LECTURE 3: LUMBAR SPINE INTERVENTIONS Flashcards
What are goals for acute phase of LBP?
mainly increase pain free ROM!
manual therapy is ____ beneficial if used early in patients that present ____ radiating leg pain
MOST BENEFICIAL with out radiating leg pain in ACUTE PHASE
what phase is CRITICAL in preventing chronicity and disability in LBP
sub-acute phase
EDUCATION IS VITAL IN THIS PHASE
What should you do to help intervene in chronic LBP?
- maximize function, encourage exercise!
- pain science education!!!
use a multi-modal approach
primary hyperalgesia
damage to tissue
-1st sensitization
-normal pain, protective bc of mechanical/chemical damage!
2ndary hyperalgesia
everything around tissue is in pain!
also normal
central sensitization is what?
CHRONIC PAIN due to functional changes in CNS: a heightened response to something that has already healed.
-altered homunculus/sensory processing
-descending anti-nociceptive mechanisms malfunction (feel good hormones not released as much)
-increased activity of pain facillatory pathways
What should you do with patients who have chronic PAIN?
de-threaten the biggest threat (fear vs pain)
medical management category for triage of LBP
-red flags
-comorbidities that are super important to address first
-leg pain with progressive neuro deficits
self-care management category for first contact health care provider triage
- low risk for psychosocial (no yellow flags)
- predominantly axial LBP
- minor or controlled comorbidities
rehab management for first contact health care provider triage
-med-high psychosocial risk
-LBP with predominantly leg pain and low psychosocial risk status
-minor/controlled comorbidities
what are the three categories for appropriate rehabilitation approaches?
- symptom modulation
- movement control
- functional optimization
CPR for manual therapy for LBP
- no symptoms past knee
- more acute (less than 16 days)
- FABQ less than 19
- at least 1 hypomobile segment in L spine
- at least 1 hip with over 35 degrees of IR
CPR for stabilization for LBP
- younger (below 40 years)
- bendy (post-partum, SLR over 91 degrees)
- aberrant mvmts or instability catch with bending/extending
- positive prone instability test
- positive pelvic pain prov., ASLR, mod Trendelenburg tests OR pain with palpation of long dorsal SI ligament/Pubic symphysis
direction specific exercises are chosen when pain is
in leg too!
contraindication for joint manipulations
- Presence of serious pathology
- PT skill
- Fracture
- Ligament rupture
- No working hypothesis
- Worsening neurological function
- Unremitting night pain
- Severe multi-directional spasm
- UMN lesions
body weight supported treadmill is good for
unloading spine for patients with
-spinal stenosis
-radicular symptoms
*use with manual therapy! or nerve glides
when should you use passive modalities?
evidence does not support.
consider for chronic LBP!
-difficulty with exercise
-short term management
-patient comfort
progression for LBP treatment seession
- manual therapy
- mobility ex
- NM re-ed
- strength
- functional ADL
use thrust manipulations for
acute LBP
use thrust and non thrust techniques for
subacute/chronic LBP
true or false: dry needling is most effective for acute LBP
FALSE
*maybe sub-acute or CHRONIC (short term effects)
When is early Sx intervention warranted?
- cauda equina
- B&B
- progressing motor deficits
- spondy grade 4-5
- severe pain (fx, infection, cancer)
- progressing scoliosis (over 45-50 degrees)