Lumbar Spine Part 3 Flashcards
Treatment-Based Classification
Lumbar Manipulation
Lumbar Instability
Lumbar Traction
Specific Exercise
Lumbar Manipulation for Acute LBP Predictor Variables
- Pain does not travel below the knee
- Onset less than 16 days ago
- Lumbar hypomobility
- Either hip has > 35° of internal rotation
- FABQ - Work subscale score < 19
High score on FABQ
suggest indication for active exercise–based approach in which feared activities gradually introduced to patient in controlled environment to assist patient in overcoming fears
Low scores on FABQ
improved likelihood to succeed with lumbopelvic spinal manipulation
FABQ work subscale
6, 7, 9, 11, 12, and 15
FABQ physical activity
2, 3, 4, and 5
Absolute Contraindications to Manipulation
Osteomyelitis
Vertebral basilar insufficiency (cervical spine)
Rheumatoid arthritis (upper cervical spine)
Use of anticoagulant medication
Lack of indications
Poor integrity of ligamentous or bony structures from recent injury or disease process
Unstable fracture
Bone tumors
Infectious disease
Lumbar Stabilization for Low Back Pain Predictor of success
SLR > 91°
< 40 years old
Aberrant motion present with forward bending
Positive prone instability test
Lumbar Stabilization for Low Back Pain Predictor of non-success
FABQ – Physical Activity < 8
Aberrant movement absent
No hypermobility during PA spring testing
Negative prone stability test
Absolute Contraindications to Manipulation
Osteomyelitis
Vertebral basilar insufficiency (cervical spine)
Rheumatoid arthritis (upper cervical spine)
Use of anticoagulant medication
Lack of indications
Poor integrity of ligamentous or bony structures from recent injury or disease process
Unstable fracture
Bone tumors
Infectious disease
Aberrant motions
Painful arc in flexion Painful arc on return from flexion Instability catch Reversal lumbopelvic rhythm Gower’s sign
Treatment for positive instability test:
Exercise including focus on RA, TrA, IO, ES, multifidus, and QL
2x a week for 8 weeks
Big three in low back rehabilitation:
curl up for rectus abdominis
side bridge for obliques, TA and quadratus
birddog for back extensors
Definition of success:
> 50% change on modified Oswestry Disability Index (ODI)
Non-success defined as < 6-point improvement on ODI
Prone Mechanical Traction with Signs of Nerve Root Compression Predictor variables:
Peripheralization with repeated lumbar extension
Positive crossed SLR
Supine Mechanical Traction for LBP predictor variables:
FABQ – Work subscale < 21
No neurological deficits
> 30 years old
Non-manual work job status
Specific Exercise: Extension Predictor Variables:
Symptoms distal to the buttock
Symptoms centralize with lumbar extension
Symptoms peripheralize with lumbar flexion
Directional preference for extension
Specific Exercise: Flexion Predictor Variables:
Older age (> 50 years)
Directional preference for flexion
Imaging evidence lumbar spinal stenosis
Extension Exercise group criteria:
Symptoms centralize with lumbar extension
Symptoms peripheralize with lumbar flexion
Directional preference for extension
Extension Treatment Approach:
End-range extension exercises
Mobilization to promote extension
Avoidance of flexion activities
Flexion exercise group criteria:
Older age (>50 years)
Directional preference for flexion
Imaging evidence of lumbar spine stenosis
Flexion Treatment Approach:
End-range flexion exercises
Mobilization or manipulation of the spine and/or lower extremities
Exercise to address impairments of strength or flexibility
Body weight-supported ambulation
Stabilization exercise group criteria:
Age (<40 years)
Average SLR (>91°)
Aberrant movement present
Positive prone instability test
Stabilization treatment approach:
Exercises to strengthen large spinal muscles (erector spinae, oblique abdominals)
Exercises to promote contraction of deep spinal muscles (multifidus, transversus abdominis)
Manipulation exercise group criteria:
- No symptoms distal to nee
- Duration of symptoms <16 days
- Lumbar hypomobility
- FABQW <19
- Hip internal rotation ROM >35°
Manipulation treatment approach:
Manipulation techniques for the lumbopelvic region
Active lumbar range of motion exercises
Traction exercise group criteria:
Symptoms extent distal to the buttock(s)
Signs of nerve root compression are present
Peripheralization occurs with extension movement or positive contralateral SLR test is present
Traction treatment approach:
Prone mechanical traction
Extension specific exercise activities
