Lecture 3: Lumbar Spine Interventions Flashcards
manual therapy: classification criteria
Anatomic location
Duration of current episode of pain
Score on FABQ
Results of segmental mobility testing in
PA direction
Hip internal rotation ROM
No sx distal to knee
Less than 16 days
Score of less than 19
At least 1 hypomobile segment in L-
spine
At least 1 hip w/ >35° of internal rotation
treatment “buckets”
Manip/manual therapy
stabilization exercises
direction-specific exercises
traction
stabilization: classification criteria
age?
general flexibility?
aberrant movements in lumbar spine?
lumbar instability?
patient hx?
- younger (<40)
- greater general flexibility (postpartum, average SLR 91)
- visible “instability catch” or aberrant mvmt during lumbar flexion / extension ROM
- prone instability test
- pt hx: post partum, (+) posterirl pelvic pain provocation, ASLR, modified trendeleburg test
OR
pan with palpation of long dorsal SI Ligament or pubic symphysis **
Direction-Specific Exercise Classification
extension?
flexion?
lateral shift?
extension: centralized pain w/ extension, periperalized with flexion
flexion: centralized wtih flexion, peripheralized with extension
lateral shift: visible frontal plane deviation of shoulders relative to pelvis, asymmetrical SB AROM and restricted/painfu; ext AROM
Direction-Specific (Extension):
Classification Criteria
- anatomic location?
- sx response to lumbar ROM?
- subjective response to movement
- distal to buttock
- sx centralize with ext, peripheralize with flx
- directional preference to extensino
Direction-Specific (Flexion):
Classification Criteria
age?
subjective response to movement?
imaging evidence?
- older (>50)
- prefer flexion
- stenosis
Direction-Specific (Lateral Shift):
Classification Criteria
- observation?
- response to movement?
- visible frontal plane shift of shoulders relative to pelvis
- directional preference for lateral traslation movement of pelvis
Traction: Classification Criteria
sx decrease w/ manual or autotraction
Acute Phase Intervention Goals
↓ pain, inflammation and mm spasm
* Promote tissue healing
* ↑ pain-free ROM (i.e. segmental
motion)
* Regain soft tissue extensibility
* Regain NM control
* Allow progression to sub-acute/
functional phase
what is a great inital choice of tx for the acute phase? what is not?
walking (good)
bed rest (bad)
early motion despite sx is encouraged
manual therapy is MOST beneficial for these patients
patient WITHOUT radiating pain
Sub-acute/Functional Phase Intervention Goals
significant ↓ or complete
resolution of pt’s pain
* Restoration of full and pain-free vertebral ROM
* Full integration of entire upper and lower kinetic chains
* Complete restoration of respiratory function
* Restoration of t-spine and UQ/LQ strength and NM control
Research suggests THIS phase =CRITICAL in preventing chronicity and
disability
* # of PT sessions required to achieve goals in THIS phase varies widely
* Correctly categorizing and then re-categorizing pts as tx progresses is VITAL
for successful outcomes in this phase
* Graded activity improved absenteeism (ie.
miss less work) in this phase
sub acute phase
continue encouraging aerobic exercise to increase activity tolerance / functional training and mobility/stretching for increased ROM
Chronic Phase Intervention Goals
-
- Maximize function and
encourage exercise! - Can ↓ pain in chronic stage
- Educate pt regarding using pain
science techniques - Use multi-modal approach
tailored to pt’s needs - Aerobic exercise
- Meds
- Etc
1º Hyperalgesia (1º Sensitization)
Normal hyperalgesia that is a protective
mechanism
2º Hyperalgesia
Adaptations in CNS
* ↑ responsiveness to stimuli from
periphery
