LBP treatment 2 of lumbar clinical syndromes Flashcards
what are some examples of types of exercises that can be prescribed for LBP?
-joint mobility- passive, active and active assisted
-muscle training - strengthening, power, endurance, control
-neurodynamic mobilising exercises “sliders and tensioners”
-co-ordination/ balance / proprioceptive activities
-cardiovascular or aerobic - NB (can help reduce inflammation)
was exercise or exercise + education combined more effective in LBP prevention according to research?
exercise + education
what are some manual therapy options for LBP?
-physiological movements - PPIVMS
-accessory movements
-Joint manipulation
-soft tissue techniques eg massage, trigger point compression, PNF, dry needling
-neurodynamic mobilisation (for radicular leg pain)
how could mechanical LBP be managed/ treated by physio?
-exercise program - aerobic, stretching, rom,strengthening (maybe)
-education - re compliance for success
-manual therapy - depends on age and if necessary - could be good for tightness or hypo mobility
what are the key management strategies for discogenic LBP?
-education- precautions regarding any activity or position that loads the symptomatic disc eg flexion or extension, lifting, sitting in flexion
-education - remain active and avoid too much bed rest
-Mckenzie exercises eg extension or lumbar rotation
exercise - first aid (pain relieving exercises) eg Mckensie, core rehab, flexibility eg hamstrings and aerobic fitness
-manual therapy - PPIVMS
recap - what is a radiculopathy?
a compression or irritation to a nerve root
what are the majority of causes of radiculopathy - according to age eg 30-50s or older patient eg 50+?
-majority of patients aged 30-50 will have a disc aetiology
-older patients 50+ cause is more likely to be related to degeneration eg spondylosis (fowlers position (will help - position of ease)
what is neurodynamics?
-an intervention aimed at restoring the homeostasis (balance) in and around the nervous system, by mobilising the nervous system itself or the structures that surround it
what does mechanosensitive mean?
cant be moved much and painful in response to longitudinal movement
recap: what do neurodybamic tests assess?
the neural compliance to movement
pos- reduced range of test with reproduction of neuropathic pain
how can we describe neurodynamic exercises for radiculopathy?
-the neurodynamic test movements are the exercises
-but NB not prescribed for every patient with radicular leg pain - and NB if they have protective muscle reactivity eg hamstrings
we don’t want to be aggressive stretching the hamstring early on
what is the criteria for direct mobilisation of neural tissue?
-they must have radicular pain or painful radiculopathy with < 1 neuro sign
what is a neuro slider exercise?
when one end of the nerve is lengthened and one is shortened, allowing the nerve to glide/slide
purpose
-it promotes nerve movement within its surrounding structures
-helps with nerve desensitisation
-best for acute nerve irritation
what is a tensioner nerve exercise?
when the nerve is stretched at both ends and applies tension
-increases nerve stretch and mobility
what are contraindications to neuro mobilisation treatment?
-if the radiculopathy is going from unilateral to bilateral
-a LMN that converts to a UMN lesion
-if the treatment causes more pain in the distal leg pain
any of those indicate that the neurological deficits are worsening
what is the management for lumbar spondylosis?
-advice and education - keep active and keeping strong
-manual therapy
-exercise - mobilising exercises are key, strengthening
