L6 Treatment of the Lumbar Spine by Problem Flashcards
facet impingement treatment
joint mobs, manips, or SNAGs
STM, PNF contract relax
muscle energy’
ther ex
directional preference
posture re-ed
facet joint sprain treatment
extension preference
mild-mod mobilizations to help movement restrictions and prevent future hypomobility
postural re-ed to avoid stiff posture
core/lumbar stabilization may help as pain will inhibit core muscles
DDD treatment - mild/mod
mobs, traction, posture training: for hypomobility
core stabilization: for hypermobility due to slackened ligaments, to improve muscle support to stabilize spine due to degeneration destabilizing
make sure pt develops posture in pain free range/neutral
DDD treatment - severe
minimize vertical loading
active mobility
bracing if symptoms increase
intra-spongy nuclear herniation treatment
aka endplate fracture
rest
avoid compressive forces on disc
control muscle guarding to reduce compression
alleviate pain with hyperextension and traction
brace pushing up on ribs to relieve vertical compression
breathing exercises for pain
soft disc treatment
posture re-ed for positions of comfort, due to fissure in disc pressure/loading disc will bring on symptoms even if relieved by MDT
HNP protrusion with no nerve root involvement - treatment
correct lateral shift if present
then passive extension if symptoms centralize w this movement
education on maintaining lordosis and active rest/walking, avoiding flexion and rotationt
PA for ext if needed for progression
breathing exercise
NMRE for addressing additional impairments
HNP protrusion with nerve root involvement
restore normal lordosis with posture re-ed, pt will be in flexion
mechanical traction
DON’T SLR, active extension, sit ups (passive MDT only) until 3 days without leg pain
then back strengthening
can nerve glide in slidelying to avoid pressure on disc
patient instructions for acute HNP protrusion
lordosis at all times, including sitting, sit to stand
no forward bending
avoid sitting/driving/lifting when in pain, and use lumbar roll
firm chair
drive w seat close to the steering wheel
lifting technique
cough or sneeze in extension to lessen pain
lumbar radiculopathy
likely from HNP w nerve root involvement, but pt now has positive neuro signs
traction
pt education on directional preference, reducing neural tension
use posture, joint mobs, STM to reduce foraminal entrapment
ther ex to address remaining impairments
spinal stenosis treatment
pt education on directional preference (flexion)
traction to control symptoms
mobs into flexion
use lumbar stab. to unweight spine
NMRE/strength of other joints/impairments
Neurogenic claudication - spinal stenosis - treatment
similar to DDD bc it is a progression of it
directional preference - flexion
improve hamstring/lumbar extensor length
ther ex: post pelvic tilt, abd shortening, to flatten lordosis
improve CV fitness on bike
nerve root adhesion treatment
scar tissue along the nerve pathway
LLTT
provoke symptoms during technique but should subside quickly after
STM or joint mob to area surrounding entrapment
HEP nerve mobilization
dural adhesion treatment
nerve mobility in slumped position
spondylolysis/spondylolisthesis treatment
posture re-ed
lumbar stabilization
flexion exercise
brace for vigorous activity
surgical fusion if severe
ankylosing spondylitis treatment
patient education on progressive process
firm mattress to keep in neutral position while stiffening
resist development of stiffening into flexion
extension exercise
joint mobs for extension while in remission
red flags for non MSK pain
symptoms increasing with rest/at night
symptoms not associated with movement/position
symptoms over large nonspecific areas
symptoms move from one joint to another
patient has a history of serious illness of serious constitutional symptoms
patient does not respond to a short trial of conservative treatment
