LBP management and lumbar issues and directional pref Flashcards
Acute low back pain
Less than four weeks
24% of US adults in a three month window
13.7% receive opioids.
33% get imaging
Unlikely to get PT referral
Overmedicalization of the condition
Underutilization of the best evidence for care
Inappropriate care, waiting surgery leads to chronicity
role of imaging for low back pain
Assess trauma
Presence of red flags or neurodeficits
Nonresponse to care
Risk of low back pain imaging
patient and provider or overreliant on imaging
decision making an absence of imaging correlation to clinical exam
Radiation exposure
Reality of image usage for low back pain
increases risk for surgery
Results change management
Useful when:
Clinical exam correlation is warranted
Lack of progress, despite care
Trauma evaluation
Non-musculoskeletal source considered
Influences of chronic low back pain
ages, 50 to 69
Less than high school education level
Lower household income
Receipt of disability income
Depression
Sleep disturbances
Comorbid medical conditions
What percentage of patients with back pain have concurrent leg pain
60%
25% stays above the knee
38% extends below the knee
somatic pain
Poorly localized
Diffuse
achy
Referred pain
Presenting in a non-local area
radicular pain
Sharp shooting generally narrow, band like pain in a defined area
Dermatomal pattern
Damaged nerve root being compressed
Unilateral
Radiculopathy
myotome weakness
Decreased to absent muscle stretch reflex
Decreased to absent sensation
Less than 5% of patients with low back pain and lower extremity symptoms
nerve root compression, but root itself is not damaged causes…
Radiculopathy, but not pain
radicular pain and radiculopathy do not always present together
Causes of lower extremity radicular pain and radiculopathy signs
Degenerative changes
Disc herniation
Space occupying lesion
Trauma
degenerative changes
Decreased space
Disc desiccation
-IVD space Narrows
Fibrosis
osteophytes - bone growth do to increase bone stress
Associated inflammation
Plate changes
disc herniation
Focal or localized displacement of disc material outside of the intravertebral disc space margins
protrusion, extrusion, sequestration
Space occupied lesion
Cancer infection other
constitutional signs
Red flags
Medical history
Family history
Thoracic and lumbar nerve exit
below the numbered vertebra
if lumbar disc is involved it is most commonly the disc
Above the numbered vertebra
lesion at L4, L5 would effect?
L5 nerve root
traction
Not recommended for patients with chronic low back pain with leg pain
peripheralization with extension and positive SLR may benefit
normal neural exam for myotomes reflexes and sensation
negative straight leg, raise test for nerve root and disc
non-radicular pain
No radiculopathy signs
neural mechanicosensitivity
no radiculopathy signs non-radicular pain
slump for nerve root would be back and leg pain
Positive findings on slump test that are not nerve root are most likely more distal symptoms present with sensitizing movements, not basic slump position with knee extended
treatment for low back pain with lower extremity neural Mechanicosensitivity
slump stretch- low severity, irritability, prolonged holds
Tensioners - low irritability, more persistent symptoms
Sliders- higher irritability, more acuity
LBP classification- manipulation
no symptoms below knee
Onset less than 16 days
low FABQ
Hypomobility
Hip internal rotation, greater than 35
LBP classification- directional preference
centralization phenomenon With movement exam
Postural preference
LBP class- stabilization
Prone instability test
Aberrant motions
Hyper mobility
Age is less than 40
Straight leg raise greater than 91
LBP class- traction
neurological signs
Leg symptoms
peripheralization with movement exam
Crossed SLR
first thing to do with directional preference
Correct the lateral shift
lateral shift patient has no pain
educate with mirror, tactile queuing visualization
Improve body awareness and general proprioception about where the body is in space
lateral shift patient has pain
Active correction, in standing
Passive correction in sidelying
Manuel treatment based on assessment
extension treatment in directional preference
Prone lying static
Prone lying extension static
Extension in lying
Extension in lying with clinician overpressure
Extension mobilization
Extension in standing
flexion treatment, directional preference
Flexion in lying
Flexion sitting
Flexion in standing
Flexion in lying with clinician overpressure
