Lumbopelvic Spine Intervention: Mobility Deficits - Lecture 3 Flashcards
Where do pts w/ back pain w/ mobility deficits not have pain passed
Normally back pain does not go passed the knee
What kind of back pain is back pain w/ mobility deficits?
Dull achy type back pain
Does back pain w/ mobility deficits follow a dermatomal pattern?
No
KNOW: Back pain w/ mobility deficits can come w/ or w/o leg pain and DOES NOT travel passed the knees
Back pain w/ mobility deficits does or does not affect lumbar spine mobility?
Does affect it
KNOW: We would do mobility testing w/ back pain w/ mobility deficits
we would also do PIVM testing (physiological movement)
typically yeild hypo mobility
What is the tissue like in the area for back pain w/ mobility deficits?
Very gaurded
Think your back: its back pain w/ mobility issues (moving hurts) and the muscles in that area are all very tense and guarded
The muscles are tight because they’re trying to protect that area
* the erector spinae along the pts back might feel very rigid (not much plyobility)
For back pain w/ mobility deficits - think weekend warrior that just twist their back and doesnt want to move it and their muscles have become very tense and guarded
These are facet reffered pain
NOTE: these reffereals are never down passed the knee
Fall under back pain w/ mobility deficits
How to know if muscle refferal isnt coming from a facet?
Push on it
You would also do myotome / dermatome / babinski / clonus / DTRs to make sure its not a radicular issue
dont memorize
KNOW: the QL is on all the time because its a stabilizer muscle. So it often refferes pain
Referes to iliac rest / greater trochanter
* So differential diagnosis are things like greater troachnteric pain syndrome
* Push on greater trochanter and see if it brings on pain (wont because its being refered from QL which you arent pushing on)
* Palpating around that QL will bring on that comprabile pain if its whats bringing on the issues
Glute med / glute min / QL / piriformis are common muscle pain generatoes (dont memorze those specificially) just knwo musclar reffered pain can be causing that back pain
Mobility deficits: LBP - SYMPTOM MODULATION PHASE (controlling symptoms phase) - symptoms are vollatile and not under control
- Thurst / non thurst manipulation to reduce pain and distability (then they can exercise)
- Find a position that centralizes (their directional preference)
- Gentle mobility/self mobilization EX
- Education (tell them not to avoid extension, just reduce the amount of extension we do until symptoms are more stable)
- Heat / cold / ultrasound / dry needling / cupping etc. - modalities used to reduce pain (don’t let them get stuck on this to much –> we don’t want them to get hooked on it)
What two things do we need present for thrust manipulation in the lumbar spine?
Duration of symptoms < 16 days
No symptoms distal to the knee
(should also not have any red flags)
KNOW: Mobility / self mobilization EX are a great follow up to mobilization / manipulation of the spine
* do exercises in the motion you just gained
* If your interventions were to improve extension do extension based exercises in the new mobility you just gained
How do we get pts w/ LBH w/ mobility deficits from symptoms mobulation to movement control
mobility exercise
Treating LBP w/ mobility deficits under symptom modulation:
* Disibility =
* Symtom staus =
* Pain =
* What 4 treatments do we do for them?
Disability = high
Symptom status = volatile
Pain = high to moderate (likely to change)
1) Directional preference exercises (put that pain back where it came from)
2) mobilization / manipulation (if they fit guidelines [<16 days / no symptoms passed the knee] for manipulation)
3) Traction (and several other modalities to treat pain)
4) Active rest
5) mobilization / self mobilization exercises (repeated movements to gain that extra mobilization they just got from the manipulation)
NOTE: we do mobility EX to get them from symptom modulation –> movement control
The LBP pt has now progressed into the movement control phase
* distability =
* Symptom status =
* Pain =
* Treatment
Distability = moderate
Symptom status = stable
Pain = moderate to low
1) Sensiomotor EX
2) Stabilization EX
3) Flexibility EX
4) Education
5) More aggressive mobility / self-mobilization EX
6) Stretching EX
7) Spinal mobilization / manipulation
8) Manual therapy for surrouunding soft tissue
Global stability
Muscles can meet activation, acquistion, and assimilation needs of lumbar spine movement
Functional Optimization for mobility deficits w/ LBP:
* Distability
* Symptom status
* Pain
* Treatment 4)
Distability = low
Symptom status = controlled
Pain = low to absent
1) Strengthn and condition EX
2) Work- or sport specific tasks
3) Aerobic EX
4) general fitness EX
NOTE: at this point were not longer flexion based or extension based –> were at the end of their treatment
Use pt specific goals here and work on them
