Lecture 6 Flashcards
What is the presumed natural history of LBP?
“80-90% of attacks of low back pain recover in about
six weeks, irrespective of the administration or type of
treatment.”
Why bother treating LBP? Isn’t LBP a
self-limiting disorder?
No, the natural history of LBP is characterized by persistent or recurrent episodes.
What is the relationship between bed rest and the reduction of LBP and Sciatic?
Acute LBP:
Bed rest less effective than advice to stay active
Sciatica:
No difference
Bed rest associated with long term disability
Bed rest results in:
Lumbar multifidus atrophy, trunk flexor shortening
What is the relationship between acupuncture and the reduction of acute/chronic LBP?
Acute LBP
Current lack of evidence precludes conclusions
Chronic LBP
More effective than no Tx or sham Tx
Not more effective than other therapy options
Possibly a useful adjunct
What is the relationship between message therapy and the reduction of subacute to chronic LBP?
Subacute/Chronic LBP
May be beneficial for pain and function
Larger effects with multimodal approach
▪ Exercise
▪ Education
What is the relationship between lumbar supports and the reduction of LBP?
Prevention
Moderate evidence supports not more effective
than lifting advice
Treatment
Conflicting evidence of low quality
May improve function in short term for Cx
No definitive evidence as yet supports the use
of orthoses after spinal interventions or in
painful conditions of the Cx or Lx spines.
What is the relationship between transcutaneous electrical nerve stimulations and the reduction of chronic LBP?
Chronic LBP (TENS vs. Placebo)
Conflicting evidence of effectiveness for pain
No evidence of effectiveness for disability
No difference in use of medical services
No difference in work status
What is the relationship between heat and ice on the reduction of LBP?
Heat: moderate evidence of small, short term pain
reduction
Cold: current lack of evidence precludes conclusions
What is the relationship between shoe insoles and the reduction of LBP?
Strong evidence that insoles do not prevent LBP
What is the relationship between low level laser and the reduction in LBP?
Current lack of evidence precludes conclusions
What are the LBP treatment guidelines for acute- subacute LBP?
STRONG-evidence in favour of SMT when
compared to sham for pain, function and health
improvements in the short-term (1-3 months).
MODERATE-evidence to support SMT and Mob +
STT combined with usual medical care (UMC) in
comparison to UMC alone for pain, function and
health improvements in the short-term.
What are the LBP treatment guidelines for chronic LBP?
MODERATE in favour of SMT in
comparison to sham for pain, function and
overall-health in the short-term.
MODERATE- evidence in favour of SMT &
mob & STT combined with exercise or
UMC in comparison to exercise and backschool
was established for pain, function
and quality-of-life in the short and longterm.
What are the options not recommended for non-specific LBP by the treatment guidelines?
Lumbar spine X-rays Interferential therapy TENS Therapeutic ultrasound Lumbar supports Spinal traction Laser therapy RF joint denervation Intradiscal electrothermal therapy (IDET) Injections of therapeutic substances into the back Percutaneous intradiscal radiofrequency thermocoagulation
What are the options recommended for non-specific LBP by the treatment guidelines?
Keep diagnosis under review at all times
AND
Promote self management: advise patients to exercise, be
physically active and to maintain normal activities as possible
AND
Offer appropriate drug treatments to manage pain and to help
people keep active
AND
Offer one or more of the following treatments
Exercise program (8 sessions)
Manual therapy (9 sessions)
Acupuncture (10 sessions)
What is the better functional outcomes of a patient with LBP?
patient compliance with self-exercise and therapy attendance
application of exercise and manual therapy
What is the worse functional outcomes of a patient with LBP?
women
electrotherapy for pain management
therapeutic ultrasound for shoulder impairments.
What are some under-utilized treatments for LBP?
Therapeutic exercise
Treatment of depression
What are some over-utilized treatments for LBP?
Muscle relaxants
Traction
TENS units
Corsets
15% of LBP is determined e.g. (trauma, stenosis, infection)
85% of LBP is non-sepcific LBP, TRUE or FALSE
True
What are the role of the transversus abdominis?
Contributes to spine stability by Insertion with
the thoracolumbar fasica. Influence to increase intra-abdominal pressure but not disc pressure
Decreases SI joint laxity
What are the 2 changes that occur to the transversus abdominis?
▪ Delayed
▪ Attenuated
What is the role of Lumbar multifidus?
The largest muscle to cross the lumbosacral
junction
Designed to stabilize the lumbar spine in prolonged flexion or extension
Controls segmental flexion
Provides 2/3 of the segmental stability at the lower
lumbar spine by dispersing load through the
thoracolumbar fascia
Contracts in an anticipatory fashion
Lumbar multifidus origin, action and insertion
Insertion: SP or vertebrae
Origin: TP of vertebrae
Action: extension and lateral rotation
Lumbar Multifidus muscle changes after back injury include what?
Structural remodelling, adipose and connective tissue but not muscular atrophy
What morphological changes can occur to the lumbar multifidus muscle during back injury?
- atrophy
- fatty infiltration
- elasticity
Stabilization exercises work by doing what?
Addressing deficits in strength, endurance, and function
Improvements in function lead to decreases in pain and disability
What stabilization plan should you make for your patient?
4 weeks of training 2 sessions of motor control training Prescribed 3 sets of 10 reps b.i.d. Improved TrA feedforward activation with arm flexion & arm extension Improvements retained at 6 Months
LBP Recurrence: comparison between medical management and stabilization exercises?
Medical Management Year 1: 84% Years 2-3: 75% Idiopathic As severe as original episode
Stabilization Exercise Year 1: 30% Years 2-3: 35% Traumatic Less severe then original episode
What is included in the Aberrant motion assessment?
Painful arc in Flexion (or return) Difficult return from flexion (Gower’s Sign) or thigh climbing Instability Catch (lateral flex or rotation) Reversal of lumbopelvic rhythm * At least one of these to be present
What is involved in the prone instability test?
- P-A test for pain provocation
Identify painful segments - Repeat P-A with hips extended
Positive finding: previously painful segments become
less painful
Know the red flag table
SLIDE 107
