L32: Formal Exercise in Lumbar and Pelvic Conditions Flashcards
_____ SHOULD be used in the management of LBP
Exercise
Exercise SHOULD be tailored to the _______
individual’s needs
How can you reducing the risk of acute to chronic?
Identify, prescribe and encourage patient – appropriate exercise (what the patient can do, will do and can manage within their lives)
What are the clinical guidelines in the summary of interventions?
Interventions: Progressive Endurance Exercise and Fitness Activities:
Clinicians should consider (1) moderate- to high- intensity exercise for patients with chronic low back pain without generalized pain, and (2) incorporating progressive, low-intensity, submaximal fitness and endurance activities into the pain management and health promotion strategies for patients with chronic low back pain with generalized pain. (Recommendation based on strong evidence)
What are the 4 factors influencing exercise prescription or self – management strategies (beyond the acute pain stage – non specific, specific LBP and pelvic pain)?
- How irritable symptoms are
- The functional tasks they need to return to doing and goals
- What they enjoy doing and can fit into their day
- Findings / impairments from the physical examination
General exercise (_____) and ______ based exercise and directional preference exercises are demonstrated to be effective for Lsp Pain and function
strengthening; motor control
No difference between exercise approaches – ____ (stabilization exercise) and _____ or motor control (stabilization exercise) and McKenzie based exercise
motor control; general
_____ is effective especially where: patient’s are introduced to exercise at their level of function, and the exercises are progressed and the patient’s preferences are considered
Exercise
What are the 4 physical benefits of Supervised / Progressive Exercise?
- Tailored program specific to pt presentation / injury / history
- Rehabilitation / prevention of reinjury
- Progressive / supervised –> less chance of unsafe selections / progressing too quickly / progressing too slowly
- Supervised by QUALIFIED therapist with suitable training and skills
What are the 6 psychological benefits of Supervised / Progressive Exercise?
- Patient feels more in control
- Actively participating in rehabilitation- If they are making progress/improving
- Other psychological benefits of exercise (i.e. mental health, decrease stress)
- Improved QOL
- More likely to continue longer term
- Motivation / Accountability- More in control
What are 6 Long Term Exercise Options for LBP?
- Progressive HEP from Physiotherapist (in clinic / patient’s home)
- Hydrotherapy
- Gym based program – Supervised by Physiotherapist OR Personal Trainer / Exercise Physiologist (physiotherapist should ideally liaise with these personnel)
- Gym based independent program- Near the end of rehab
- Group Fitness Classes- People who have hard time motivating themselves
- Clinical Pilates (Physiotherapist)
What is the physiotherapy HEP for LBP?
Acute / early stages –> as per content delivered in this course
What are 6 situations when to progress exercise in LBP management?
- Decrease in pain / symptoms
- Increase in ROM
- Ability to perform previous exercises / meet functional goals
- Relative to current load of work
- TAKE CARE with adding in weights / sets / reps / holds –> may be slower in some patients than others!! (Ensure no latency in symptoms)
- Functional tolerance
Consider demands of task and the types of joint ranges they need to maintain during this task to help create a targeted exercise program. Give 3 exercises. Example: Desk / Office worker
- Seated exercises to increase postural endurance, 4 point kneeling, squats
- Hip flexor / thoracic mobility (Stretching), scapular exercises (As they are sitting in a kyphotic position, slouched)
- Deadlifts
Consider demands of task and the types of joint ranges they need to maintain during this task to help create a targeted exercise program. Give 5 exercises. Example: Water Polo Player
ER of hips –> contralateral UL and LL
- Bent knee fallouts
- 4 point leg extensions / arm extensions / opposites- Contralateral
- Squats- Power and strength
- Squat rows / sword draws
- Rotation maintenance / thoracic ROM exercises
When is hydrotherapy used?
- Often have land based Ax initially –> individual hydrotherapy program –> initial individual session in pool with physio –> moved into class / independent session (each patient on own program)
- Good to manage symptoms (esp. pain) –> get them moving –> progress to land based activities faster/can progress in the pool
When should you progress hydrotherapy?
- Progressions then made as required by physiotherapist
- Make sure you know when to progress IN THE POOL (i.e. adding resistance / progressing exercises)- Shallower water; Can sometimes stay in pool
- Make sure you know when to progress OUT OF THE POOL to other forms of exercise if / when appropriate
Who is hydrotherapy used for?
Not just for the ‘elderly’, but often younger patients stereotype it like this!
What are 4 situations where hydrotherapy is ideal?
- Chronic pain
- Pain that responds to heat / lower load weight bearing
- Post Surgical (i.e. graduated return to load / WB needed)
- If a generalized global exercise program is needed
Some patients find less confronting than other forms of exercise
What are 4 gym based programs?
- Supervised by Physiotherapist- Clinic gym or you can go with patient to their preferred gym or physio working in gyms
- Supervised by Personal Trainer
- Supervised by Exercise Physiologist
- Independent- Only when patient is healthy, confident and safe (10% of population- less likely)
- Know what to do
- Know when to stop
What are 6 return to gym exercises?
- May start with squats / deadlifts UNWEIGHTED, focus on posture, technique, position, patient’s awareness of what they are doing correctly / incorrectly
- Lunges body weight (if no unilateral WB concerns)
- Consider barbell position (forwards or backwards i.e. encouraging flexion / extension during all exercises)
- Bent over rows
- Clean and press
- Leg press – significant load on the intra-abdominal pressure control system in a very high range of hip and knee flexion – maybe appropriate in functional training – generally leave towards end
What are 3 characteristics to return to gym examples in terms of progressions?
- PROGRESSIONS: Slow progression of sets / reps / weight (depending on presentation), care with latent pain
- MAY progress further to dynamic exercises +/- adding load with dynamic exercises, but care needs to be taken (i.e. Kettle Bell Swings)
- Don’t forget cardio / cross training
- General fitness
- The patient loves cardio and don’t modify their activity/not appropriate anymore (need to give specifics)
What are 5 Cardio options (depending on presentation, stage of rehab, equipment available)?
- Exercise bike (upright or recumbent)
- If not too much flexion
- Treadmill +/- incline
- Cross trainer / elliptical trainer
- Stair machine
- Rowing machine
- Upper body fitness
What are 5 Les Mills group fitness type classes?
- Body Attack / Body Step / Body Combat —> Aerobics / Higher impact
- Not in the acute phase –> if they don’t want to stop –> give modifications
- Shock absorption through spine is massive (esp. pregnant women)
- Body Pump –> Weights (low weight, high reps)
- Shock absorption through spine is massive (esp. pregnant women)
- RPM / Sprint –> Indoor cycle
- Body Balance –> Mixture of yoga / Pilates / Tai Chi
- Extreme positions (eg. hypermobile –> pull out of stretching )
- Body Jam / Sh’bam –> dance classes (higher impact)
When should you used group fitness Les Mills type classes?
Not in the acute phase –> if they don’t want to stop –> give modifications
