Lecture 6

Question 1

What is the presumed natural history of LBP?

Answer 1

“80-90% of attacks of low back pain recover in about
six weeks, irrespective of the administration or type of
treatment.”

Question 2

Why bother treating LBP? Isn’t LBP a

self-limiting disorder?

Answer 2

No, the natural history of LBP is characterized by persistent or recurrent episodes.

Question 3

What is the relationship between bed rest and the reduction of LBP and Sciatic?

Answer 3

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

Question 4

What is the relationship between acupuncture and the reduction of acute/chronic LBP?

Answer 4

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

Question 5

What is the relationship between message therapy and the reduction of subacute to chronic LBP?

Answer 5

Subacute/Chronic LBP
 May be beneficial for pain and function
 Larger effects with multimodal approach
▪ Exercise
▪ Education

Question 6

What is the relationship between lumbar supports and the reduction of LBP?

Answer 6

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.

Question 7

What is the relationship between transcutaneous electrical nerve stimulations and the reduction of chronic LBP?

Answer 7

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

Question 8

What is the relationship between heat and ice on the reduction of LBP?

Answer 8

 Heat: moderate evidence of small, short term pain
reduction
 Cold: current lack of evidence precludes conclusions

Question 9

What is the relationship between shoe insoles and the reduction of LBP?

Answer 9

 Strong evidence that insoles do not prevent LBP

Question 10

What is the relationship between low level laser and the reduction in LBP?

Answer 10

Current lack of evidence precludes conclusions

Question 11

What are the LBP treatment guidelines for acute- subacute LBP?

Answer 11

 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.

Question 12

What are the LBP treatment guidelines for chronic LBP?

Answer 12

 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.

Question 13

What are the options not recommended for non-specific LBP by the treatment guidelines?

Answer 13

 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

Question 14

What are the options recommended for non-specific LBP by the treatment guidelines?

Answer 14

 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)

Question 15

What is the better functional outcomes of a patient with LBP?

Answer 15

 patient compliance with self-exercise and therapy attendance
 application of exercise and manual therapy

Question 16

What is the worse functional outcomes of a patient with LBP?

Answer 16

 women
 electrotherapy for pain management
 therapeutic ultrasound for shoulder impairments.

Question 17

What are some under-utilized treatments for LBP?

Answer 17

 Therapeutic exercise

 Treatment of depression

Question 18

What are some over-utilized treatments for LBP?

Answer 18

 Muscle relaxants
 Traction
 TENS units
 Corsets

Question 19

15% of LBP is determined e.g. (trauma, stenosis, infection)

85% of LBP is non-sepcific LBP, TRUE or FALSE

Answer 19

True

Question 20

What are the role of the transversus abdominis?

Answer 20

Contributes to spine stability by Insertion with
the thoracolumbar fasica. Influence to increase intra-abdominal pressure but not disc pressure
 Decreases SI joint laxity

Question 21

What are the 2 changes that occur to the transversus abdominis?

Answer 21

▪ Delayed

▪ Attenuated

Question 22

What is the role of Lumbar multifidus?

Answer 22

 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

Question 23

Lumbar multifidus origin, action and insertion

Answer 23

Insertion: SP or vertebrae
Origin: TP of vertebrae
Action: extension and lateral rotation

Question 24

Lumbar Multifidus muscle changes after back injury include what?

Answer 24

Structural remodelling, adipose and connective tissue but not muscular atrophy

Question 25

What morphological changes can occur to the lumbar multifidus muscle during back injury?

Answer 25

1. atrophy
2. fatty infiltration
3. elasticity

Question 26

Stabilization exercises work by doing what?

Answer 26

 Addressing deficits in strength, endurance, and function

 Improvements in function lead to decreases in pain and disability

Question 27

What stabilization plan should you make for your patient?

Answer 27

 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

Question 28

LBP Recurrence: comparison between medical management and stabilization exercises?

Answer 28

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

Question 29

What is included in the Aberrant motion assessment?

Answer 29

 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

Question 30

What is involved in the prone instability test?

Answer 30

1. P-A test for pain provocation
    Identify painful segments
2. Repeat P-A with hips extended
    Positive finding: previously painful segments become
   less painful

Question 31

Know the red flag table

Answer 31

SLIDE 107