Lumbar And SIJ Flashcards
Low back pain with movement coordination deficits
Acute versus seven acute versus chronic
Symptoms impairments and interventions
Symptoms:
– Acute/subacute/chronic – referred extremity pain, numerous episodes in recent years
Impairments:pain reproduced with provocation of involved segments, movement coordination impairments
– Acute: pain with rest and initial to midrange movements
– Subacute: pain with mid range and in range movements
–Chronic: pain worsens with sustained and range movements in positions
–Subacute/chronic: mobility deficits and thorax and lumbopelvic region, diminished trunk pelvic muscle strength and endurance
Interventions: neuromuscular reeducation, self-care/management training/work reintegration training.
– Acute: considered temporary external device
– subacute/chronic: manual therapy, therapeutic exercise
low back pain with mobility deficits
Acute vs subacute
Symptoms impairments interventions
Symptoms:
–acute-pain duration less than one month, unilateral, onset link to recent awkward movement or position
– Subacute- unilateral lower back pain, sensation of back stiffness
Impairments:
–Acute-range of motion limitations, restricted segmental mobility, symptoms provoked with spinal movement
– Subacute – symptoms reproduce with end range spinal motions, restricted the thoracic, lumbar, lumbopelvic, or hip range of motion and mobility testing
Interventions:
– Acute/subacute –manual therapy, therapeutic exercise for spinal mobility, patient education for return to active lifestyle
Acute low back pain with related lower extremity pain
Symptoms impairments interventions
Symptoms: symptoms worsen with flexion activities, no paresthesias
Impairments: there extremity pain can be centralized with specific postures, reduced lumbar lordosis, limited lumbar extension mobility, lateral shift
Interventions: therapeutic exercise/manual therapy/traction to promote centralization and improve lumbar extension mobility, patient education, progress to intervention strategies consistent with seven cute or chronic low back pain with movement coronation impairments
Indications for low back pain with related cognitive or affective tendencies
One or more of the following:
– two positive responses to primary care evaluation of mental disorder screen.
1: during the past month have you often been bothered by feeling down depressed or hopeless?
2: during the past month have you often been bothered by little interest or pleasure in doing things?
– High FABQ
– High pain catastrophizing scale
Lumbar spine differential diagnosis recommendation level and three conditions for referral
Recommendation level: a
Conditions for referral:
1: patient clinical findings are suggestive serious medical or pathologic pathology
2: reported activity limitations or impairment of body function and structure are not consistent with those presented in the diagnostic section section of these guidelines
3: patient symptoms are not resolving with interventions aimed at normalizing the patients impairments of body function
Lumbar spine outcome measures and MDC
ODI – 10
Role in Morris disability questionnaire – five
Low back pain interventions and recommendation level
Manual therapy – A
Trunk coordination strengthening and endurance exercises – A
Centralization and directional preference exercises – A
flexion exercises – C
or quarter nerve mobilization exercises – C
Traction – D
Patient education counseling – B
Progressive endurance exercise and fitness activities – A
Subgroup of patients with lumbar spine radicular symptoms they respond well to mechanical traction
Signs of nerve root compression along with Peripheralization of symptoms or positive cross straight leg raise
Low back pain with radiating pain
Acute versus subacute versus chronic
Symptoms impairments and interventions
Symptoms: radiating pain in the lower extremity, or extremity paresthesias numbness and weakness
Impairments: LE radicular symptoms, positive intention test, nerve root involvement
-Acute – initial to mid range, subacute – midrange the end range, chronic – sustained and range
Interventions patient education to reduce compression and manage pain, manual therapy, traction, nerve root mobility
Clinical prediction rule for manual therapy and low back pain
Two most predictive factors of clinical prediction rule
Symptoms ration less than 16 days No symptoms distichs knee Lumbar hypomobility At least one hip greater than 35° internal rotation FABQ score less than 19
Four more increased success with thrust manipulation from 45 to 95%
Most important factors: symptom duration less than 16 days and not having symptoms distal to knee
Clinical prediction rule for stabilization exercises
Age less than 40
Positive prone instability test (+LR= 1.7, -LR= .48)
Presence of aberrant movement with motion testing
Straight leg raise greater than 91°
Three out of four = positive LR 4.0
Fewer than two = negative LR .20
Factors that do not negatively affect recovery from low back pain
Work-related spinal loading, prolonged sitting, participation in sports activities
Clinical prediction rule to determine likely recovery time
Lower than average initial pain
Shorter duration of symptoms
Fewer previous episodes
Yellow flags for low back pain (7)
Emotional distress, hypervigilance, pain catastrophizing, elevated FABQ, low self efficacy, miss understanding of the nature of their pain, misunderstanding about best interventions for long-term success
Lumbar spine fracture rules
Prolonged use of corticosteroids Mild trauma age greater than 50 years Age greater than 70 years Known history of osteoporosis Recent major trauma at any age
