Interventions Flashcards
List the 4 groups of ICF Classifications for LBP
- Acute/Subacute with MOBILITY deficits
- Acute/subacute/chronic with MVMT COORDINATION impairment
- Acute with REFERRED LE pain
- Acute/subacute/chronic with RADIATING pain
(manual therapy, strong evidence)
What group of pts is THRUST manipulation good for?
acute LBP, pt with mobility deficits and back-related buttock or thigh pain
(manual therapy, strong evidence)
What group of pts is THRUST and NONTHRUST mobilization good for?
Subacute/chronic LBP pts with mobility deficits
What type of manual therapy is recommended for pts with acute LBP?
thrust AND nonthrust to reduce pain and disability
soft tissue mob and massage for short term pain relief
What type of manual therapy is recommended for pts with chronic LBP?
thrust OR nonthrust joint mob to reduce pain and disability
soft tissue mob, massage, and DN for short term pain relief
What type of manual therapy is recommended for pts with chronic LBP with leg pain?
(mod evidence) thrust OR nonthrust mob to reduce pain and disability
nerve mob + other treatments to improve pain and disability
What type of manual therapy is recommended for pts with chronic LBP with leg pain?
(mod evidence) thrust OR nonthrust mob to reduce pain and disability
nerve mob + other treatments to improve pain and disability
What patients would benefit from trunk coordination, strengthening and endurance exercises?
pts with subacute and chronic LBP with coordination impairment and pts post lumbar microdiscectomy
which pts would benefit from mod-high intensity exercises and incorporating progressive, low intensity submaximal fitness and endurance activity into the pain management and health promotion strategies?
Chronic LBP without generalized pain
Repeated movements for promoting centralization to reduce symptoms in pts is good for…
acute LBP with related LE pain
Repeated exercises in a specific direction for improving mobility and reducing symptoms is good for pts with…
acute, subacute and chronic LBP with MOBILITY deficits
(mod evidence)
use of specific trunk muscle activation and trunk mobility exercises to reduce pain is good for
Acute LBP
(Mod evidence)
trunk muscle strengthening, endurance, and specific trunk muscle activation to reduce pain is good for
acute LBP with leg pain
Exercise recommendations for general CHRONIC LBP
trunk muscle strengthening and endurance, multimodal exercise interventions, specific trunk muscle activation, aerobic exercise or general exercise
Exercise recommendations for older adults CHRONIC LBP
trunk m strengthening (spinal stabilization) and endurance exercise or general exercise
Specific trunk m activation and movement control is good for
1. strong evidence
2. mod evidence
- chronic LBP with movement control impairment
- chronic LBP with leg pain
What 6 things should pt education and counseling emphasize?
promotion of understanding the anatomical/structural strength of the spine
neuroscience that explains pain perception
favorable prognosis
active pain coping strategies that decrease fear
early resumption of normal activities
importance of improving activity level, not just pain level
What pt education is good for Acute LBP? (mod)
active education strategies
What pt education is good for chronic LBP
pain neuroscience education and PT interventions (manual therapy)
What pts should you NOT use traction on
acute/subacute pts w/o radicular LBP or pts with CLBP
What pts can you use traction on? (weak evidence)
intermittent traction for signs of n root compression and peripheralization
What are the 5 clinical prediction rules for pts who are likely to respond to SPINAL MANIPULATION?
- duration of symptoms < 16 days (ACUTE)
- FABQ work subscale < 19 (not afraid of movement)
- at least one hip > 35 degrees of IR (don’t have OA)
- hypomobility in L spine
- NO symptoms distal to knee
Evidence for SPINAL STENOSIS recommendation:
manipulation + exercise
Evidence for pts with CLBP – spinal manip, back school and exsc therapy
spinal manip is best
evidence for specific stabilization exercises (MF)
lower recurrence of LBP
Clinical prediction rules for stabilization exercise program
3 or more to predict success with program
- age < 40
- avg SLR > 91 degrees (losey goosey)
- aberrant mvmnt present
- positive prone instability test
clinical prediction rule for radiographic instability
2 or more to rule in
- are < 37
- lumbar flexion ROM > 53 deg
- total ext ROM > 26
- beighton scale of general laxity > 2
- segmental intervertebral testing (PA) lack of hypomobility )not excessive, not restricted)
Rhythmic stabilization and combined isotonic exsc (alternating conc/ecc contraction) both showed sig improvement in static endurance and lumbar mobility in what pts?
chronic LBP
extension oriented centralization and directional preference is good for what pts?
LBP + referred LE pain
EOTA better than strengthening for THIS pt population
Spinal stenosis evidence for excs…
flexion oriented! alone it is not enough, must combine with MT, impairment specific excs
Slump stretching > lumbar mob + exsc is better for what pts?
LBP + REFERRED pain, not radiculopathy
Distraction manip and nerve mob is effective and safe in what pts?
Lumbar stenosis + leg pain w or w/o LBP
- No diff in pain intensity, pain pressure threshold and disability in motor control group and nerve mob + motor control group
- Nerve mob pt improved in SLR / neuropathic symptoms
What pts?
Lumbar radiculopathy due to disc herniation
Traction in FLEXION vs EXTENSION
flexion: greater separation of IV foramen (stenosis)
extension: greater separation of disc space
INDICATIONS for traction
HNP/Disc
DJD/DDD
Joint Hypomobility
Facet Impingement
M spasm
CONTRAINDICATIONS for traction
Hyperacute joint
Tumor
Infection
Systemic Disease
Vascular Compromise
RELATIVE CONTRAINDICATIONS for traction
Spinal joint instability
Osteoporosis
Pregnancy
Hiatal Hernia
Claustrophobia
Force of traction:
50% BW
how effective is traction for LBP w and w/o radiculopathy
little or no impact w or w/o other treatment
how effective is traction for LBP+leg pain +signs of n root compression
- Traction = greater improvements in disability and fear after 2 wks
- SHORT TERM EFFECTS for those with fear of mvmt
- NO diff at 6wks
how effective is traction for pt with disc hernation
- Continuous lumbar traction for decreasing size of material
position/direction of pull for mechanical traction in pts with DJD/DDD and lateral stenosis
supine, ant pull (flexion)
position/direction of pull for mechanical traction in pts with HNP
prone post pull (ext)
