lecture 3: lumbar spine interventions Flashcards
what are the 2 main objectives to LBP interventions
- relieve acute pain
-attempt to prevent transition to chronicity
individuals w LBP are ___ in nature
heterogenous
what are the acute phase intervention goals (6)
- decrease pain
-promote tissue healing - increase pain free ROM
- regain soft tissue extensibility
-regain NM control
-allow progression to subacute functional phase
what is the great initial choice for Tx for acute phase LBP
walking
what is the most beneficial if used early in pts what presents w/o radiating leg pain for LBP
manual therapy
what is highly encouraged in the acute phase of LBP
early motion
what is teh subacute /fucntinal phase intervention goals
-achieve significant decrease of pain
- restoration of full and pain free ROM
- full integration of upper and lower kinetic chains
- complete restoration of respiratory function
- restoration of t spine and UQ/LQ strength and NM contrl
research suggest that sub acute phase for LBP is CRITICAL in what
preventing chronicity and disability
what are the 3 major protocols for LBP that have been studied over the past 40 years
- williams flexion ex’s
-McKenzies ex’s - spinal stabilization ex’s
what are chronic phase intervention goals for LBP
-maximize function and encourage exercise
-use multimodal approach tailed to pt needs (aeordib ex’s , meds , etc)
what is the difference between chronic phase and chronic pain
chronic phase has no tissue damage just pain
what is primary hyperalgesia (primary sensitization)
normal hyperalgesia that is a protective mechanism
what is secondary hyperalgesia
adaptations in CNS
- increase responsiveness to stimuli from periphery
what is the hallmark to chronic pain
central sensitization
what is central sensitization
fucntinal changes in the CNS what include altered sensory processing in the brain, malfunctioning of descending anti nocicpetive mechanisms , increased activity or pain pathways
What are the clinical prediction rule (CPR’s) for manual therapy
- no ss distal to the knees
- less than 16 days of when pain started
- score of less than 19 on FABQ
- at least 1 hypo mobile segment in L spine
- at least 1 hip w > 35 ° of IR (bc then we know its not coming from the hip bc normla ROM)
what are the CPR’s for stabilization
- less than 40 years
- post partum , average SLR > 91°
- visible instability catch or aberrant movements during lumbar flexion/extenion ROM
- (+) prone instability test
- (+) postieor pelvic pain provaction , ASLR< modified tredeneleburg test ORRRRR pain w palpation of long dorsal SI ligament or pubic symphysis
what is the CPR’s for direction specific extension criteria
- ss distal to buttock (radiating pain)
- symptoms centeralize w lumbar ex
symptoms peripheralize w lumbar flex - directional preference for extension
what is the CPR’S for direction specific flexion criteria
- greater than 50 years
- directional preference for flexion
-lumbar spinal stenosis
what is the clinical prediction rules for direction specific (lateral shift) criteria for LBP
- visible frontal plane shift of shoulders relative to pelvis
- directional preference for lateral translation movements of pelvic
what is the McKenzie exercise
directional specific exercise for LBP , technique makes NO attempt at being tissue specific
what are the 3 direction specific exercise (McKenzie) terms and which is sent here most
- postural
- dysfunction
- derangement
3 is seen the most
what does the dysfucntion term for direction specific exercises mean
- pain only produced at end range
- fixed name pattern (always the same)
- radiate a little
- condition unchanged after testing
what is the derangement term for the direction specific exercises (McKenzie) mean
- symptoms produces/ altered w mid range movements
- painful arc may occur
- variable pain patterns
- progressive increase and decrease during test
- rapid and lasting changes after testing
