LECTURE 3: LUMBAR SPINE INTERVENTIONS

Question 1

What are goals for acute phase of LBP?

Answer 1

mainly increase pain free ROM!

Question 2

manual therapy is ____ beneficial if used early in patients that present ____ radiating leg pain

Answer 2

MOST BENEFICIAL with out radiating leg pain in ACUTE PHASE

Question 3

what phase is CRITICAL in preventing chronicity and disability in LBP

Answer 3

sub-acute phase
EDUCATION IS VITAL IN THIS PHASE

Question 4

What should you do to help intervene in chronic LBP?

Answer 4

1. maximize function, encourage exercise!
2. pain science education!!!

use a multi-modal approach

Question 5

primary hyperalgesia

Answer 5

damage to tissue
-1st sensitization
-normal pain, protective bc of mechanical/chemical damage!

Question 6

2ndary hyperalgesia

Answer 6

everything around tissue is in pain!
also normal

Question 7

central sensitization is what?

Answer 7

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

Question 8

What should you do with patients who have chronic PAIN?

Answer 8

de-threaten the biggest threat (fear vs pain)

Question 9

medical management category for triage of LBP

Answer 9

-red flags
-comorbidities that are super important to address first
-leg pain with progressive neuro deficits

Question 10

self-care management category for first contact health care provider triage

Answer 10

1. low risk for psychosocial (no yellow flags)
2. predominantly axial LBP
3. minor or controlled comorbidities

Question 11

rehab management for first contact health care provider triage

Answer 11

-med-high psychosocial risk
-LBP with predominantly leg pain and low psychosocial risk status
-minor/controlled comorbidities

Question 12

what are the three categories for appropriate rehabilitation approaches?

Answer 12

1. symptom modulation
2. movement control
3. functional optimization

Question 13

CPR for manual therapy for LBP

Answer 13

1. no symptoms past knee
2. more acute (less than 16 days)
3. FABQ less than 19
4. at least 1 hypomobile segment in L spine
5. at least 1 hip with over 35 degrees of IR

Question 14

CPR for stabilization for LBP

Answer 14

1. younger (below 40 years)
2. bendy (post-partum, SLR over 91 degrees)
3. aberrant mvmts or instability catch with bending/extending
4. positive prone instability test
5. positive pelvic pain prov., ASLR, mod Trendelenburg tests OR pain with palpation of long dorsal SI ligament/Pubic symphysis

Question 15

direction specific exercises are chosen when pain is

Answer 15

in leg too!

Question 16

contraindication for joint manipulations

Answer 16

1. Presence of serious pathology
2. PT skill
3. Fracture
4. Ligament rupture
5. No working hypothesis
6. Worsening neurological function
7. Unremitting night pain
8. Severe multi-directional spasm
9. UMN lesions

Question 17

body weight supported treadmill is good for

Answer 17

unloading spine for patients with
-spinal stenosis
-radicular symptoms
*use with manual therapy! or nerve glides

Question 18

when should you use passive modalities?

Answer 18

evidence does not support.
consider for chronic LBP!
-difficulty with exercise
-short term management
-patient comfort

Question 19

progression for LBP treatment seession

Answer 19

1. manual therapy
2. mobility ex
3. NM re-ed
4. strength
5. functional ADL

Question 20

use thrust manipulations for

Answer 20

acute LBP

Question 21

use thrust and non thrust techniques for

Answer 21

subacute/chronic LBP

Question 22

true or false: dry needling is most effective for acute LBP

Answer 22

FALSE
*maybe sub-acute or CHRONIC (short term effects)

Question 23

When is early Sx intervention warranted?

Answer 23

1. cauda equina
2. B&B
3. progressing motor deficits
4. spondy grade 4-5
5. severe pain (fx, infection, cancer)
6. progressing scoliosis (over 45-50 degrees)