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MI2 > Lumbar Spine Treatment > Flashcards

Lumbar Spine Treatment Flashcards

1
Q

What are the treatment options for the spine?

A
  • Education
  • Passive treatments
  • Active treatments
  • Lifestyle modifications
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2
Q

What should treatment selection be based on?

A
  • Diagnosis: Triage, specific vs non-specific
  • Stage: Actue, subacute, chronic
  • Irritability
  • Client problems & priorities/contributing factors
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3
Q

What is the back pain triage?

A
  1. Simple musculoskeletal back pain (95% of LBP)
  2. Spinal nerve root compression (4% of LBP)
  3. Serous spinal pathology (1.5% of LBP)
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4
Q

What red flag conditions require urgent referral?

A
  • CE
  • Unstable, severe or progressive neuro signs
  • Fractures
  • VBI
  • Non-mechcanical symptoms with additional red flag findings
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5
Q

What red flag conditions require referral “very soon”?

A
  • Ankylosing spondylitis
  • Non-mechanical symptoms without other signs, not responding within a couple of sessions
  • Significant yellow flags
  • Neurogenic claudication
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6
Q

What are the patterns of back pain?

A
  • Facet joint
  • Disc
  • Leg pain dominant vs back pain dominant
  • Centralisation & peripheralisation
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7
Q

What should patient education include?

A
  • About the injury
  • About contributing factors
  • Expected recovery time frame
  • About treatment options
  • Reduce threat value of LBP
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8
Q

What are the common themes of pain-related fear?

A
  • Predictability, controllability & intensity of pain
  • Negative past personal experiences of pain
  • Influence of societal back beliefs
  • Process of seeking diagnostic certainty
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9
Q

What is the general prognosis for a patient with acute LBP?

A

90% of people recover in 6 weeks

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10
Q

What does research show regarding bed rest for the spine?

A
  • Avoid completely or limit to < 2 day

- > 2 days detrimental to recovery

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11
Q

What are some of the passive interventions for LBP?

A
  • Taping (early-on in acute LBP)
  • Traction
  • Manual therapy
  • Mobilisation
  • Manipulation
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12
Q

What is the physiological reasoning behind traction?

A
  • Providing the nerve root with more room

- Relieving pressure

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13
Q

What does the evidence show regarding traction?

A
  • Lots of evidence to show it doesn’t work in short, medium or long term
  • But may help some patients
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14
Q

What does manual therapy involve?

A
  • Treat a pattern (e.g. open a facet joint) or

- Treat what you see

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15
Q

What is mobilisation?

A

Passive movement that can be controlled by the patient (PPIVM, PAIVM)

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16
Q

What is manipulation?

A
  • Passive movement consisting of a high velocity, small amplitude thrust within the joint’s limit
  • Cannot be controlled by the patient
17
Q

How are PAIVMs graded?

A

Maitland Joint Mobilisation Grading Scale

1: Small amplitude, early range
2: Large amplitude, early-mid range (back & forth)
3: Large amplitude, mid-end of range
4: Small amplitude, end of range
5: (Manipulation) Small amplitude, quick thrust at end of range

18
Q

When should grade 1/2 and grade 3/4 mobilisations be used?

A
  • If pain is primary complaint, grade 1-2

- If stiffness is primary complaint, grade 3-4

19
Q

What are the indications for mobilisations?

A

Joint pain & dysfunction e.g. restricted AROM & PPVIM and/or painful restriction with PAIVM

20
Q

What are the CIs for mobilisations?

A
  • Acute inflammatory disease
  • Infection
  • Tumours/cancer
  • Atherosclerosis
  • Aneurysms
  • DVT
  • Spinal cord compromise
  • Cauda equina syndrome
21
Q

What are the precautions for mobilisations?

A
  • Neurological changes
  • Rheumatoid arthritis
  • Osteoporosis
  • Ligament laxity
  • Pregnancy
  • Prolonged use of anticoagulants & corticosteroid
22
Q

What are the active interventions for LBP?

A
  • Exercise (general/specific)
  • Posture
  • Behavioural therapy
  • Back schools
  • Lumbar supports
  • Muscle energy techniques
23
Q

What factors related to LBP does general exercise positively influence?

A
  • Poor sleep
  • Deconditioning
  • Depression
  • Anxiety/stress
  • Provides analgesic effects
24
Q

What are the two types of specific exercise for LBP?

A
  • McKenzie

- Core

25
Q

What does McKenzie exercise involve?

A

Uses directional preference to determine the movement that reduces pain (flexion, extension, lateral flexion etc) - treatment then focuses on this movement

26
Q

What does evidence show regarding core exercise for LBP?

A
  • Core muscles (multifidus, TA) work differently after an episode of LBP (turn on later)
  • Patients with LBP don’t turn on these muscle in preparation for movement
  • May be beneficial to train these muscles
27
Q

What are the ways of re-training the core muscles?

A
  • Palpation with cues/ECG

- Real-time ultrasound

28
Q

What does research show regarding posture in people with LBP?

A
  • They tend to hold their spine more rigid, don’t adjust their posture
  • Can result in great muscle fatigue, loading of the facet joints
29
Q

What is the optimal sitting posture for people with LBP?

A
  • Neutral spine position with slight lumbar lordosis & relaxed thorax
  • Avoid painful end-range positions
  • Activate key trunk muscles
30
Q

What is the general rule for treating acute LBP?

A
  • Choose passive intervention to reduce pain & restore movement
  • Education & early return to activity is essential
31
Q

What is the general rule for treating subacute/chronic LBP?

A

Greater focus on active interventions & lifestyle modifications

32
Q

What are the reasons for using outcome measures?

A
  • Objectively record changes
  • Compliance for third party payers (Work cover etc)
  • Identify treatments that work & are cost-effective
  • Early identification of people with high-risk of ongoing pain
33
Q

What should be measured for outcome measures?

A
  • Symptoms
  • Function
  • QOL
  • Fear of movement (kinesiophobia)
  • Fear-avoidance beliefs
34
Q

What are the types of outcome measures?

A
  • VAS/numerical rating scale
  • Questionnaires
  • Physical tests (ROM, pain-free ROM, muscle endurance tests)
  • SMART evaluation
35
Q

What are two outcome measures for lumbar flexion?

A
  • Modified Schober
  • Fingertips to floor
  • Biering sorensen test (back endurance)

MI2 (10 decks)

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