offer as HEPs
What is involved in the physical examination for acute LBP?
Look at posture (protective deformities?)
Get them to do single plan active movements (does the lumbar spine actually move?)
Look at muscle spasm -pain
From the P/I look at easing factors and try some repeated movements to try to centralise pain
NO PRONE DAY 1
PPIVMs in side lying
Maybe some PAIVMs if you can to narrow it down but you might not need to on day 1
Treatment of acute LBP on day 1
Assurance and education
Tell them to move (not like nerve where you tell them to rest)
Manual therapies - depends on what you find
Soft tissue massage for muscle pain
Pain relief - TENS, heat, drugs
Ergonomics and ADLs
What is the McKenzie approach?
Repeated active movements away from deformity correct ‘derrangement syndrome’ and centralise pain.
Lateral shift correction first, first restore lordosis through extension
Self management options for acute lower back pain.
Analgesics Heat Sleeping position Taping to prevent flexion HEP - McKenzie extensions
How would you treat acute vs chronic nerve root pain?
Acute: openers e.g. traction, rotation away
Chronic: mobilise the interface e.g. segmental rotation, transverse glides towards, lateral flexion away?? and neural mobilisations
Good for arthritis?
Larger amplitude movement, openers or traction?
How do you progress the techniques? (PPIVMs and PAIVMs)
Increase time of application
Increase grade
Change to position of restriction
Combine some techniques
