Lumbar Spine Flashcards
Radiology and LBP
advanced imaging as the first intervention is associated with higher health care utilization and charges than physical therapy
pt knowledge of imaging findings does not alter outcome and is associated with lesser sense of well-being
Diagnostic imaging is indicated for
pts with low back pain only if they have severe progressive neurologic deficits or S/S that suggest a serious underlying condition
Red flags clinical exam
*4 weeks is adequate amount of time for msk to respond to PT”
general health changes
hx of cancer
unexplained weight loss
fevers and chills
recent history of infection
loss of bowel/bladder control
saddle paresthesisas
spasms
severe pain
atypical location of symptoms
extreme limitation of movement
What indicators predict time of recovery?
lower avg initial pain score
shorter duration of symptoms
persons w/fewer previous episodes
not avoiding activities
self-efficacy
understanding of what pain/recovery entails
Gaining Compliance through communication and understanding
pt perceptions
discussion of compliance
use of cues
self-efficacy
generalization (transferring info to new siutations)
evaluate
CPGs for LBP
classify individuals with LBP
interventions are matched to S/S and limitations
first choice should be exercise, STM, pt education
Selection of exercise interventions should be based on
clinical reasoning
research evidence
pts values, expectations, preferences
Pathoantomical vs Classification
don’t try to identify source of symptoms, instead identify symptoms and place pt into a subgrop
Centralize w/movement in 1 direction and peripheralize with an opposite movement EXTENSION INTERVENTIONS
Specific exercise classification
end-range extension exercises
mobilization to promote extension
avoidance of flexion
mobs of LE
exercise to address impairments
neural gliding
Centralize w/movement in 1 direction and peripheralize with an opposite movement EXTENSION CHARACTERISTICS OF PT
symptoms distal to butt
centralize w/lumbar extension
peripheralize with lumbar flexion
directional preference for extension
Acute disk lesions
mid 30s to 40s
bending, lifting, attempt to stand after sitting in flexion
pain is almost constant, increases with inactivity. Flexion causes severe pain, extension limits pain
Centralize w/movement in 1 direction and peripheralize with an opposite movement FLEXION CHARACERISTICS
older age
directional preference for flexion
usually lumbar spinal stenosis
Centralize w/movement in 1 direction and peripheralize with an opposite movement FLEXION INTERVENTIONS
mobs or manips of the spine and LE
exercise to address impairments of strength/flexibility
body weight supported treadmill ambulation
Centralize w/movement in 1 direction and peripheralize with an opposite movement LATERAL FLEXION CHARACTERISTICS
visible frontal plane deviation of shoulders to pelvis
directional preference for lateral translation movements of pelvis
Centralize w/movement in 1 direction and peripheralize with an opposite movement LATERAL FLEXION INTERVENTIONS
exercises to correct lateral shift
mechanical or positional traction
Have recent onset of symptoms <16d
AND no symptoms distal to knee
manipulation classification
Does pt have at least 3 of the following
avg SLR ROM >91
positive prone instability test
positive aberrant movements
age <40
Stabilization classification
Pt subgroups of 2021 CPG
acute or chronic LBP
LBP w/leg pain
LBP in >60yrs
Post-op LBP
Instability means
urgent or emergency condition
Unstable segment
motor control issues
What are teh typical S/S of a person that may benefit from stabilization exercises?
catching
3+ episodes of LBP
increased episodes of LBP
Exercises for pts with back pain and leg pain
Trunk activation exercise (acute and chronic)
Trunk strengthening (acute)
Acute LBP exercises
Trunk activation exercise
Chronic LBP exercises
Trunk strengthening
Multimodal
Trunk activation
Aerobic
General
Older adults LBP exercises
general
Postoperative LBP exercises
general
Trunk muscle strengthening and endurance exercise
exercise training prescribed to restore or improve strength, endurance, power of trunk
Specific trunk muscle activation exercise
target specific deep trunk muscles using co-contraction to alter or restore control or coordination of lumbopelvic region
General exercise
restore or improve overall strength or endurance of major muscle groups of the upper/lower extremities and trunk, including flexibility and aerobic
Aerobic exercise
restore or enhance capcity of efficiency of CV system
Multimodal exercise
exercise training that combines 2 or more of the LBP interventions
