LBP- exam 1 Flashcards
What is the STarT Back Tool regarding LBP
determines risks of persistent disabling P! and matches treatments
Which vertebral spine has the smallest amount of spine-related pathology?
thoracic
______ is the leading cause of:
worldwide disability
activity limitation and work absence
half > 65 yrs. of age will have _____
______% will experience ______ in their lifetime
LBP; LBP; 80%
Prevalence of LBP:
-women ______ men
-older_____ younger age
-lower___________
-higher__________
women > men
older > younger ages
lower educational status
higher physical work demands
Risk factors of LBP:
previous LBP
co-morbidities (diabetes, asthma,etc.)
poor mental health
smoking, obesity, and low activity levels
awkward postures, heavy lifting, and fatigue
genetics w/age related disc changes ONLY, otherwise questionable
Functional ROM: sit—–stand
Picking up objects from the floor:
35-42º flexion
60º flexion
You must complete the normal range to be functional. T or F
False
LBP imagining with MRI
-1/3 of asymptomatic individuals had “abnormal” findings which are:
IDD
Age-related disc changes
N. compression
Facet hypertrophy
1/2 of __________ individuals with LBP had abnormalities
symptomatic
Imaging with CT and MRI - 2/3 of asymptomatic individuals had disc changes from __________ yrs. of age
30-60yrs.
Who should get imagining with LBP?
> 50yrs. of age w/ hx of cancer
saddle parathesis
bowel and bladder dysfunction
specific neurological deficits (spinal n., brain, spinal cord)
progressive/disabling symptoms
NO improvement after 6wks. of conservative Rx
Imagining DOES improve outcomes and guidelines consistently recommend. T or F
False; DOES NOT
Nearly all cases have an _________ source hence the term non-specific LBP
unidentified nociceptive
PT Rx:
__________ gap between evidence and_______
___________ of unsupported and _________ Rx
SUBSTANTIAL; practice
OVERUTILIZATION; ineffective
Most LBP preventions _________ evidence and _______ is largely effective in adults.
lack; exercise
First line Rx for LPB
-against
-for (6)
against: bed rest, in-depth explanation of the cause
:spinal and structural strength
neuroscience explanation
overall favorable prognosis
active P! coping mechanisms that decrease fear
stay active w/early resumption for ADLs
emphasis on function
Why is education important for LBP pts.
greater emotion = greater P! and persistence
improve emotion = less P! and persistence
Dry needling is the most beneficial PT Rx for pts. with LBP. T or False
false; very low to moderate evidence of benefit on P!
What are some examples of modalities?
Are they effective?
heat, US, e-stim, LASER, etc
generally ineffective and NOT recommended, short-term results at best (window to begin other interventions)
soft tissue mobilization is a long-term or short-term benefit of all LBP types?
short term
What are some barriers to overcome to BEST practice?
increase consultation time and follow up
better incentives to return to work
PSA - the basics
reward quality and NOT volume with reimbursements
PT Rx:
LBP Classifications into subgroups, which are:
mechanical traction
directional preference
mobilization/manipulation
stabilization
The MOST beneficial traction for LBP is static tx. T or F
false; NO benefit
When intermittent tx is most often beneficial
pts experiencing radiculopathy
Intermittent Tx is more supported in ______ and when
_____ yrs of age
_____in last 24hrs. distal to knee
Oswestry questionnaire score > ______
_____ n. root compression, crossed SLR, and/or centralization
prone
18-60
paresthesias
30
(+)
What is centralization?
abolition of distal and/or spinal P! in a distal to a proximal direction in response to repetitive motion(s) or sustained position(s)
What is directional preference and where is it most commonly?
a position, motion, and/or factor that alleviates symptoms
MOST common extension, may centralize LE symptoms to LB
What is most effective for subgroups?
Manipulation
Manipulation effect larger than _________
Greater effective when combined with _______
Long-term effect ______ well established
mobilization
exercise
NOT
Mobilization/Manipulation non-thrust mobilization helps:
decrease pressure P! threshold
Can you begin the exercise with stabilization ?
Yes, safe and effective to do it early
-3x10 low resistance
You MUST supervise pts. with LBP. T or F
False, only if pt. NOT progressing or presistent LBP exists
Sub-acute and persistent LBP
First Line Rx: in order is
(2)
- motor activation/coordination
- Aquatic therapy, pilates, and yoga
LBP pts. get mental health benefits w/ resistance and aerobic training? T or F
True
__________prevents reoccurrences @ 3yrs after 4 wks of training
motor control - local mm activation
Motor control - local mm activation is effective for nonspecific LBP and functions in _______ or w/ other _________
isolation; therapeutic exercises
Diaphragmatic breathing is _________ with persistent LBP
impaired
Cognitive Behavioral Therapy:
-first-line Rx with persistent LBP
helping pts understand and manage all biopsychological elements contributing to their symptoms
- prognosis for LBP _________
1a. _______52%
_______58%
82% of pts ______________
rapid improvements within one month
P!
Disability
return to work
Most pts. with LBP improve substantially in _________ wks.
6
MD Rx:
_____________ ONLY recommended with an inadequate response to exercise and cognitive behavioral therapy
medications
MD Rx:
_________ and _______ injections are NOT recommended for non-specific LBP
epidural; facet joint
What are epidural injections recommended for?
radicular P!
