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
